AbstractObstetric violence has been recognized as a significant risk factor for maternal morbidity and mortality globally. However, there is lack of literature on the abuse of birthing women and their maternal rights in formal healthcare settings in Niger. This paper explores women’s experiences of violence in public maternity care in Niger to identify drivers, facilitators, manifestations, and consequences of the maltreatment of women during labor and delivery. We qualitatively explored the experiences of women who gave birth in a public maternity hospital or clinic within the 5 years preceding the study. We conducted five key informant interviews to help inform recruitment and interview protocols, a listening session with eight mothers, and individual interviews with 50 women from four areas of the urban region of Niamey. The 58 participating mothers shared experiences that included physical abuse (slapping), verbal abuse (insults), psychological abuse (mockery), discrimination (social status/ economic status), financial coercion (demanding money prior to care), and harmful birthing practices (forcing the baby out with elbows). Socio-cultural aspects driving maltreatment of women included beliefs about expression of pain during labor and delivery, while social connection and the presence of the physician during delivery were protective factors. Our study findings reflect global concerns about obstetric violence and its consequences. Given the high burden of maternal and infant morbidity and mortality in Niger, it is critical to train clinical staff in safe and respectful maternity care, to improve supervision of care, to institute legal recourse for women, and to consider the integration of traditional birth attendants in clinical settings.

The term 'marriageability' is used frequently in child marriage literature but is rarely defined. We propose a conceptual framework to define marriageability and use qualitative case studies to illustrate how ideas about marriageability contribute to child marriage. Pressure to capitalize on a girl's marriageability before it declines in order to secure the 'best' partner may explain why child marriage persists. We find that marriageability involves both eligibility-or perceived readiness for marriage-as well as desirability or 'value' on the marriage market. We propose that understanding marriageability in context, particularly in countries with limited evidence on interventions to address child marriage, is essential for suggesting ways interventions may critically examine notions of marriageability and disrupt pathways to child marriage.

This article is a case study of a capacity-building project to reduce malnutrition, implemented by a non-governmental organization (NGO) in Niger. It aims to generate a set of lessons learned on the processes of sustaining health interventions in vulnerable contexts. Using a theoretical framework on sustainability, we carried out a thematic analysis on semi-structured individual interviews (n = 124) collected, between 2016 and 2017, during the evaluative research of the NGO project. The data analysis revealed several risks and opportunities to sustain the project activities, classified according to the characteristics of a routine identified in the theoretical framework: memory, routines, values, and rules. Our findings show a low level of sustainability of the project. Several activities were stopped at the end of the project and others may not continue in the long term. Indeed, local realities-poverty and political fragility-combined with the 'short-term' and vertical logics of the project's implementation have hindered the project activities' sustainability. In vulnerable environments, sustainability should not simply be seen as an outcome to be achieved at the end of the project. The sustainability process must be activated by key stakeholders, focusing not only on the resources stabilizing but also on the resilience of the structures and systems in which interventions are embedded.

BackgroundData on childhood disability is essential for planning health, education and other services. However, information is lacking in many low- and middle-income countries, including Niger. This study uses the Key Informant Method, an innovative and cost-effective strategy for generating population-based estimates of childhood disability, to estimate the prevalence and causes of moderate/severe impairments and disabling health conditions in children of school-going age (7–16 years) in the Kollo department of western Niger.MethodsCommunity-based key informants were trained to identify children who were suspected of having the impairment types/health conditions included in this study. Children identified by key informants were visited by paediatricians and underwent an assessment for moderate/severe vision, hearing, physical and intellectual impairments, as well as epilepsy, albinism and emotional distress.ResultsTwo thousand, five hundred sixty-one children were identified by key informants, of whom 2191 were visited by paediatricians (response rate = 85.6%). Overall, 597 children were determined to have an impairment/health condition, giving a prevalence of disability of 11.4 per 1000 children (10.6- 12.2). Intellectual impairment was most common (6.5 per 1000), followed by physical (4.9 per 1000) and hearing impairments (4.7 per 1000). Many children had never sought medical attention for their impairment/health condition, with health seeking ranging from 40.0% of children with visual impairment to 67.2% for children with physical impairments.ConclusionThe Key Informant Method enabled the identification of a large number of children with disabling impairments and health conditions in rural Niger, many of whom have unmet needs for health and other services.

Public hospitals in Africa are experiencing major organizational dysfunctions, which are particularly acute in waste management. The opening of a new reference hospital in Niamey offers the opportunity to study the implementation of an innovative waste management system. The objective of this study was to document the agents’ representations, practices, and construction of waste management standards in a new tertiary hospital in Niamey. We sought to study the implementation of innovative materials in waste management and the progressive construction of protocols, habits, and levers of adaptation. This research was carried out using a socio-spatial approach and essentially mobilized the tools of qualitative investigation. Our study highlighted that a hospital waste management culture is progressively established, thanks to an effort to plan activities, to promote the sector, the activities and the emergence of a profession organized around waste management. However, the distinct waste management sectors are struggling to stabilize due to the differentiated statuses and perceptions of the agents. Finally, the success of hospital waste management depends on waste collection at the city level. The Niamey referral hospital is intended to be an infrastructure of excellence, a showcase for neighboring countries. In this respect, our study shows that it is crucial to invest in planning, the enhancement of the profession and the recognition of all the agents involved in waste management.

In Burkina Faso, Burundi and Niger, the policy to remove user fees for primary care was carried out through significant adjustments in public financial management (PFM). The paper analyzes the PFM adjustments by stage of the budget cycle and describes their importance for health financing. The three countries shifted from input-based to program-based allocation for primary care facility compensation, allowed service providers autonomy to access and manage the funds, and established budget performance monitoring frameworks related to outputs. These PFM changes, in turn, enabled key improvements in health financing, namely, more direct funding of primary care facilities from general budget revenue, and payments to those service providers based on outputs and drawn from noncontributory entitlements. The paper draws on these experiences to provide key lessons on the PFM enabling conditions needed to expand health coverage through public financing mechanisms.

ABSTRACT The externalized European “migration management” in West Africa has technologically modernized and militarized border posts. This threatens visa-free travel, freedom of settlement and borderland economies in parts of the Economic Community of West African States (ECOWAS). It has interrupted historical mobility patterns, depleted the diversity of mobility practices and criminalized regional economies. At the same time, one can observe intensified and asymmetrical violent conflict in some of these borderlands. By taking the Kantchari-Makalondi borderland as a case study we analysed the relations between migration policies, insecurity, forced immobility and economic decline. Our observations and interviews with migrants, traders, security forces and borderlanders lead us to question conventional narratives on border control and African mobilities as a binary relation between Africa and Europe. Instead, they foreground the multiple practices of (im)mobility in these spaces: the circulation and blockage of travelers, merchandise, surveillance technologies, and military interventions and their impact on security and livelihoods.

Abstract Background: Data on childhood disability is essential for planning health, education and other services. However, information is lacking in many low- and middle-income countries, including Niger. This study uses the Key Informant Method, an innovative and cost-effective strategy for generation population-based estimates of childhood disability, to estimate the prevalence and causes of moderate/severe impairments and disabling health conditions in children of school-going age (7-16 years) in the Kollo department of western Niger. Methods: Community-based key informants were trained to identify children who were suspected of having the impairment types/health conditions included in this study. Children identified by key informants were visited by paediatricians and underwent an assessment for moderate/severe vision, hearing, physical and intellectual impairments, as well as epilepsy, albinism and emotional distress. Results: 2,561 children were identified by key informants, of whom 2191 were visited by paediatricians (response rate = 85.6%). Overall, 597 children were determined to have an impairment/health condition, giving a prevalence of disability of 11.4 per 1000 children (10.6- 12.2). Intellectual impairment was most common (4.9 per 1000), followed by physical (4.9 per 1000) and hearing impairments (4.7 per 1000). Many children had never sought medical attention for their impairment/health condition, with health seeking ranging from 40.0% of children with visual impairment to 67.2% for children with physical impairments. Conclusion: The Key Informant Method enabled the identification of a large number of children with disabling impairments and health conditions in rural Niger, many of whom have unmet needs for health and other services.

This article uses qualitative data from Niger to examine adolescent girls’ perceptions of their own agency in marriage decisions and contextual factors influencing these perceptions. We find that girls make marital decisions within a context that stresses parental consent and community approval, places a high value on obedience, and is constrained by limited opportunities, gendered distribution of labor, and dominant social norms promoting an early and narrow ‘window of opportunity’ for marriage. Findings demonstrate that interventions aiming to delay marriage in Niger must work to influence both community norms supporting child marriage and girls’ own motivations in martial decision-making.

We propose a short epistemological and methodological reflection on the challenges of doing ethnographical research on public services (‘bureaucracies’) from the inside. We start from the recognition of the double face of bureaucracy, as a form of domination and oppression as well as of protection and liberation, and all the ambivalences this dialectic entails. We argue that, in classical Malinowskian fashion, the anthropology of bureaucracy should take bureaucrat as the ‘natives’, and acknowledge their agency. This means adopting basic anthropological postures: the natives (i.e. the bureaucrats) must have good reasons for their seemingly ‘absurd’ (or arbitrary) practices, once you understand the context in which they act. Based on intensive fieldwork and understanding ethnography as a form of grounded-theory production, to explore this ‘rationality in context’ of bureaucrats should be a major research objective. As in day-to-day intra-organisational practice and in internal interactions between bureaucrats, state bureaucracies function largely as any other modern organisation, the anthropology of bureaucracy does not differ that much from the anthropology of organisations. One of the major achievements of the latter has been to focus on the dialectics of formal organisation and real practices, official regulations and informal norms in organisations ‘at work’. This focus on informal practices, pragmatic rules and practical norms provides the main justification for the utilisation of ethnographic methods. In fact, it is difficult to see how informal norms and practices could be studied otherwise, as ethnography is the only methodology to deal with the informal and the unexpected.