Samuel Loewenberg provides a vivid description of increasing hunger in Niger (Aug 21, p 579), but gives insuﬃcient emphasis to the imperative to increase access to voluntary family planning. Niger has a total fertility rate of 7·4, 49% of the population is younger than 15 years, and the current population of 15·9 million is projected to grow to between 52 and 64 million by 2050, making it the second most populous country in Africa. Only 15% of women enter primary school, and only one in ten uses any form of contraception. The total fertility rate of 3·3 assumed in “low” population projections for 2050 is unlikely to be achieved unless there is a much greater emphasis on voluntary family planning and education for girls. Adair Turner has commented, “How Niger is going to feed a population growing from 11 million today to 50 million in 2050 in a semi-arid country that may be facing adverse climate change is unclear.” More needs to be done in agricultural and economic development, but the humanitarian agencies confronting malnutrition in Niger should work to make family planning more accessible, for example by striving to remove the many existing barriers to using contraceptives. A practical ﬁrst step would be to empower village volunteers to distribute injectable contraceptives, as is being done safely in other countries.
Published in The Lancet Vol 376 November 13, 2010.