With the world’s highest birth rate in a country where first-time mothers are often barely past puberty, having a baby in impoverished Niger can be tantamount to a death sentence.

The West African state and humanitarian groups have worked to slash both birth and maternal mortality rates, but despite strides results are not good enough, the UN warned this week.

“Every two hours, a Niger woman dies from complications linked to pregnancy or childbirth,” deplored Monique Clesca, the UN Population Fund (UNFPA) representative in the country.

Some 3000 people, mainly women, gathered in the western city of Tahoua as part of a new push to rein in the birth rate and reduce maternal mortality.

“Dying while giving life is a social injustice,” railed Malika Issoufou, wife of Niger’s President Mahamadou Issoufou, while visiting women suffering from gynaecological complications in the Tahoua hospital.

The trend has not been easy to buck in a culture that encourages early marriage, big families and pregnancies in quick succession, and where some clerics in mainly Muslim Niger have blasted contraception as against Islam and “dictated by white people from the West”.

“The more kids you have, the more you’re worth,” said Clesca, describing traditional views.

“When girls marry, they’re under pressure to prove they’re fertile within the first year.”

This has left landlocked Niger, where more than 60 per cent live below the poverty line, with the highest birth rate in the world, an average of 7.6 children per woman, official figures show.

In 2006, Niger made all pre-natal care free of charge, as well as birth by Caesarean, which up to then was prohibitively expensive. Contraceptive products are also distributed at no charge.

“Ten years ago, no one dared broach demographic questions. Now, everyone is talking about them, starting with the government, the president,” said Isselmou Boukhary, Niger’s deputy representative for the UN children’s fund, UNICEF.

Even if the situation remains “quite worrisome”, it’s slowly improving, Boukhary told AFP.

With 535 mothers dying for every 100,000 live births – meaning one woman for every 186 viable births, Niger is among the world’s top 15 countries with the worst maternal mortality.

Yet the situation has improved since 2006, when 648 women died for every 100,000 births, according to Niger’s health ministry.

During the same period, contraceptive use has gone from five to 12 per cent, the ministry said.

A tradition of early marriage has not helped. Nearly 80 per cent of Niger women are wed by the time they reach 18 and 40 per cent before the age of 15, making complications frequent.

Health ministry official Gali Asma said 80 per cent of Niger’s maternal deaths occur outside proper health facilities, and yet 70 per cent of Niger women give birth at home with traditional midwives.