Niger

This landlocked west African nation gained its independence from France in 1960, and has a population of 13.3 million. Its female life expectancy is 43.7 years, among the lowest in the world. The birth rate is 50.7 per 1,000, and the fertility rate is 7.3 births per woman (2008), the second highest in the world; only Mali has a higher fertility rate.

During the French colonial period, little was done for the country's health care system except in Niamey, the capital, where a small hospital was built for the European population and the local elite. After independence, the health care system was improved and extended, but the country is desperately poor, and foreign aid groups pay for much of the medical care. There are only 377 doctors in the country, and 2,716 nurses. It is also worth noting that there are only 21 midwives in the entire country, and about half of the population has no access to government medical care because of their geographical isolation, or their inability to pay the cost of attending a hospital or clinic.

In village society, mothers rely on kinship groups and village elders for help in birthing and bringing up children. Very few villagers or urban dwellers go to school, with the two-thirds of children under 14 at work. The result has been a low literacy rate: 20 percent for males, and only 9 percent for women. The lack of education has led to problems with starting any family planning program. Only 14 percent of women aged 15–49 reported using any form of contraception in 2000.

Three types of marriage are permitted in Niger: civil marriage, customary marriage, and Islamic marriage; polygamy is permitted under customary marriage and Islamic marriage. The legal age for marriage varies by region, but is higher in the south than in the north; customary law permits marriage as young as 9 years of age, and it is common to marry at a young age. With 86 percent of girls marrying before they turn 18—in some clans marriage is generally expected when a girl becomes 16—the nation's infant mortality rate is 116.7 per 1,000 live births, the fifth highest in the world, and the maternal mortality rate at 1.6 per 100 births is also the fifth highest in the world. Abortion is legal in Niger only to save the woman's life. Unsafe abortions still occur and represent a major threat to women's health: one 2008 study found that the complications of induced abortion accounted for over 20 percent of maternal deaths.

The low life expectancy for both men and women has resulted in 680,000 children under the age of 17 in the country becoming orphans. In addition, in recent years there has been a higher prevalence of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), which has added to Niger's health problems.

Save the Children ranks Niger last out of 33 Tier III or Least Developed Countries on the Mothers', Women's and Children's Index.