Population Growth, Maternal and Infant Mortality in Niger
John Moor wrote this article in about 2011 to describe the terrible suffering of women in Niger not only in the famine but also in the reproductive mortality statistics (a lot of which could be prevented if their fertility rate declines). He worked as a government doctor in Botswana for 13 years in the last century and continues to have an interest in the health problems of Africa. The Editor has added some updated some statistics to 2014 –
Famine as an Indicator of extreme poverty
Famine is severe scarcity of food in a community. In our country we have no experience of this awful condition. The last famine in England was in 1623
Food is a basic need of human life and we may take famine as a marker of extreme poverty.
In 2005 there were severe food shortages of food in Niger. The TV and newspapers ascribed the disaster to drought, plagues of locusts, bad distribution of food and sometimes to grain hoarding by merchants. These factors are important. But the population of Niger which was 2 million in 1950 reached 10 million by the year 2000.
[Editor: by 2014 the population is 17.5 million – 17,536,553 to one estimate – see today’s population ]
Most people in Niger are subsistence farmers. They need extensive areas of ground to pasture their animals and arable land on which to grow crops. Over the years the ground available for each family has been decreasing and now it is barely sufficient to supply their needs. So any minor disruption of the harvest is liable to tip the balance and there is a shortage of staple foods. These facts are rarely mentioned in newspapers or TV but it is important to know about them if one is to help the people concerned.
Some Health Statistics
Useful indicators of health in a country are the maternal and infant mortality rates. The maternal mortality rate is the the number of women who die of a pregnancy related cause per 100,000 births. The infant mortality rate is the number of babies who die under one year of age per 1000 live births. The Total Fertility Rate (TFR) is the average number of babies a woman bears. Here are the figures for the UK, and for Niger.
|Total fertility rate||maternal mortality||infant mortality|
These facts are derived from http://www.indexmundi.com for 1012-2013
The human suffering
Looking at these figures one is appalled at the numbers of women in Niger who die as a result of pregnancy (almost one in a thousand). As the average woman has 8 pregnancies this means that nearly one in one hundred women die of a pregnancy related problem during their reproductive life. Think of the number of orphans this leaves. For every woman that dies there are likely to be several mothers who just survive a difficult labour but are left with disabling symptoms. These include fistula (causing permanent incontinence) and a “dropped womb”. Think of the number of mothers with such a disability who cannot adequately suckle and nurture their newborn child. . Equally distressing is the number of children who die in the first year of life. Mothers rearing more than 2 children under 5 years have a hard task even if they are fit and have access to a good child health service. How much worse if their food supply is chancy and if there is no good “under 5 clinic” to promote child health and treat sick babies.
There is another difficulty connected with high birth rates. With increasing parity (births), labours become quicker and easier; this is common knowledge. What is not commonly known is that, after baby no. 4, deliveries become successively more dangerous. Midwives call mothers in their fifth and succeeding pregnancies “Grand Multiparae” (multips) and always recommend that they should deliver in hospital. We should note that if, by family planning the TFR drops, there will be fewer Grand multips and so fewer high risk mothers.
The work of charities
Let us now consider what is being done by charities to improve conditions in poor countries. Most charities that work to foster better living conditions in the third world do not mention child spacing as a way to help. Their advertising literature does not recognise population growth as a problem.
This is a partnership of 163 national family planning associations with its HQ in London. It gives training and finance to national associations worldwide. It helps especially in those poor countries where the government is unable to provide good family planning clinics. Inevitably it is heavily involved in the prevention and treatment of AIDS. Where abortion is legal it will give counselling and if necessary arrange for abortions in a safe environment.
Different countries have different priorities and IPPF tries to help each country according to its special needs. The Planned Parenthood Association of Ghana asked for help with a Family Health Project for an under-served group in the Volta region. Trokosi (a form of slavery of young women) was formerly practised in this community. The IPPF was able to respond and the incidence of AIDS and of unwanted pregnancies were both reduced. The IPPF is a nongovernmental organisation which is funded partly by governments and partly by individuals.
Reducing the Total Fertility Rate is a very difficult project involving health, family customs and education. First it is essential to provide high quality Family Planning clinics which are easily accessible The IPPF helps individual countries to maintain high standards of care. One reason for very large families is that a couple require children to care for them in their old age. The children are an “insurance policy”. As so many children die in childhood parents opt to have many. Child mortality may be reduced by promoting “under 5” clinics.
The children receive vaccines against common childhood diseases The mothers are encouraged to breast feed the babies. They are also taught how to nurse a child suffering from common illnesses.
Over the longer time period it is necessary to improve women’s education. Girls are led to realise that there are other possibilities in life besides rearing babies.
What sort of result may be achieved? We take the example of Botswana. The TFR in 1960 was 6.7. In 1968 the government invited IPPF to start family planning work. They advised the strategy outlined above. In 2005 the TFR was 3.5 The work is now performed by the Botswana Family Welfare Association which is a member of IPPF. In 2013 the TFR rate in Botswana is now 2.5
Family Planning Clinics are cheap.
Health services are expensive. We learn this every day in our newspapers when the NHS has to make cuts A family planning service is very cheap compared with a maternity service. Most of the work can be done by specially trained nurses, the drugs and equipment are not costly and many mothers only need to attend twice a year.
What benefits may we expect the people of Niger to gain if the mothers can achieve a lower fertility rate?. With fewer pregnancies and fewer babies the maternal and infant mortality rates will fall. The tragedy of death in childbirth will become very rare and trauma to the birth canal a thing of the past. Mothers will be able to give more care to each child and the children, being protected against many common infections will have a better chance of survival. Finally we come back to where we started. In course of time there will be fewer mouths to feed and more food for each person to eat.