Author: Balkissa Harouna, January 11 2018 - NIGER: a landlocked country in West Africa, with about 17 million inhabitants, holding the world record of the strongest fertility rate: 8 children on average for a woman. This picture is the one most often used internationally to describe my native country, a country where family planning is faced also with enormous challenges.
First, above all, some myths about family planning are hiding critical realities, which are largely ignored.
Secondly, the population, in a large proportion is still reticent to use family planning services. Yet, the first public program of family planning was launched in November, 1984, so about thirty years ago. Unfortunately, the fertility rate always remains high: the objective of 25 % use of contraceptives in 2015, fixed by the national family planning policy has not been reached ( the current rate being estimated at approximately 12 %)!
Therefore, it is most legitimate to wonder about the real role of family planning on the reduction of fertility in Niger:
- Why family planning programs implemented so far did not give the expected results, despite huge investments made by the Government with the support of donors, during the last three decades?
- Why the majority of Nigerien citizens are still keeping a negative attitude towards family planning?
On the basis of a literature review about family planning in Niger, we have identified some major myths, which help to better understand both the stagnation of the fertility rate and the wall of resistance to family planning demonstrated by a majority of Nigerien citizens, especially in rural areas.
According to me, one inextricable situation probably impinges adversely on family planning in Niger. One wonders how family planning programs could be promoted effectively in the field with the major strategic choice imposed during past years: the priority given to the supply of services instead of the stimulation of the demand?
Family planning in Niger was clearly caught during a number of years between a rock and a hard place. On one hand, the rock consists in "a lasting illusion of results", maintained by myths about a supposed efficacy of the family planning policy. On the other hand, the hard place is duly reflected in "an environment particularly hostile to the concept of family planning itself", owing mainly to strong prejudice against family planning, voluntary maintained by fundamentalist religious associations.
That's why, deeply convinced about the value added of family planning for the promotion of an inclusive society in Niger, my analysis is a personal contribution to the advocacy for family planning in Niger. In fact, I strongly believe that a revitalization of family planning in Niger is possible through one required strategic orientation, supported by all stakeholders : a better distribution of investments between the demand and the supply of family planning services.
This strategic policy change is indispensable; otherwise, the myths will continue to pointlessly limit the results of family planning programs implemented in the field - the hostile environment will also continue to undo all the sensitization efforts made by family planning programs….Through a more detailed analysis of the major myths about family planning in Niger, this article gives objective arguments in favor of this Strategic Change….
1. What are the major myths about family planning in Niger?
The concept of unsatisfied needs in family planning plays a key-role in a family planning program. This concept is defined of two manners: either, the need for family planning services to space out births or the need for family planning to limit births. Unsatisfied needs to limit births are the proportion of married women who don't want more children but who are not using an effective method of contraception. Unsatisfied needs for the spacing of births are the proportion of married women who want to delay their next pregnancy within two years or more but who do not use an effective method of contraception.
Myth 01: There is a high level of unsatisfied needs of family planning in Niger.
Family planning programs in Niger were designed on the basis of a hypothesis: a potential high level of unsatisfied needs of family planning as it is the case generally in developing countries having high levels of fertility. Nevertheless, various authors having analyzed the question, seem unanimous on an entirely different reality.
Indeed, in an article about this issue, Potts and al (2011), confirm the weakness of the level of unsatisfied needs for family planning in Niger : they reported that "Niger is one of the rare countries in the world with an insignificant level or even no unsatisfied needs of family planning for a major reason: a strongly pro-birth culture in which the size of desired family is even superior to the current size. More than a quarter of 40-year-old Nigerien women have 10 children or more! Only one Nigerien woman on 100 wishes to have at most, two children".
Myth 02: Family planning programs have had an impact on contraceptive prevalence.
The use of contraception, more exactly the modern methods, is one of major factors of fertility reduction. (United Nations, 2012 ). Contraceptive prevalence is one of the most relevant indicators used to estimate the effects of family planning programs. There is an inverse relation between contraceptive unsatisfied needs prevalence and needs for family planning services: unsatisfied needs of family planning should be particularly raised when the rate of contraceptives use is upwards of or equal to 40% (Nations, United, 2012 ). With a rate of contraceptives use estimated at 12% around 2015, we can suppose at first sight that in the specific context of Niger, the impact of unsatisfied needs of family planning on contraceptive prevalence remains negligible.
Finally, the current evolution of the rate of modern contraceptives use is too slow to change the projections: actually, a control of the population growth in 2050 in Niger seems like an utopia. A dramatic reality remains in spite of the investments made since many years by the Government with the support of donors: based on the current trend of contraceptive prevalence, the strong population growth in Niger would probably persist until 2100 and even on from there!
Myth 03: Family planning has had an impact on fertility reduction.
In Niger, like in other countries of sub-Saharan Africa, the satisfaction of the demand for family planning services has less impact on fertility reduction (Casterline and El-Zeini, on 2014), because most women use contraception to space out the births, and not to limit them (Moultrie and al, on 2012; Romaniuk, 2011). So, for the moment, the efficiency of family planning on the reduction of the fertility in Niger should rather be considered as a myth. Because, the bitter report is there: fertility rates in Niger still remain high during the last few years in spite of a political commitment to address this issue.
Within the literature on family planning, most analyses are converging implicitly on the same conclusion: given the traditionalist context of Niger, the current policy cannot probably arouse an increase in the use of contraceptives to reach the level needed in order to really impact on the fertility evolution in Niger (Potts and al, on 2011). If we take into account these unequivocal perspectives, strategic policy changes are an imperative. Wouldn't it better for all stakeholders supporting family planning in Niger to forget all the myths in order to accept all the involved inedible realities?
Denying the realities about family planning in Niger and keeping on designing family planning programs based on myths is not the best alternative. Accepting them and having the courage to review the orientation design of family planning policy would probably be much more relevant. Everyone can realize that there is an urgent need to stimulate the demand of family planning services in order to ensure a significant evolution in the use of modern contraceptives for corollary reduction of the fertility rate.
2. Towards a reorientation in the national family planning policy with a more well-balanced distribution of investments?
According to Pierre Ngom (1999) in a critical article about family planning programs in Africa, family planning has a double objective: both the stimulation and the satisfaction of couples needs for their fertility's regulation. Therefore, the strategic arbitration for the distribution of investments between the supply and the demand for family planning services should be made, based on the specific context of every country.
In Niger, the strategic priority in family planning policy so far seems obviously to be the supply of services instead of the stimulation of the demand for family planning services. The unbalanced distribution of the budget of the interventions of the PDES aiming at the control of the population growth demonstrates it clearly : 84% for the improvement of the supply of family planning services and hardly 16 % for the interventions to stimulate the demand. Is such an imbalance really justified?
It is true that, at the beginnings of family planning in developing countries, the supply of services, was the major concern (Seltzer, 2002 ). Indeed, as explained by Bertrand and al (1995), for years, the problem of access to family planning services was considered to be the major factor limiting contraceptive use in developing countries. This is the major reason why, probably, family planning programs were more focused on the improvement of the supply of services : a better access to family planning services being supposed to be the panacea to the problem of contraceptives use.
However, in the specific context of Niger, a country, where, notwithstanding, there is a sluggish demand for family planning services, paradoxically, the supply of family planning services remains the strategic priority. Once we accept this paradox, we discover a truth that could give a new opportunity for family planning development in Niger through a reinvigoration of stakeholders' focus on the demand for family planning services.
No matter what the potential obstacles to this change in the attitude of the strategic actors involved in family planning interventions, it is a needed change, a desirable change, a change beneficial in the future of family planning in Niger….This change is critical, given that the demand for family planning services remains insignificant
despite the measure of free access to contraceptive adopted in recent years by the Nigerien Government.
Eventually, one of the most striking conclusion is the paltry amount allocated to investments for the demand for family planning services in Niger in relation to the estimated needs required to resolutely fight the ingrained bias against family planning. What accounts for this paradox ? A revision of the national family planning policy is indispensable, if sincerely we want to improve the impacts on fertility reduction.
With a fertility rate of 7.8, Niger will reach a population of 58.2 million inhabitants in 2050, and then become the second most populated country of Western Africa according to the projections of the Population Reference Office. A control of the population growth in the long term seems out of reach: the current level of contraceptives use is so derisory that this fight seems for the moment a losing battle.
Nevertheless, such a dire prospect could probably be thwarted only if the Required Changes in the National Family Planning Policy are sincerely accepted by all the stakeholders involved with the leadership of the Nigerien Government. Indeed, the restricted efficiency of the current family planning policy is an irrefutable reality which should not be obliterated, neither by technical and financial partners nor by public authorities. They all have the ideal opportunity there to demonstrate their real commitment for the control of the population growth: by deciding to initiate the discussions about the strategic changes urgently needed in order to maximize the impact of family planning on fertility reduction, and this, within a consensual approach.
Today, more than ever, Niger is at a crossroads in its fight for the control of the population growth. Procrastination is useless because it is the moment to make a decisive choice between two different ways :
- The one is the way of the denial of realities, which if chosen, would favor the status quo in the orientation of the national family planning policy by persisting in pretending that it works effectively and by pursuing investments in ambitious family planning programs while maintaining paradoxically, an environment hostile to the objectives of reduction of the fertility.
- The other is the way of the acceptance of realities, which if chosen, would favor rather the reorientation of the current policy through a better distribution of investments between the demand and the supply of family planning services with also an alignment of all the sector policies ( education, health…) with the objective of fertility reduction.
By opting for the second alternative, by beginning right now the strategic changes, which should absolutely not be delayed, public authorities would eventually give an ultimate chance to Niger to win a determining bet both for the country sustainable development and for the future prospects of the young generation: the control of the population growth before 2050 and this, in spite of the pessimism of all the current projections.
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