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This past July, I was assigned by the Packard Foundation to document their women’s reproductive health care programs in northern Nigeria. The most populous country in Africa, Nigeria has one of the highest fertility rates in the world. Nigeria is culturally divided between the Muslim north and the Christian south. The Packard Foundation was the first foundation to implement family planning programs in the Muslim north. Girl’s education was an integral part of the programs funded by Packard; the education of girls is the best indicator of reproductive health outcomes as they mature into women of childbearing age.

As recently as six years ago it was inconceivable to imagine any birth control or family planning options. They were regarded as taboo. The accepted norm was that, “God gives children and God will provide for the children.” It was therefore not unusual to see women giving birth to 10 or more children. The cultural belief system encouraged the high birth rate; the more offspring a woman had, the more respect she received from her husband and the greater her status within the community.

Changing culture is a formidable task, and in a relatively short period Packard had made an impact. Government corruption is a fact of life in Nigeria and citizens can expect none of the services we take for granted. People turn to religion for both security and assistance. Unfortunately, religion comes in only one flavor- fundamentalist- and there are frequent conflicts and massacres between Christians and Muslims. When it comes to religious competition, having a high birth rate is a great advantage. In this climate, the fact that the Packard Foundation has implemented family planning programs, is indeed remarkable.