Niger’s malnourished children

Sometimes, when she has no more food to give to her children, Haowa has to watch as they cry themselves to sleep. "It doesn't take long for them to calm down", she says, staring at her hands. Her voice is quiet, almost dispassionate.

Haowa's husband is a subsistence farmer, and often, she says, the maize and millet he grows just isn't enough to feed his two wives and their 12 children. The slight 31-year-old is constantly hungry: She regularly skips her dinner, she says, so she has more food to give to her eight children.

Malnourishment is common in Niger

She shrugs and stares down at the two tiny toddlers she's cradling in her arms. Haowa has pulled up her bright, colorful blouse to let them suckle her breasts.

As she looks on impassively, one of her sons slowly extends his hand and feebly tries to push his brother away - almost, it seems, as if he's fighting his triplet for their mother's milk.

His mother leans forward and gestures to his thin body. "You can see from the eyes, the head, the stomach and the arms", she whispers.

The two children, she says, are both severely malnourished. Their hair is dusty blonde, a sure sign that they are lacking vital proteins and minerals.

Their movements are lethargic, as several fat flies crawl over their large dark eyes and noses, they just stare vacantly into the distance.

Another of Haowa's children, a petite 10 year-old in a bright red dress and a matching headscarf tied tightly around her wispy blond, is sitting on the floor next to her mother. She smiles shyly, peering from behind the third triplet she's cuddling in her arms.

The toddler is clutching an empty plastic package: It's an emergency ration that the small health clinic in southern Niger hands out to parents of severely malnourished children. Haowa has come to the clinic for help.

Periodic famines

Every week, some 30 to 40 children receive the peanut paste, mixed with oil, flour and soya. For in Niger, one of the world's least developed countries, resources are scarce.

Every year the desert inches further south, eating into the arable land. The UN estimates that almost a third of the country's population is malnourished. When harvests periodically fail, famine strikes and as malnutrition turns severe, families pour into the nutrition centres.

This chronic food insecurity is compounded by extremely high fertility rates: In Niger, on average, women have 7.6 children and often mothers like Haowa just aren't able to feed them all.

That is why the small clinic doubles as a family planning centre. Only a few meters from Haowa and her children, several women are sitting on a wooden bench in the shade of a small hut, chatting and laughing.

They're patiently waiting for their turn for a contraceptive implant. As a nurse in a no-nonsense neat white uniform summons a young woman with a flower-print headscarf inside, she hands her baby to another woman, and disappears into the dark and cramped hut.

Only 12 percent of women using contraceptives

It's a small operation, the nurse explains as she pushes a thin needle into the woman's arm and inserts the tube. She shrugs: the next day, the woman will be able to work again. Then she dabs iodine onto the tiny square lump in the woman's arm - and it's the turn to summon the next patient.

The women waiting outside for their implant are in fact a minority in Niger: According to the UNFPA, the United Nations Population Fund, which is the sole provider of contraceptives in a country where only a fraction of the budget is allocated to family planning, only 12 percent of all women were using any kind of contraceptives in 2012. The UNFPA wants to raise that figure to 50 percent in 2020.

It's an ambitious plan in a country where large families and many wives are seen as a symbol of status and wealth: According to the UNFPA, only a third of women want to space out their births.

Access is not the main problem - contraceptives, including the pill, female and male condoms and implants are distributed free of charge - but rather ignorance. Many women believe that contraceptives can make them barren or lead to internal bleeding and other diseases.

The first time she took the pill, a young woman in a tiny village not far from the health center says, she was terrified. "But then I saw that everything was fine, and I continued taking them." She smiles: It's important to space her births, she says, proudly cradling her one-month-old baby.

Does she feel she needs to compete with her husband's first wife? She shrugs, then grins. Niger is polygamous and often women still compete for having the most children.

Men are often opposed to contraceptives

The men are often opposed to family planning, as the UNFPA tends to label the use of contraceptives. That is why the organisation has set up the "school for husbands": Twice a month, community elders and leaders meet up to talk about family planning and health issues - and then stage instructive plays for the community.

In the courtyard of the small health centre, the entire village seems to have crowded round to see the performance, women and children are packed on the floor.

A small boy is hanging off the branch of a tree to get a better view of the rug on the floor, which, together with a long line of shoes, marks the stage: A man is listening in mock earnest to his wife, who is explaining why it is better to space her births.The man stares, then nods vigorously and the onlookers cheers and stamp their feet.

Next to the impromptu stage, the village elders, crouch on the floor, angrily waving away any child that ventures too close to the stage. Each of them is proudly wearing a small orange badge that marks them out as members of the “school for husbands”.

The school, UNFPA officials say, is extremely effective: It's members collect money for health checks for pregnant women and cajole their peers to use contraceptives – or send their wives for an implant.

After she gave birth to her triplets, Haowa got a contraceptive implant. Does she regret not getting one earlier? She shakes her head and smiles - it's a small, affectionate smile. No, she says, it's good to have three children.

And yet, ever since the triplets were born, there hasn't been enough food to go around even though this year the harvests have been good. At night, she often dreams of food. She laughs. It's a desperate, shrill laugh that shakes her body but the two children in her arms barely react.