`
USAID Kulawa Project
March 2023
BASELINE REPORT
Baseline Report – USAID Kulawa Project 2
Cover page photo: A health worker in a community health center takes the temperature of a child. 
Photo credit: Save the Children.
Thisreport is made possible by the generous support of the American people through the United States Agency for
International Development (USAID) under the terms of Cooperative Agreement No. 72068520CA00005. The
contents are the responsibility of Save the Children and do not necessarily reflect the views of USAID or the 
United States Government. 
Baseline Report – USAID Kulawa Project 3
CONTENTS
List of Tables......................................................................................................................................................................................... 5
Acronyms and Abbreviations ......................................................................................................................................................... 7
Summary of Performance Indicators........................................................................................................................................... 8
Introduction....................................................................................................................................................................................... 11
Background........................................................................................................................................................................................ 11
Project Description......................................................................................................................................................................... 11
1. Evaluation Objectives................................................................................................................................................................ 12
1.1 Global objective ........................................................................................................................................................................ 12
1.2 Specific objectives.................................................................................................................................................................... 12
2. General methodology................................................................................................................................................................ 13
2.1 Sites and target populations................................................................................................................................................. 13
2.2 Study design and methods..................................................................................................................................................... 13
2.3 Sampling....................................................................................................................................................................................... 14
2.4 Assessment tools ...................................................................................................................................................................... 19
2.5 Results evaluation indicators ............................................................................................................................................... 19
2.6 Recruitment and training of data collection agents ..................................................................................................... 19
2.7 Monitoring and follow-up...................................................................................................................................................... 20
2.8 Data collection report............................................................................................................................................................. 20
2.9 Limitations .................................................................................................................................................................................. 21
3. Main Results.................................................................................................................................................................................. 21
3.1 Sociodemographic characteristics of the population surveyed............................................................................... 21
3.2 Family planning knowledge, use and attitudes .............................................................................................................. 24
3.3 Fertility and prenatal care..................................................................................................................................................... 29
3.4 Gender-based violence (GEM scale).................................................................................................................................. 31
3.5 Vaccination of children by 12 months............................................................................................................................... 34
3.6 Service provision....................................................................................................................................................................... 35
Conclusion.......................................................................................................................................................................................... 40
Annexes............................................................................................................................................................................................... 42
Annex 1: Health infrastructure sampled ................................................................................................................................. 42
Annex 2: Health personnel and use of services in the facility surveyed ...................................................................... 43
Annex 3: USAID Kulawa zone demographics ........................................................................................................................ 44
Annex 4: Key primary indicators................................................................................................................................................ 45
Annex 5: List of sites ....................................................................................................................................................................... 46
Annex 6: Data collection tools by indicator............................................................................................................................ 50
Annex 7: Calculations of indicators of need and demand for family planning........................................................... 51
Annex 8: GEM scale calculation.................................................................................................................................................. 55
Annex 9: Calculation of the attitude of providers towards adolescents indicator................................................... 57
Baseline Report – USAID Kulawa Project 4
Annex 10: Calculation of the service availability index...................................................................................................... 59
Annex 11: Demand Satisfied for Family Planning................................................................................................................ 60
Annex 12: Synoptic sheet of indicators ................................................................................................................................... 62
Baseline Report – USAID Kulawa Project 5
LIST OF TABLES
Table 1: USAID Kulawa zone demographics.......................................................................................................................... 14
Table 2: Weight of study sub-populations by age group ................................................................................................... 15
Table 3: Sample size calculation ................................................................................................................................................. 16
Table 4: Sampling distribution by region................................................................................................................................. 16
Table 5: Number of households surveyed and non-response rate ................................................................................ 20
Table 6: Number of health facilities and service providers surveyed........................................................................... 21
Table 7: Sociodemographic characteristics of the population surveyed..................................................................... 22
Table 8: Proportion of all men and women with knowledge of FP................................................................................. 24
Table 9: Proportion of audience who recalled hearing or seeing a specific message (RH/FP) promoted in the 
past 24 months by USG-funded programs ............................................................................................................................. 25
Table 10: Rate of use of modern contraceptive methods ................................................................................................. 26
Table 11: Proportion of target population with a positive attitude towards FP....................................................... 27
Table 12: Indicators of contraceptive demand and unmet need (15-24 years) ......................................................... 28
Table 13: Adolescent fertility rate............................................................................................................................................. 29
Table 14: Proportion of women aged 15 to 49 who made at least one antenatal visit during their last 
pregnancy........................................................................................................................................................................................... 30
Table 15: Proportion (%) of women aged 15 to 49 having attended 4 ANC or more during the last pregnancy
................................................................................................................................................................................................................ 30
Table 16: Proportion of women whose antenatal consultations were provided by a qualified health 
professional........................................................................................................................................................................................ 31
Table 17: Proportion of the target population stating that hitting or beating a wife would be justified ......... 31
Table 18: Proportions of target population stating that hitting or beating a wife would be justified, by type 
of question.......................................................................................................................................................................................... 32
Table 19: Target population proportion who support equitable gender norms ....................................................... 34
Table 20: Proportion of children aged 12-23 months according to vaccination card availability...................... 35
Table 21: Proportion of children aged 12-23 months completely vaccinated by 12 months of age (children 
with cards verified).......................................................................................................................................................................... 35
Table 22: Proportion of providers with a positive attitude towards the use of FP and its services by 
adolescents ........................................................................................................................................................................................ 36
Table 23: Percentage of health facilities with at least one service provider trained to manage and refer 
SGBV.................................................................................................................................................................................................... 37
Table 24: Percentage of women who give birth in a facility and who initiated or left with a modern 
contraceptive method before discharge ................................................................................................................................. 37
Table 25: Percentage of women who give birth in a facility and received counseling on post-partum family 
planning before discharge ............................................................................................................................................................ 37
Table 26: Number of newborns who receive postnatal care within two days of delivery in USG-supported 
programs............................................................................................................................................................................................. 38
Baseline Report – USAID Kulawa Project 6
Table 27: Service availability indices ........................................................................................................................................38
Table 28: Health infrastructure..................................................................................................................................................42
Table 29: Health personnel..........................................................................................................................................................43
Table 30: USAID Kulawa zone demographics .......................................................................................................................44
Table 31: Key primary indicators...............................................................................................................................................45
Table 32: List of sites ......................................................................................................................................................................46
Table 33: Data collection tools by indicator...........................................................................................................................50
Table 34: Demand Satisfied for Family Planning..................................................................................................................60
Baseline Report – USAID Kulawa Project 7
ACRONYMS AND ABBREVIATIONS
AFD Agence Française de Développement (French Agency for Development)
ANC Antenatal Consultations
CS Health Post (Case de Santé)
CSI Integrated Health Center (Centre de Santé Intégré)
DH District Hospital
DHS Demographic and Health Survey
ENAFEME Enquête Nationale sur la Fecondité et la Mortalité des Enfants de moins de cinq ans 
(National survey on fertility and mortality of children under five)
FP Family Planning
GBV Gender Based Violence
GEM Gender Equitable Men
INS Institut National des Statistiques (National Statistics Institute)
MCHC Mother and Child Health Centers
mCPR Modern Method Contraceptive Prevalence Rate
NGO Non-Governmental Organization
ODK Open Data Kit
PIRS Performance Indicator Reference Sheet
RH Reproductive Health
SBC Social Behavior Change 
SGBV Sexual and Gender-Based Violence
SMART Standardized Monitoring and Assessment of Relief and Transitions
USAID United States Agency for International Development
USG United States Government
WHO World Health Organization
WRA Women of Reproductive Age
Baseline Report – USAID Kulawa Project 8
SUMMARY OF PERFORMANCE INDICATORS
Performance indicators Maradi Tillabéri Zinder Overall
A- Knowledge, use and attitudes about family planning
Contraceptive prevalence rate: all methods
All women (15-49 years) 23.6% 14.8% 6.7% 15.2%
Women (15-24 years) 18.3% 12.1% 8.0% 13.2%
Women (25-49 years) 27.6% 16.5% 5.9% 16.6%
Contraceptive prevalence rate: modern methods
All women (15-49 years) 17.4% 14.7% 4.8% 12.0%
Women (15-24 years) 12.7% 12.1% 6.3% 10.2%
Women (25-49 years) 20.9% 16.3% 3.8% 13.2%
Percentage of target population with increased knowledge 
of family planning/other health services.
39.2% 40.3% 18.2% 31.1%
Women (15-49 years) 66.3% 59.2% 33.1% 52.1%
Men (15-54 years) 4.6% 9.5% 0.4% 3.7%
Percentage of target population with positive attitudes 
toward family planning
91.1% 92,.3% 81,.2% 87,.4%
Women (15-49 years) 95.6% 96.8% 80.5% 90.1%
Men (15-54 years) 85.3% 85.0% 82.0% 83.9%
Percentage of audience who recall hearing or seeing a 
specific family planning/reproductive health (family 
planning/reproductive health) message supported by the 
USG 
39.0% 26.3% 28.1% 32.1%
Women (15-49 years) 32.9% 25.2% 41.8% 34.5%
Men (15-54 years) 46.7% 28.2% 11.8% 28.9%
B- Recent fertility and antenatal care
Adolescent birth rate (per 1000) 282 249 290 278
Percentage of women who had four or more antenatal visits 
during last pregnancy
56.0% 50.4% 48.8% 52.2%
C- Contraceptive demand and unmet needs
Women 15-24 years
Unmet need (spacing) (%) 1.6% 0.8% 0.4% 1.0%
Unmet need (limiting) (%) 0.2% 0.0% 0.0% 0.1%
Total unmet need (%) 1.8% 0.8% 0.4% 1.1%
Met need (spacing) (%) 19.2% 13.2% 4.6% 13.4%
Met need (limiting) (%) 0.7% 0.0% 0.4% 0.4%
Total met need (%) 19.9% 13.2% 4.9% 13.8%
Baseline Report – USAID Kulawa Project 9
Performance indicators Maradi Tillabéri Zinder Overall
Total demand (spacing) (%) 20.8% 14.0% 4.9% 14.4%
Total demand (limiting) (%) 0.9% 0.0% 0.4% 0.5%
Total contraceptive demand (%) 21.7% 14.0% 5.2% 14.8%
Demand satisfied by modern methods (%) 67.0% 94.2% 66.7% 75.6%
Demand satisfied by all FP methods (%) 91.8% 94.2% 93.3% 92.7%
Women 15-49 years
Unmet need (spacing) (%) 1,3% 1,0% 0,1% 0,9%
Unmet need (limiting) (%) 2,8% 0,8% 1,6% 1,7%
Total unmet need (%) 4,1% 1,7% 1,7% 2,6%
Met need (spacing) (%) 23,7% 16,0% 6,2% 16,3%
Met need (limiting) (%) 1,6% 0,4% 0,9% 1,0%
Total met need (%) 25,3% 16,4% 7,1% 17,3%
Total demand (spacing) (%) 25,0% 17,0% 6,4% 17,2%
Total demand (limiting) (%) 4,4% 1,2% 2,4% 2,7%
Total contraceptive demand (%) 29,4% 18,2% 8,7% 19,9%
Demand satisfied by modern methods (%) 69,0% 89,8% 56,5% 74,1%
Demand satisfied by all FP methods (%) 86,2% 90,4% 80,7% 86,9%
D- Gender-based violence
Percentage of target population with at least a moderate 
equity score on the Gender Equitable Men (GEM) scale
50.2% 44.6% 59.7% 52.8%
Women (15-49 years) 31.2% 34.9% 43.9% 36.9%
Men (15-54 years) 74.2% 60.4% 78.5% 73.5%
Percentage of target population stating that it is justified to 
hit or beat his wife
54.6% 69.2% 60.6% 60.0 %
Women (15-49 years) 76.3% 85.1% 86.4% 82.1%
Men (15-54 years) 27.0% 43.3% 29.9% 31.1%
E- Vaccination of children
Percentage of children completely vaccinated by 12 months 57.2% 28.7% 46.2% 48.8%
F- Service provision
Proportion of providers with a positive attitude towards the 
use of family planning and its services by adolescents
39.2% 39.2% 46.5% 42.3%
Percentage of health care units with at least one service 
provider trained to manage and report sexual and gender￾based violence (SGBV)
61.2% 58.5% 43.5% 53.3%
Number of newborns receiving postnatal care within two 
days of delivery in USG-supported programs (from the 
sample of the survey)
15,473 6,654 31,090 53,217
Baseline Report – USAID Kulawa Project 10
Performance indicators Maradi Tillabéri Zinder Overall
Number of newborns receiving postnatal care within two 
days of delivery in USG-supported programs (extrapolated 
to the USAID Kulawa area) 
37,844 58,146 158,437 254, 427
Percentage of women who give birth in a facility and start or 
leave with a modern contraceptive method before 
discharge
23.0% 37.0% 28.0% 28.0%
Percentage of women who give birth in a facility and receive 
counseling on family planning before discharge.
59.0% 87.0% 73.0% 70.0%
Service Availability Index 16.4% 19.7% 20.0% 18.7%
Baseline Report – USAID Kulawa Project 11
INTRODUCTION
Background
Despite significant progress recorded in recent decades in the areas of maternal and child health in Niger, 
significant challenges still persist. Maternal, neonatal, and infant mortality remain a concern, with 
prevalence levels still high, thus confirming the need to continue to undertake major efforts to satisfactorily 
improve the health of mothers, newborns, babies, and children in Niger. Indeed, malnutrition and 
micronutrient deficiencies remain a major public health concern, affecting particularly young children and 
pregnant and lactating women. The prevalence of chronic malnutrition in children under five is 47.0%, 
above the “30% threshold” set by the World Health Organization (WHO, SMART Survey, 2022). The rate of 
wasting among women aged 15 to 49 is 3.0%. The maternal mortality rate is 553 per 100,000 live births and 
the mortality rate for children under five is 104 per 1,000 (AFD, 2020). Rapid population growth, coupled 
with a lack of access to health services and strong social and behavioral norms at community level, and 
consequently limited access to information on health, family planning (FP), and nutrition, have an 
increasingly negative impact on family health, especially on children, the most vulnerable segment of the 
population. Despite strong political will to reverse these trends, the challenges remain enormous.
Project Description
The United States Agency for International Development (USAID) Kulawa project is a five-year (2020-
2025) initiative to support the Government of Niger in improving health, family planning (FP), and nutrition 
outcomes in Maradi, Zinder, and Tillabéri regions. Meaning “to care for” in Hausa, USAID Kulawa 
collaborates with the Ministry of Public Health, Population and Social Affairs (MOPH/P/SA), local 
government, health providers, and communities to implement activities that will reach 1.4 million women of 
reproductive age, 1.1 million children under age five, and 2.6 million youth and adolescents ages 15-35, with 
a focus on youth ages 10-24, in 17 health districts in Maradi, Zinder, and Tillabéri. 
In collaboration with the MOPH/P/SA, Save the Children (SC) leads USAID Kulawa with partners 
Pathfinder International, PRONTO International, and Viamo, and works in partnership with local 
government, national non-governmental organizations (NNGOs), and beneficiary communities.
USAID Kulawa’s Theory of Change is grounded in our development hypothesis: If local populations, 
including youth, have greater access to integrated high quality maternal, newborn, and child health 
(MNCH)/FP and nutrition services, and if linkages between these services at the community and facility 
levels and with other sectors are strengthened, and if community demand for, engagement, and trust in 
services grows, then utilization will increase, social and behavior change (SBC) will occur at the institutional 
and individual levels, and health outcomes will improve. Resilience in the Sahel Enhance (RISE) II operating 
principles of community-led development, systems strengthening, inclusive targeting, and collaboration for 
Baseline Report – USAID Kulawa Project 12
collective impact guide USAID Kulawa’s approaches and are complemented by an emphasis on women and 
youth empowerment, gender equality, collaborating, learning, and adapting (CLA), and resilience.
USAID Kulawa envisions resilient communities, including their most marginalized and disadvantaged 
members, benefiting from better access and use of high quality maternal, newborn and child health, family 
planning and reproductive health (RH), and nutrition services, collaborative alliances across communities 
and facilities and across health sectors and other sectors, stronger governance and accountability of local 
systems and institutions.
The objective of the USAID Kulawa project is to increase the use of quality maternal, neonatal, and infant￾child health, family planning and nutrition services in the areas of intervention. The activities will achieve 
the objective through the following results:
Result 1: Increased availability and accessibility to quality services, including for young people.
Result 2: Improved quality of care systems in the delivery of health services.
Result 3: Strengthened integration in the delivery of health services.
Result 4: Increased functional capacity of local organizations in the health sector.
USAID Kulawa also features several important crosscutting objectives, including improved management of 
shocks, risks, and stresses; enhanced social, economic, and political agency of women and 
adolescents/youth; and enhanced governance of institutions and organizations. 
In order to establish the baseline situation of the project in the communities of intervention, this 
assessment was conducted by GRADE Africa in the three regions of project intervention (Maradi, Tillabéri 
and Zinder) complements the first study conducted in 2021 to establish the baseline. This report presents 
the main results and findings of this evaluation.
1. EVALUATION OBJECTIVES
1.1 Global objective
The main objective of this study is to establish the reference levels of specific project indicators not covered 
by the first study. This will allow the project team to be able to ensure or adjust the targeting, to measure 
the changes linked to the interventions and to highlight the potential for project integration, sustainability 
and scaling up.
1.2 Specific objectives
The study pursues specifically two sub-objectives:
Baseline Report – USAID Kulawa Project 13
Have relevant data for indicators related to project themes, which are maternal, neonatal and infant-child 
health (including prenatal and postnatal care), nutrition, sexual and reproductive health, sexual and gender￾based violence, and family planning;
Formulate recommendations based on the evidence from the study to help decision-making in the context 
of project interventions.
2. GENERAL METHODOLOGY
2.1 Sites and target populations
The study sites are made up of all the localities of intervention of the USAID Kulawa project in the three 
target regions, namely Maradi, Tillabéri and Zinder. Depending on the health area to which it belongs, each 
locality is attached to a case de santé/health post(CS) or a health center.
This baseline survey was conducted at household and health facility level. The household survey targeted 
women aged 15 to 49, men aged 15 to 54, and children aged 0 to 35 months. The health facility assessment 
looked at health providers and health facilities. Calculations of the size of the target population are based 
on population projections from 2012 to 2035 by department, as provided by the National Institute of 
Statistics (Annex 3).
2.2 Study design and methods
The methodological approach is quantitative through a survey of households and health facilities. 
Depending on the target, specific tools were used to collect information relating to the main USAID Kulawa 
project indicators.
A form was designed to list all the households in a locality. In addition, using a questionnaire, information on 
the composition of the household was collected from the head of the household or his legal representative, 
who was assumed to be able to provide information on the household.
2.2.1 Household survey
The project interventions target several segments of the population (men, women, and children). The 
project has numerous indicators relating to these segments on which the data collection focused, 
particularly among households. To this end, a variety of tools were necessary for the data collection. Many 
project performance indicators have a reference metadata sheet (see USAID Performance Indicator 
Reference Sheet (PIRS), which guided collection tools design and calculations of the indicators.
2.2.2 Survey of health facilities
The purpose of the health structures’ evaluation was to determine the levels of access and use of maternal 
and child health services (ANC and RH/FP in particular) and nutrition. It also aimed to establish the status of 
Baseline Report – USAID Kulawa Project 14
the equipment needed to provide quality health services. The ultimate goal is to ensure that people, 
especially women and children, receive the best possible health services. A specific tool has been designed 
for healthcare providers (see Appendix 4 on the main project indicators and collection methods).
2.3 Sampling
2.3.1 Household survey
Sampling frame
The USAID Kulawa project has a database of 3,692 interventions sites in the Maradi, Tillabéri and Zinder 
regions. A “site” is a village that is attached to a CS or a health center. In this database, each village appears 
with all its geographical identifiers (region, district, and municipality of attachment). This database served as 
a sampling frame for drawing the survey sample.
Sampling size
It is expected that the results will be representative of the scale of each region of intervention. The process 
of determining the sample size was therefore conducted to satisfy this condition and fit the budget. The size 
of the sample was then modeled on the proportions of the different targets by region.
Table 1: USAID Kulawa zone demographics
Regions Districts Total 
Population
12-23 
months
Women of 
reproductive age
10-24 
years old
Maradi
Aguié 352 248 27 980 76 329 117 190
Dakoro 902 716 71 704 195 610 300 327
Gazaoua 229 876 18 259 49 812 76 478
Guidan Roumdji 749 924 59 568 162 501 249 494
Tessaoua 738 662 58 673 160 061 245 748
Tillabéri
Balleyara 153 613 12 202 33 124 51 106
Filingué 439 795 34 934 94 834 146 317
Kollo 667 306 53 005 143 892 222 008
Say 251 818 20 002 54 300 83 778
Tillabéri 325 986 25 894 70 293 108 453
Zinder
Damagaram 
Takaya
345 788 27 467 73 946 115 041
Dungass 507 374 40 302 108 501 168 800
Gouré 470 025 37 335 100 514 156 374
Kantché 
(Matamèye)
572 345 45 462 122 395 190 415
Magaria 828 367 65 799 177 145 275 592
Mirriah 727 651 57 799 155 607 242 084
Takeita 353 887 28 110 75 678 117 736
Total USAID 
Kulawa
8 617 381 684 495 1 854 542 2 866 941
Source: Save the Children Niger, 2022
Baseline Report – USAID Kulawa Project 15
From Table 1 above, the proportions of different target populations were calculated. The result obtained is 
recorded in Table 2 below.
Table 2: Weight of study sub-populations by age group
Regions Districts 12-23 months WRA 15-49 years 10-24 years
Maradi Aguié 7.9 21.7 33.3
Dakoro 7.9 21.7 33.3
Gazaoua 7.9 21.7 33.3
Guidan Roumdji 7.9 21.7 33.3
Tessaoua 7.9 21.7 33.3
Tillabéri Balleyara 7.9 21.6 33.3
Filingué 7.9 21.6 33.3
Kollo 7.9 21.6 33.3
Say 7.9 21.6 33.3
Tillabéry 7.9 21.6 33.3
Zinder Damagaram Takaya 7.9 21.4 33.3
Dungass 7.9 21.4 33.3
Gouré 7.9 21.4 33.3
Kantché (Matameye) 7.9 21.4 33.3
Magaria 7.9 21.4 33.3
Mirriah 7.9 21.4 33.3
Takeita 7.9 21.4 33.3
The result shows constant and equal proportions between health districts, i.e., 7.9% for children aged 12-23 
months, 21.7% for women of childbearing age (15-49 years) and 33.3% for 10–24-year-old. The calculation 
of the sample size is based on the following formula:
2
2
* (1 ) * * (1 )
*
t p pd k n
mX
α
α
−+ =
Where n is the number of households to survey; X ̅ is the average number of the target population per 
household; t_∝^2 is the quantile of order (1-∝/2) of the centered reduced normal distribution, squared; 
m_∝^2 is the absolute margin of error associated with the level of confidence (1-∝) associated with the 
estimate of p; p is the prevalence of the indicator of interest; d is the sampling effect; and k is the 
nonresponse rate. The sizes of the samples obtained according to the target populations are recorded in 
Table 3 below.
Baseline Report – USAID Kulawa Project 16
Table 3: Sample size calculation
Region Target 
Groups
Proportion 
value
Design 
Effect
Non￾response 
rate
Minimum 
number of 
individuals/ 
stratum
Average 
number per 
household 
targeted
Number of 
households to 
include in a 
stratum
Maradi
12-23 
months 7.9% 2 0.07 168 0.3 561
Women 
15-49 
years
21.7% 2 0.07 391 1.3 301
10-24 
years
33.3% 2 0.07 511 0.4 1,278
Tillabéry
12-23 
months 7.9% 2 0.07 168 0.3 561
Women 
15-49 
years
21.7% 2 0.07 391 1.3 301
10-24 
years
33.3% 2 0.07 511 0.4 1,278
Zinder
12-23 
months 7.9% 2 0.07 168 0.3 561
Women 
15-49 
years
21.7% 2 0.07 391 1.3 301
10-24 
years
33.3% 2 0.07 511 0.4 1,278
Thus, the sample size for all three regions is 3,840 households distributed as follows:
Table 4: Sampling distribution by region
Region Number of households to survey
Maradi 1,280
Tillabéri 1,280
Zinder 1,280
Total 3,840
The size of the sample is identical between the different target groups and between the three regions of 
intervention of the project.
Sampling plan
The sampling plan for this survey is of the two-stage stratified type. The primary survey unit, the cluster, is 
the intervention site or village. Each region corresponds to a sampling stratum. For the selection, no 
distinction was made between urban and rural areas in each region. In each stratum, the first stage sample 
was drawn independently by a systematic draw. The second stage was also taken independently in each 
primary unit drawn in the first stage and in a systematic manner.
As indicated above, a sampling base made up of all the USAID Kulawa project intervention sites is available. 
It contains 3,692 sites or localities. The sampling frame was set for each target region according to the 
Baseline Report – USAID Kulawa Project 17
municipality and the department, in alphabetical order. At the first stage of sampling, 120 clusters (sites or 
locality of intervention) were systematically selected with equal probability from all three sampling strata, 
40 clusters per stratum, by conducting a systematic random selection with equal probability to survey the 
3,840 households (Appendix 5). Such a selection procedure offers an implicit stratification by department 
level and within each region.
After drawing the first stage statistical units, a counting operation was conducted in each site selected the 
same day of the survey, in order to have the exact number of ordinary households residing in the site. This 
made it possible to compile a complete list of all the households from which was drawn, at the second stage, 
a sample of 32 households following a systematic selection. At the time of the household visits, all 
household members were identified using the household questionnaire. This operation made it possible to 
identify the members eligible for individual interviews. Individual questionnaires intended for women aged 
15 to 49, mothers and guardians of children aged 0 to 35 months and men aged 15 to 54 were administered 
in each selected household, depending on the presence of eligible persons.
During the survey, in case of absence or refusal to participate in the survey, the household was replaced by 
the next or the previous household on the list. Once a site was selected and if the security or geographical 
accessibility conditions were not met, it was automatically replaced among the villages on the replacement 
list.
It is important to note that prior to the data collection phase, the scope of work and the methodology for 
this study were submitted to IRB for review and approval, which confirmed that this study adheres to the 
accepted ethical standards of a genuine research study.
2.3.2 Survey of health facilities and service providers
The household survey was coupled with an assessment of health structures and a survey of service 
providers. This assessment is representative of the type of structure and geographical area 
(region/department) in the three regions. For this assessment, the regions were also considered as strata. 
The sample size defined was 146 health structures, or 17% of the 871 structures in the area covered by the 
USAID Kulawa project, with a confidence level of 95% and a margin of error of 5%. The health structures 
visited were made up of district hospitals (12/12, i.e., 100%); Mother and Child Health Centers (3/3, or 
100%), centre de santé intégré/integrated health centers (83/257, or 30%) and case de sante/health posts
(48/598, or 30%).
All district hospitals (DH) and mother and child health centers (MCHC) in the three regions were targeted 
by the study. With regard to centre de santé intégré/integrated health centers (CSIs) and case de 
sante/health posts (CS), all of the 120 intervention sites or villages sampled for the household survey or 
frequented by their populations were counted and automatically visited for the health facilities assessment. 
The complement of CSIs and CSs was drawn randomly from the respective databases of CSIs and CSs in all 
three regions/strata to reach a total of 146 health structures. Depending on the type of health structure, 
the team interviewed one (1) manager per structure, one (1) service provider per CS, two (2) per CSI, two (2) 
Baseline Report – USAID Kulawa Project 18
per MCHC, three (3) per district hospital. For health facilities where the number of providers is greater than 
the number of providers to be surveyed, RH/FP service providers were selected for the study.
Inclusion criteria
For this study, the participant inclusion criteria were based primarily on age and sex for the household 
survey and acceptance to participate in the survey. The study population consisted of women aged 15 to 49, 
men aged 15 to 54, children aged 0 to 35 months and health care providers residing in the project 
intervention area. These criteria were intended to cover the people targeted by project interventions. For 
the service providers, the criterion was the fact of practicing in the health structure selected. The providers 
were randomly selected across types and domains of service in RMNCH among all providers present at time 
of survey, made up of doctors, nurses and midwives.
Participants recruitment and registration
Once the households were selected, the data collection team began their visits. The team first contacted 
the head of the household or their representative, in order to obtain their consent to participate in the 
study. A questionnaire was administered for the composition of the household, and in order to have some 
household characteristics. The head of the household or their representative gave their authorization for 
the participation of the other members of the household in the study. To this end, a person was randomly 
drawn among men aged 15 to 54 and another among women aged 15 to 49. The data collection agents first 
requested informed consent from the selected individuals before administering the questionnaires.
Informed consent
Informed consent was collected from participants and in a private setting. For the women, the interviews 
were conducted in isolated places and in the absence of a third party. Study participants were given the 
option to sign the consent form, decline, or postpone the decision. Individuals were given time to decide 
whether they wanted to participate or not. It was made clear to all participants that the purpose of the 
study was to establish baseline values for the USAID Kulawa project intervention, and that at the end of the 
intervention a similar exercise would be conducted to determine the extent to which the project had 
brought changes in health sector.
Additionally, participants were assured that they could decline to answer any questions posed by the 
interviewers, and that they could withdraw their consent at any time. The questionnaires were given by 
interviewers of the same gender as the participants in order to minimize discomfort and bias. A document 
to obtain specific consent for unmarried minors between the ages of 15 and 17 had been drawn up. This 
consent was obtained from their biological or adoptive parents, in order to obtain their consent for 
questioning these minors. The children were then informed that their parents agreed for them to be 
interviewed but they also had the choice of accepting or refusing the interview without any constraint or 
discomfort. As marriage automatically confers emancipatory majority status, there was no specific consent 
for married minors. At health facility level, letters of authorization from the Niger Ethics Committee and the 
Baseline Report – USAID Kulawa Project 19
General Secretariat of the Ministry of Public Health, Population and Social Affairs facilitated the 
collaboration of service providers for the survey. On the day of the interviews, the collection agent obtains 
the consent of the head of the health facility to conduct all the interviews necessary for the study. 
Subsequently, an isolated office was chosen to conduct the various interviews in order to guarantee 
confidentiality without disrupting service delivery.
2.4 Assessment tools
The tools used for this evaluation survey consisted of an individual questionnaire for "Women aged 15 to 
49", an individual questionnaire for "Men aged 15-59", an "Inventory of health centers" and an individual 
“Healthcare provider” questionnaire. The tools included aspects from previously validated tools from DHS 
(version 8) and custom, newly designed components that were validated by the USAID Kulawa gender and 
FP teams. Data collection was conducted using the ODK application installed on tablets. The individual 
female questionnaire was administered to female members who fulfilled the criteria and who had given 
their consent to participate in the evaluation. The household and male questionnaires were also 
administered to obtain information on the households of the eligible women. The household questionnaire 
was addressed to the head of household or to any competent member of the household, able to provide 
information on the household. The individual male questionnaire only concerned the spouses of the women 
interviewed.
Data security
The management of the data collected followed security protocols. Necessary measures were taken to 
ensure data confidentiality and avoid any breach with security level and restriction parameters set 
according to the tasks (server access, data management, safeguarding, etc.). Data files are stored on an ONA 
server with limited access. A sufficiently strong password protects any unauthorized access to its content.
2.5 Results evaluation indicators 
The USAID Kulawa monitoring and evaluation framework includes monitoring indicators. Annex 6 on 
collection tools by indicator presents a summary of the evaluation indicators included in this report.
2.6 Recruitment and training of data collection agents
The recruitment of survey agents was conducted from November 1 to 6, 2022 in Niamey, respecting the 
usual procedure for recruiting data collection agents at GRADE Africa. This is successively the recruitment 
announcement, the receipt of application forms, the review of application forms, the pre-selection of 
potential candidates and the interview for the selection of candidates to be trained. After the training and 
based on the performance of the participants, 54 interviewers, including twelve team leaders, were 
retained and nine interviewers were put on the waiting list as reservists.
Baseline Report – USAID Kulawa Project 20
From November 9 to 14, 2022, at the General Seyni Kountché Stadium in Niamey, the selected candidates 
were trained on the USAID Kulawa project, the study (Methodology, Assent/consent forms, 
Questionnaires), the ODK application and its use and ethical principles.
2.7 Monitoring and follow-up 
Data collection took place from November 17 to December 3, 2022. An itinerary had been drawn up for 
each team in order to facilitate their movement and vehicle management. The methodology adapted in the 
field consisted first of presenting the objective of the mission to the village chief, convening a village general 
assembly to explain to the whole community the objective of the mission and to ask for their cooperation. 
After this presentation to the community, the data collection agents proceeded first to count the 
households, then to select the eligible households. Each team leader established the distribution of 
households to be surveyed by each interviewer. In accordance with the protocol of this study, 
consent/assent was required before each interview through the forms previously prepared for this purpose 
for households and also for health facilities.
For the CSs whose village names did not appear in the file, the heads of the respective CSIs, sometimes with 
the assistance of village chiefs, helped to identify and find them. In order to have quality data, the team 
leaders, in addition to conducting the survey, checked the completed forms before sending them to the 
server. After each village, the teams were invited to synchronize the data collected. At central level, data 
extraction was conducted every two days to check the quality of the data. The central coordinator was 
responsible for conducting this task and sharing the observations and comments resulting from the analysis 
with the various regional supervisors, who in turn passed on the information to the team leaders. About 
35% of the questionnaires were checked for quality.
2.8 Data collection report
The population data collected are recorded in Table 5. The highest non-response rate, which nevertheless 
remains low, was 6% in the Zinder region. It remains close to that recorded in Maradi (5%). The non￾response rate was almost negligible in Tillabéri (1%). This non-response rate remains overall lower than the 
error rate introduced when calculating the sample, which is 7%.
Table 5: Number of households surveyed and non-response rate
Region Expected Surveyed Non-response rate
Maradi 1280 1213 5%
Tillabéri 1280 1263 1%
Zinder 1280 1202 6%
Total 3840 3678 4%
For health facilities, 146 were surveyed. The CSIs are the most numerous (83), followed by the CS, which 
number 48 for all three regions.
Baseline Report – USAID Kulawa Project 21
Table 6: Number of health facilities and service providers surveyed
Structure type Maradi Tillabéri Zinder Total
District Hospital (DH) 4 3 5 12
Mother and Child Health Center (MCHC) 1 1 1 3
Centre de santé intégré/integrated health centers
(CSI)
27 29 27 83
Case de sante/health post (CS) 18 6 24 48
Total health facilities 50 39 57 146
Providers surveyed 84 71 99 254
A Mother and Child Health Center (MCHC) was surveyed in each region. For district hospitals (DH), 4 were 
surveyed in Maradi, 3 in Tillabéri and 5 in Zinder, making a total of 12 district hospitals.
The selection of CSI and CS depended on the random choice of sites or villages. Once the sites or villages 
had been randomly selected, the sites or villages come with their linked CSI and CS. In the case of Tillabéri 
region, the selected sites or villages are attached to 6 CS and 29 CSI. 
2.9 Limitations
This study has some contextual or methodological limitations. The results of the study are only 
representative of the USAID KULAWA project intervention. It should be noted that the volatile security 
situation made it impossible to visit some initially sampled villages which were subsequently substituted. 
Some health facilities considered CSIs do not have the required staff and adequate services of a CSI. 
According to information received from mothers in the Tillabéri region, the health record book of some 
children was kept by providers due to non-payment of the 1,000 CFA franc ($1.65) fee required by the 
health structures.
3. MAIN RESULTS
3.1 Sociodemographic characteristics of the population surveyed
The study’s target population consists of women aged 15 to 49 and men aged 15 to 54. The survey results 
show that adolescents and young people represent 40.9% among women and 21.6% among men. Overall, 
the 25 to 29 age group is the most represented in the sample for both sexes. Regional disparities across age 
groups are observed. The proportion of women aged 15-24 are almost equivalent in Tillabéri (38.6%) and 
Zinder (39.7%) but higher in Maradi (43.3%). Among men, regional disparities are observed among 30-34 
years old with 17.0% in Tillabéri and 18.4% in Zinder against 11.8% in Maradi.
Baseline Report – USAID Kulawa Project 22
The distribution of the population by marital status indicates a high proportion of monogamous married 
people among women (67.7%) as well as among men (62.8%). Single people are relatively poorly 
represented with 6.0% among women and 17.3% among men. Regional analyses highlight differences 
according to the marital status of respondents. Polygamous married women are more represented in 
Maradi (29.6%) than in Tillabéri (15.4%) and Zinder (20.9%). The same trends emerge among men. With 
regard to the level of education, the majority of women (56.9%) have no education while among men, 
Koranic instruction (51.6%) represents the large part of the sample. Analyses by region highlight disparities 
of attendance at secondary level of education, regardless of gender. Indeed, women from Zinder (2.5%) are 
less represented than those from Maradi (9.0%) and Tillabéri (11.2%) for secondary education. Household 
heads represent 82.2% among men against 13.3% among women. At regional level, there are more female 
heads of households in Zinder (20.3%) compared to Maradi (9.5%) and Tillabéri (8.4%).
Table 7: Sociodemographic characteristics of the population surveyed
Age groups
Marad
i 
n=101
1
Tillab
éri
n=920
Zind
er
n=70
9
Overa
ll
n=26
40
Mara
di
n=81
9
Tillab
éri
n=549
Zind
er
n=66
9
Overa
ll
n=203
7
Women Men
15-19 years
23.0% 19.8%
19.1
% 20.8%
14.4
% 
12.8% 6.5% 10.8%
20-24 years
20.3% 18.8%
20.6
% 20.1%
11.8
% 
12.2% 9.3% 10.8%
25-29 years
23.3% 20.1%
20.7
% 21.6%
19.3
% 
15.6%
17.2
% 
17.8%
30-34 years
12.6% 15.9%
14.9
% 14.2%
11.8
% 
17.0%
18.4
% 
15.5%
35-39 years
10.1% 12.3%
10.0
% 10.6%
14.3
% 
14.8%
18.1
% 
16.0%
40-44 years
5.2% 7.7% 8.7% 7.1%
13.3
% 
13.1%
12.9
% 
13.1%
45-49 years 5.5% 5.3% 6.1% 5.7% 9.0% 14.4% 9.4% 10.2%
50-54 years 0.0% 0.0% 0.0% 0.0% 6.1% 0.0% 8.1% 5.8%
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Marital Status Mara
di
Tillabé
ri Zinder
Overa
ll Maradi
Tillabé
ri Zinder
Over
all
Women Men
Married monogamous 
61.6
% 
73.2% 70.8% 67.7% 57.1% 64.5% 68.5%
62.8
% 
Married polygamist
29.6
% 
15.4% 20.9% 23.1% 22.1% 8.7% 22.1%
18.5
% 
Divorced / Separated 0.7% 1.5% 5.0% 2.5% 0.6% 1.3% 1.1% 0.9%
Widower / widow 0.6% 0.7% 0.6% 0.6% 0.0% 1.1% 0.5% 0.4%
Baseline Report – USAID Kulawa Project 23
Single / Never Married 7.5% 9.1% 2.7% 6.0% 20.2% 24.4% 7.9%
17.3
% 
Free Union 0.0% 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
100.
0 
Education
None 53.5
% 56.1% 61.0% 56.9%
8.6% 27.1% 11.5%
14.5
% 
Literate 7.9% 0.4% 5.0% 5.1% 6.0% 0.9% 1.1% 3.0%
Koranic 17.2
% 12.7% 25.4% 19.3%
43.4% 35.0% 75.5%
51.6
% 
Primary 12.4
% 19.3% 6.1% 11.6%
21.9% 22.2% 7.0%
17.1
% 
Secondary
9.0% 11.2% 2.5% 7.0%
19.4% 14.2% 4.6%
13.2
% 
Superior 0.0% 0.4% 0.0% 0.1% 0.9% 0.6% 0.3% 0.6%
Total
100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.
0 
Relationship
Head of household
9.5% 8.4% 20.3% 13.3%
80.3% 74.3% 91.9%
82.5
% 
Wife or husband 81.7
% 75.3% 73.3% 77.1% 0.1% 0.0% 0.2% 0.1%
Son or daughter
8.1% 11.0% 5.1% 7.6%
18.8% 22.0% 7.2%
15.9
% 
Son / daughter-in-law 0.2% 3.2% 0.2% 0.9%
Grandson/daughter or child of 
wife/ husband
0.2% 0.4% 0.2% 0.3% 0.6% 1.5% 0.5% 0.8%
Father / mother 0.0% 0.1% 0.0% 0.0%
Brother or sister
0.0% 0.2% 0.0% 0.1% 0.0% 1.1% 0.3% 0.4%
Co-wife 0.1% 0.0% 0.6% 0.3%
Other relative
0.1% 0.5% 0.2% 0.2% 0.0% 0.6% 0.0% 0.2%
Adopted/ guardianship 
0.0% 0.9% 0.0% 0.2% 0.1% 0.4% 0.0% 0.2%
Baseline Report – USAID Kulawa Project 24
Not related 0.0% 0.0% 0.0% 0.0% 0.0% 0.2% 0.0% 0.1%
Total
100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.
0 
3.2 Family planning knowledge, use and attitudes
This section assesses the study population's levels of knowledge and use of contraceptive methods, as well 
as their attitudes about family planning.
3.2.1 Knowledge of FP and other health services
This indicator is the proportion of men (aged 15-54 years) and women (aged 15-49 years) with knowledge 
of FP/other health services within the target population. A person is assumed to know about FP 
methods/other health services only when they meet at least three (3) of the following: a) can identify at 
least three (3) family planning methods (modern or traditional); b) states where a modern FP method can be 
obtained; c) can identify the period of a woman's menstrual cycle when she is most likely to become 
pregnant; and, d) can identify as a myth the belief that if a woman has already used a contraceptive method, 
it is more difficult for her to become pregnant later.
Table 8: Proportion of all men and women with knowledge of FP
FP knowledge (%) Maradi Tillabéri Zinder Overall
Women (15-49 
years)
Yes 66.3% 59.2% 33.1% 52.1%
No 33.7% 40.8% 66.9% 47.9%
Total 100.0 100.0 100.0 100.0
Men (15-54 years) Yes 4.6% 9.5% 0.4% 3.7%
No 95.4% 90.5% 99.6% 96.3%
Total 100.0 100.0 100.0 100.0
Total Yes 39.2% 40.3% 18.2% 31.1%
No 60.8% 59.7% 81.8% 68.9%
Total 100.0 100.0 100.0 100.0
The results of the study (Table 8) show that 52.1% of women and 3.7% of men demonstrated having a broad 
knowledge of modern contraceptive methods (at least three of the aforementioned criteria).
3.2.2 Promotion of RH/FP messages by the United States Government 
The indicator is the percentage of the audience who recall hearing or seeing a specific FP/RH message 
promoted by the United States Government (USG) within the previous 24 months. The “audience” is 
defined as the target population for the particular FP/RH message (e.g., women of childbearing age). 
“Recall” refers to the percentage that can spontaneously name (or recognize when mentioned) a particular 
FP/RH message. “Specific FP/RH message promoted by USG” refers to a communication promoted by USG 
with an identifiable aspect (e.g., logo, character, etc.) that the respondent could not name unless s/he had 
Baseline Report – USAID Kulawa Project 25
been exposed to the communication. This indicator is calculated as a percentage and is specific to the 
reporting year.
Numerator: sample-weighted number of audience who recall a specific FP/RH message promoted by the 
USG.
Denominator: total sample-weighted number of audience surveyed x 100.
The United States Government, through its Agency for International Development (USAID), supports 
family planning and reproductive health programs in Niger. This support aims, among other things, to raise 
awareness and inform populations about the dimensions of FP, to make FP services available and to 
organize advocacy actions to help populations benefit from these services without major constraints.
Table 9: Proportion of audience who recalled hearing or seeing a specific message 
(RH/FP) promoted in the past 24 months by USG-funded programs
RH/FP Message Promoted by USG Funded Programs
Region
Overall Maradi Tillabéri Zinder
Women (15-49 years)
Yes 32.9% 25.2% 41.8% 34.5%
No 67.1% 74.8% 58.2% 65.5%
Total 100.0 100.0 100.0 100.0
Men (15-54 years)
Yes 46.7% 28.2% 11.8% 28.9%
No 53.3% 71.8% 88.2% 71.1%
Total 100.0 100.0 100.0 100.0
Overall
Yes 39.0% 26.3% 28.1% 32.1%
No 61.0% 73.7% 71.9% 67.9%
Total 100.0 100.0 100.0 100.0
The results show that more than one in three women (34.5% of women aged 15 to 49) from the three 
regions declared having heard a specific reproductive health/family planning message promoted by 
programs funded by the USG. Women in the Zinder region seem to have more access to the messages, with 
41.8%. The Tillabéri region records the lowest level of exposure to the messages, with 25.2%.
3.2.3 Current use of modern contraception
The results show that 12.0% of the women surveyed are currently using a modern contraceptive method in 
the project area.
Baseline Report – USAID Kulawa Project 26
Table 10: Rate of use of modern contraceptive methods
Usage rate Maradi Tillabéri Zinder Overall
All methods
All women 23.6% 14.8% 6.7% 15.2%
Women 15-24 years 18.3% 12.1% 8.0% 13.2%
Women 25-49 years 27.6% 16.5% 5.9% 16.6%
Modern Methods
All women 17.4% 14.7% 4.8% 12.0%
Women 15-24 years 12.7% 12.1% 6.3% 10.2%
Women 25-49 years 20.9% 16.3% 3.8% 13.2%
The highest rate of use among women is in Maradi region with 17.4% of users. The Zinder region has the 
lowest rate of use of modern contraceptive methods (4.8%).
3.2.4 Attitudes about family planning
The indicator is the proportion of the target population with a positive attitude towards FP and FP methods. 
It measures the attitudes towards FP of individuals among the target populations in the project area in 
order to allow USAID Kulawa to measure attitudinal factors contributing to behavioral outcomes, and to 
help the project prioritize intermediate factors for implementation. Key elements of the definition:
Target audience: Men (15-54 years); Women of childbearing age (15-49 years)
“Positive” attitude towards FP: a positive attitude is a favorable or positive evaluation of FP brought about 
by beliefs, experience, or emotions.
Inquiry statements:
The survey statements use a 5-point Likert scale (i.e., strongly agree, agree, neither agree nor disagree, 
disagree, strongly disagree); a “positive” score per question should either strongly agree/agree or 
disagree/strongly disagree, depending on the focus of the question, and indicate a favorable assessment of 
FP.
To what extent do you agree or disagree with the following statements:
1. A husband and wife should talk about birth spacing and contraceptive methods.
2. Men whose wives use contraceptives lack authority over their wives and families.* 
3. It is shameful to be associated with a woman who uses contraceptives.* 
4. A wife is justified in asking her husband to use a condom if she knows he has .a disease that can be 
sexually transmitted.
5. A husband and wife should use contraceptives to limit the number of children they have.
Baseline Report – USAID Kulawa Project 27
* Signifies reverse scoring
Numerator: sample-weighted number of target audience with a positive attitude towards FP and FP 
methods
Denominator: Sample-weighted number of target audience surveyed
The analyses show that, in all the regions studied, 9 women out of 10 aged 15 to 49 (90.1%) have a positive 
attitude towards family planning. The regions of Maradi (95.6%) and Tillabéri (96.8%) record higher rates of 
women with a positive attitude towards family planning. Women in Zinder region seem less favorable to 
family planning with a rate of 80.5%.
Table 11: Proportion of target population with a positive attitude towards FP
Attitudes toward FP Maradi Tillabéri Zinder Overall
Women
Positive 95.6% 96.8% 80.5% 90.1%
Negative 4.4% 3.2% 19.5% 9.9%
Total 100.0 100.0 100.0 100.0
Men
Positive 85.3% 85.0% 82.0% 83.9%
Negative 14.7% 15.0% 18.0% 16.1%
Total
Total 100.0 100.0 100.0 100.0
Positive 91.1% 92.3% 81.2% 87.4%
Negative 8.9% 7.7% 18.8% 12.6%
Total 100.0 100.0 100.0 100.0
For all the regions of the study, nearly 4 out of 5 men (83.9%) have a positive attitude towards family 
planning. The regions of Maradi and Tillabéri, as with women, have the highest proportions of men with a 
positive attitude. Analyses by sex reveal that women (90.1%) have a more positive perception of FP than 
men (83.9%). 
3.2.5 Demand satisfied for family planning
The main indicator is the percentage of adolescent girls and young women (15-24 years), or their partners, 
who are in union or sexually active, unmarried, and who do not want a child or no more children (limitation), 
or delay the next pregnancy (spacing) and are currently using a modern method of contraception. Women 
using a traditional method are assumed to have an unmet need for modern contraception.
Numerator: number of adolescent girls and young women (aged 15-24 years) using any modern 
contraceptive method, including female sterilization, male sterilization (partner), pill, IUD, injectables, 
implants, male condom (partner), female condom, emergency contraception, a vaginal method, the 
lactational amenorrhea method, or other modern methods.
Denominator: Total number of adolescent girls and young women (ages 15-24) who have a met or unmet 
need for family planning (total demand for family planning).
Baseline Report – USAID Kulawa Project 28
The procedures for calculating the indicators on the need and demand for FP are detailed in Annex 7.
Table 12: Indicators of contraceptive demand and unmet need (15-24 years) 
Indicators Maradi Tillabéri Zinder Overall
Unmet need for spacing (%) 1,6% 0,8% 0,4% 1,0%
Unmet need for limiting (%) 0,2% 0,0% 0,0% 0,1%
Total unmet need (%) 1,8% 0,8% 0,4% 1,1%
Met need for spacing (%) 19,2% 13,2% 4,6% 13,4%
Met need for limiting (%) 0,7% 0,0% 0,4% 0,4%
Total met need (%) 19,9% 13,2% 4,9% 13,8%
Total demand for FP (spacing) (%) 20,8% 14,0% 4,9% 14,4%
Total demand for FP (limiting) (%) 0,9% 0,0% 0,4% 0,5%
Total demand for FP (%) 21,7% 14,0% 5,2% 14,8%
Demand satisfied by modern methods (%) 67,0% 94,2% 66,7% 75,6%
Demand satisfied by all FP methods (%) 91,8% 94,2% 93,3% 92,7%
A significant portion of total contraceptive demand among young people (14.8% in the three regions) is met 
by modern or traditional contraceptive methods (92.7%). Considering only modern methods, this coverage 
is 75.6% for all three regions. Tillabéri is distinguished by a high proportion of demand satisfied by modern 
methods (94.2%). This does not seem to be the case for Zinder and Maradi (91.8% and 67.0%).
The proportion of unmet need for family planning among people remains low overall, with 1.3% of total 
unmet need. While these unmet needs are lower in Tillabéri (0.0%) and Zinder (0.0%), they are relatively 
higher in Maradi (3.0%). Also, in Maradi, the unmet need for birth spacing is greater than for limitation. 
The overall results for women aged 15-24 years showed significant regional differences. In Maradi, the 
demand for FP demand is 21.7%, most of which is for spacing. Among the 21.7% with a demand for FP, 67%
have their demand satisfied with a modern method. Compared to other regions, Maradi has a somewhat 
stronger demand for FP, but only two thirds of it is met by a modern method. The goal of the project in 
Maradi could be to close the gap of demand satisfied by modern methods by helping to shift users of 
traditional FP methods to modern methods, while working to increase knowledge, understanding and 
access to modern methods for those with an unmet need. Conversely, in Zinder, the situation is slightly 
different. There, total demand is very low (5.2%), and demand satisfied by a modern method is similar to 
Maradi (66.7%). Here, it may be more useful to focus on increasing demand for FP, particularly on improving 
knowledge about the healthy timing and spacing of pregnancies, as well as improving attitudes towards FP 
(e.g., dispelling myths, promoting joint decision-making on FP use with partners, etc.). The modern method 
contraceptive prevalence rate (mCPR) cannot increase in Zinder if the demand for FP does not increase 
first.
Baseline Report – USAID Kulawa Project 29
3.3 Fertility and prenatal care
3.3.1 Adolescent fertility
The indicator is the adolescent birth rate or the number of births to women aged 20-24 years per 1,000 
women during the previous five years (WHO 2010). It is a subset of the age-specific fertility rates 
(TFPA/ASFR).
Numerator: number of live births to girls aged 20-24 years in the previous five years (total weighted 
number of live births over the last 5 years divided by 5).
Denominator: Total population of adolescent girls aged 20-24 surveyed.
In terms of reproductive health, adolescent fertility plays a major role. Maternity-related death risks are 
high for adolescent girls and their babies. In Niger, women aged 20-24 years record 34% of maternal deaths 
(EDSN, 2012) and their babies are five times less likely to survive than those of women aged over 24 years. 
Neonatal and infant mortality rates are 43‰ and 72‰ respectively (ENAFEME-2021). 
Table 13: Adolescent fertility rate
Region
Surveyed population of 
women aged 20-24 
years
Total number of live births of 
20-24 year olds over the last 
five years
Crude birth rate (per 1000) 
of adolescent girls
Maradi 205 325 282
Tillabéri 194 244 249
Zinder 145 222 290
Total 544 791 278
Table 13 shows that the rate of 278 live births per 1,000 adolescent girls aged 20-24 years in the previous 
five years is still high in the USAID Kulawa project regions (Maradi, Tillabéri and Zinder). The Tillabéri 
region is characterized by a lower rate of 249‰ compared to the other regions which have rates above 
280‰. 
3.3.2 Antenatal consultations
The indicator is the percentage of women who had four or more antenatal visits during the last pregnancy. 
This indicator measures the percentage of women of reproductive age (15-49 years) with a live birth who 
received antenatal care (ANC) four or more times during their most recent pregnancy. ANC should be 
provided by trained health personnel. “Skilled health personnel” refers to doctors, nurses, midwives, skilled 
birth attendants or clinical officers. Visits to trained or untrained traditional birth attendants (TBAs) are 
excluded.
Baseline Report – USAID Kulawa Project 30
Numerator: sample-weighted number of women (15-49 years) who received at least four antenatal visits 
with a skilled health professional during the most recent pregnancy that resulted in a live birth in the past 
five last years.
Denominator: sample-weighted number of women (15-49 years) who had a live birth in the past five years.
Prenatal visits are a great opportunity to raise awareness and strengthen women's reproductive freedoms. 
In addition to medical monitoring of pregnancy and promotion of infant feeding, these visits are 
opportunities to offer contraceptive methods to women.
Table 14: Proportion of women aged 15 to 49 who made at least one antenatal visit 
during their last pregnancy
Antenatal consultations during the last 
pregnancy
Maradi
n=781
Tillabéri
n=563
Zinder
n=475
Total
n=1819
Yes 93.5% 93.5% 91.2% 92.7%
No 6.5% 6.5% 8.8% 7.3%
Total 100.0 100.0 100.0 100.0
The results in Table 14 show that 9 out of 10 women made at least one prenatal visit during their last 
pregnancies, in the three regions. No significant regional disparities were observed.
As for the analysis of the number of prenatal visits conducted, the results of the survey (Table 15) show that 
5 out of 10 women made four or more prenatal visits during their last pregnancies in the regions of Maradi, 
Tillabéri and Zinder.
Table 15: Proportion (%) of women aged 15 to 49 having attended 4 ANC or more 
during the last pregnancy
Number of ANC Maradi
n=781
Tillabéri
n=563
Zinder
n=475
Total
n=1819
4 ANC and more 55.4% 52.1% 49.6% 52.6%
Less than 4 ANC 44.6% 46.0% 48.8% 46.4%
No response 0.0% 1.9% 1.6% 1.0%
Total 100.0 100.0 100.0 100.0
Full monitoring of the pregnancy is a guarantee for a safe motherhood, but this follow-up must be provided 
by qualified personnel (doctor, nurse, midwife) for better care of the pregnant woman.
3.3.3 Prenatal consultations by a health professional
Data on prenatal consultations were collected during the facility assessment, at facility level. This might be 
the reason why most women were counseled by a qualified health professional. Data analysis shows that 
most prenatal consultations for women of reproductive age are provided by qualified personnel, i.e., 
Baseline Report – USAID Kulawa Project 31
personnel with the knowledge and skills necessary to assist the woman during pregnancy and capable of 
provide effective care for both mother and child after birth.
Table 16: Proportion of women whose antenatal consultations were provided by a 
qualified health professional
Antenatal consultations by a qualified 
health professional
Maradi
n=781
Tillabéri
n=563
Zinder
n=475
Total
n=1819
Yes 93.5% 93.0% 89.4% 92.1%
No 6.5% 6.3% 10.6% 7.9%
Total 100.00 100.00 100.0 100.0
The results in Table 16 show that 9 out of 10 consultations are carried out by a Doctor, a Nurse or a 
Midwife.
3.4 Gender-based violence (GEM scale)
3.4.1 Population opinion on violence against women
The indicator is the proportion of people who consider wife beating an acceptable way for a husband to 
discipline her for any reason. The "target population" reflects a group intended to benefit from domestic 
violence messages. Based on the WHO checklist found in the study on women's health and intimate partner 
violence against women, evaluators can ask: 
Sometimes a husband is annoyed or irritated by the things his wife is doing. In your opinion, would a 
husband be justified in hitting or beating his wife:
 If she is unfaithful?
 If she disobeys her husband?
 If she argues with her husband?
 If she refuses to have sex with him?
 If she doesn't clean the house properly?
Numerator: Sample-weighted number of respondents who answered “yes” to any of the questions related 
to what justifies the wife being beaten by her husband, as indicated above.
Denominator: Sample-weighted total number of respondents.
Table 17: Proportion of the target population stating that hitting or beating a wife 
would be justified
Baseline Report – USAID Kulawa Project 32
Justification for 
hitting or beating 
wife
Maradi 
Women (n=1011)
Men (n=819)
Tillabéri
Women (n=920)
Men (n=549)
Zinder
Women (n=709)
Men (n=669)
Total
Women (n=2640)
Men (n=2037)
Men 
(15-54 
years)
Yes 27.0% 43.3% 29.9% 31.1%
No 73.0% 56.7% 70.1% 68.9% 
Total 100.0 100.0 100.0 100.0 
Women 
(15-49 
years)
Yes 76.3% 85.1% 86.4% 82.1%
No 23.7% 14.9% 13.6% 17.9% 
Total 100.0 100.0 100.0 100.0 
Total
Yes 54.6% 69.2% 60.6% 60.0 %
No 45.4% 30.8% 39.4% 40.0 %
Total 100.0 100.0 100.0 100.0 
The results show that women approve of hitting or beating a wife more than men. It appears that 82.1% of 
women maintain that it would be justified to hit or beat a wife against 31.1% of men.
Analyses by region show that men in Tillabéri (43.3%) are far more likely to approve of hitting or beating 
their wives than men in Maradi and Zinder, 27.0% and 29.9%, respectively. On the other hand, women in 
Zinder (86.4%) approve of this more than those in Maradi and Tillabéri (76.3%, 85.1%).
Table 18: Proportions of target population stating that hitting or beating a wife would 
be justified, by type of question
 Maradi Tillabéri Zinder Total Maradi Tillabéri Zinder Total
Women Men
 • If she's unfaithful?
Yes 50,1% 78,7% 78,4% 67,7% 20.3% 34.2% 19.6% 23.8%
No 44,1% 17,8% 17,6% 27,8% 73.0% 48.5% 69.2% 65.1%
Undecided 5,8% 3,5% 4,0% 4,5% 6.7% 17.3% 11.2% 11.1%
Total 100,0 100,0 100,0 100,0 100.0 100.0 100.0 100.0
 • If she disobeys her husband?
Yes 48,3% 58,4% 55,4% 53,7% 17.1% 29.3% 12.3% 18.8%
No 46,3% 33,8% 39,6% 40,2% 76.6% 54.3% 73.4% 69.5%
Undecided 5,4% 7,8% 4,9% 6,1% 6.4% 16.4% 14.4% 11.7%
Total 100,0 100,0 100,0 100,0 100.0 100.0 100.0 100.0
 • If she quarrels with her husband?
Yes 36,6% 45,0% 25,7% 36,6% 12.8% 23.3% 11.1% 15.1%
No 57,8% 40,3% 70,8% 55,2% 79.1% 61.6% 77.1% 73.7%
Baseline Report – USAID Kulawa Project 33
 Maradi Tillabéri Zinder Total Maradi Tillabéri Zinder Total
 Women Men
Undecided 5,6% 14,7% 3,5% 8,2% 8.1% 15.1% 11.8% 11.2%
Total 100,0 100,0 100,0 100,0 100.0 100.0 100.0 100.0
 • If she refuses to have sex with him?
Yes 38,7% 60,1% 34,4% 45,0% 12.9% 21.9% 22.7% 18.6%
No 55,0% 30,7% 57,4% 47,2% 75.7% 57.9% 70.0% 69.0%
Undecided 6,3% 9,2% 8,2% 7,8% 11.4% 20.2% 7.3% 12.4%
Total 100,0 100,0 100,0 100,0 100.0 100.0 100.0 100.0
 • If she doesn't do the housework properly?
Yes 30,0% 40,0% 41,8% 36,6% 7.0% 17.9% 9.1% 10.6%
No 65,5% 50,4% 53,6% 57,1% 83.8% 67.9% 77.1% 77.3%
Undecided 4,6% 9,6% 4,7% 6,3% 9.3% 14.2% 13.8% 12.1%
Total 100,0 100,0 100,0 100,0 100.0 100.0 100.0 100.0
3.4.2 Gender Equitable Men (GEM) Scale
The indicator is the percentage of the target population with at least a moderate equity score on the GEM 
scale. This index measures attitudes towards gender norms for intimate relationships or different social 
expectations for men and women, using the Gender Equitable Men (GEM) scale.
Numerator: The number of sample-weighted target people who score moderate or high on the GEM scale.
Denominator: the number of target people interviewed.
The GEM scale calculation procedures are detailed in Annex 8.
Scoring procedures:
Each of the above items is rated on a 3-point scale, where 1 = agree, 2 = partially agree, and 3 = disagree. 
The answers to each item should be added together according to the point value assigned to the answer. 
The total point value for the GEM scale ranges from 24 to 72. Each score results in a low equity score (24-39 
points); moderate (40-56 points); and high (57-72 points).
Table 19 presents the results of the index according to the percentage of men and women ranked low, 
medium, and high in terms of overall acceptance of more equitable norms. The GEM scale was constructed 
from responses from the following four sub-themes: violence domain, sexual relations domain, reproductive 
health and disease prevention domain, and domestic chores, and everyday life domain.
The GEM scale analysis results show that 5.8% of men and 2.9% of women strongly support equitable 
gender norms. By region, men from Zinder (8.7%) and Tillabéri (6.5%) approve of fair gender norms more 
Baseline Report – USAID Kulawa Project 34
than those from Maradi (2.4%). Among women, Tillabéri records the highest rate of high equity (12.0%) 
against very low rates of high equity in Maradi (0.1%) and Zinder (0.3%).
Table 19: Target population proportion who support equitable gender norms
GEM scale Maradi Tillabéri Zinder Total
Men
Low equity 25.8% 39.6% 21.5% 26.5%
Moderate equity 71.8% 53.9% 69.8% 67.7%
High equity 2.4% 6.5% 8.7% 5.8%
Total 100.0 100.0 100.0 100.0
Women
Low equity 68.8% 65.1% 56.1% 63.1%
Moderate equity 31.1% 22.9% 43.7% 34.0%
High equity 0.1% 12.0% 0.2% 2.9%
Total 100.0 100.0 100.0 100.0
Total
Low equity 49.8% 55.4% 40.3% 47.2%
Moderate equity 49.1% 34.7% 55.6% 48.7 %
High equity 1.1% 9.9% 4.1% 4.1%
Total 100.0 100.0 100.0 100.0
It should be noted that, in all regions, men scored higher on the GEM scale than women. 
3.5 Vaccination of children by 12 months
The indicator is the percentage of children who are completely vaccinated by 12 months (one dose of BCG 
vaccine, three doses of poliomyelitis vaccine, three doses of DPT3 vaccine and one dose of measles vaccine).
Numerator: number of surveyed children (aged 12-23 months) who received 1*BCG, 3*DTP3 and 1* 
measles vaccines by 12 months and have appropriate documentation.
Denominator: Total number of surveyed children (aged 12-23 months) with vaccination card. 
Only children whose vaccination card was seen by the data collection agent were included in the 
denominator and among these children only those who are fully vaccinated were identified. It should also 
be noted that children whose vaccination dates are not reported on the cards were not considered in the 
numerator.
Vaccination is recognized as one of the most effective measures to prevent mortality, morbidity, and 
complications from infectious diseases in children. According to USAID's performance indicator, a child is 
considered fully immunized when it has received one BCG vaccine, three doses of DTP3 vaccine and one 
dose of measles vaccine. During the survey, the information collected on the vaccination of children aged 
12-23 months comes from two complementary sources: vaccination records and/or cards (which makes it 
Baseline Report – USAID Kulawa Project 35
possible to accurately establish vaccination completeness, as well as the compliance with the vaccination 
schedule), and the mother's declaration, based on the answers given when no vaccination document for the 
child was available.
Table 20: Proportion of children aged 12-23 months according to vaccination card 
availability
Vaccination card availability Maradi
n=576
Tillabéri
n=641
Zinder
n=579
Total
n=1796
Vaccination card
Yes, verified 52.2% 33.1% 39.1% 43.1%
Yes, not verified 37.5% 51.5% 43.7% 42.9%
No record 10.3% 15.4% 17.2% 14.0%
Total 100.0 100.0 100.0 100.0
The analyses of vaccination cards availability show that the cards of 43.1% of the children were seen by the 
data collection agents in all the regions of the study. The availability of the cards is highest in Maradi 
(52.2%), followed by Zinder (39.1%). In Tillabéri, vaccination records were scarcely available (31.1%).
The results also show that 14.0% of children do not have a vaccination card. Zinder records the highest rate 
of children without vaccination cards (17.2%) and Maradi has the lowest rate (10.3%).
Table 21: Proportion of children aged 12-23 months completely vaccinated by 12 
months of age (children with cards verified)
Vaccination card availability Maradi
n=79
Tillabéri
n=67
Zinder
n=78
Total
n=224
Completely vaccinated
No 42.8% 71.3% 53.8% 51.2%
Yes 57.2% 28.7% 46.2% 48.8%
Total 100.0 100.0 100.0 100.0
The results of the study show that 48.8% of children aged 12 to 23 months are fully vaccinated in the three 
regions of the study. The vaccination rate is higher in Maradi (57.2%), followed by Zinder (46.2%). The 
Tillabéri region has the lowest vaccination rate (28.7%).
3.6 Service provision
3.6.1 Attitude of providers towards adolescents
The indicator is the percentage of providers with positive attitudes towards youth/adolescents using FP 
and other health services. This index measures health providers' attitudes toward adolescents (15-19 
years) and youth (20-24 years) using family planning and other adolescent sexual and reproductive health 
services (ASRH).
Baseline Report – USAID Kulawa Project 36
Numerator: Number of providers who express positive attitudes towards youth/adolescents using FP and 
other health services
Denominator: number of providers studied during the USAID Kulawa assessment
The procedures for calculating provider attitude towards adolescent indicators are detailed in Annex 9.
Literature demonstrates that the unwelcoming behaviors and judgmental attitudes of health workers are 
real obstacles to the use (and/or continuity) of health services, particularly among adolescents. Adolescent 
embarrassment or embarrassment discussing sensitive topics with health providers, less supportive 
provider attitudes toward FP use, and disappointment with how health providers ask questions, uncertainty 
about what providers do with the information, and being treated disrespectfully, and even being refused 
service by their health providers are often cited as discouraging. Health providers are sometimes 
uncomfortable with topics or mistakenly believe that providing age-appropriate reproductive health 
information will encourage sexual activity.
Table 22: Proportion of providers with a positive attitude towards the use of FP and 
its services by adolescents
Service provider attitude Maradi
n=401
Tillabéri
n=269
Zinder
n=505
Total
n=1175
Positive 35.7% 33.8% 46.5% 39.4%
Negative 64.3% 66.2% 53.5% 60.6%
Total 100.0 100.0 100.0 100.0
Our analyses (see Table 22) reveal that 39.4% of service providers in the study area say they have a positive 
attitude towards family planning. Service providers in Zinder seem more favorable than those of Maradi 
(35.7%) and Tillabéri (33.8%).
3.6.2 Health facilities with at least one service provider trained to care for and refer 
victims of sexual and gender-based violence (SGBV)
The indicator is the percentage of health facilities in the geographic area of study (e.g., country, region, 
community) with at least one provider who has been trained in the last three years in the identification, care 
and support of sexual gender-based violence (SGBV). This indicator is measured at DH, MCHC and CSI
level, where USAID Kulawa-supported SGBV training takes place. CS level establishments are not included.
This indicator is calculated as follows:
(Number of health facilities reporting having at least one provider who has been trained in the last 
three years for the clinical management of victims of SGBV/Total number of health facilities 
surveyed) x 100.
Baseline Report – USAID Kulawa Project 37
The results show that 53.3% of units have at least one service provider trained to deal with SGBV. Maradi 
(61.2%) and Tillabéri (58.5%) seem to have more health units with at least one service provider trained to 
manage SGBV than Zinder (43.5%).
Table 23: Percentage of health facilities with at least one service provider trained to 
manage and refer SGBV
SGBV health facilities Maradi Tillabéri Zinder Total
Yes 61.2% 58.5% 43.5% 53.3% 
No 38.8% 41.5% 56.5% 46.7%
Total 100.0 100.0 100.0 100.0 
3.6.3 Delivery in a health facility and discharge with a modern contraceptive method
According to the results, 28.0% of women who gave birth in a facility started or left with a modern 
contraceptive method before discharge. Women from Tillabéri (37.0%) and Zinder (28.0%) seem to benefit 
from this advantage more than those from Maradi (23.0%).
Table 24: Percentage of women who give birth in a facility and who initiated or left 
with a modern contraceptive method before discharge
FP before discharge Maradi
n=32 197
Tillabéri
n=14 132
Zinder
n=38 599
Total
n=84 928
Yes 23.0% 37.0% 28.0% 28.0%
No 77.0% 63.0% 72.0% 72.0%
Total 100.0 100.0 100.0 100.0
3.6.4 Delivery in a facility and counseling on post-partum family planning (PPFP) use 
before discharge
The analyses show that in the study area more than 3 women out of 5 (70.0%) who give birth in a facility 
receive advice on family planning before leaving.
The regions of Zinder (73.0%) and Tillabéri (87.0%) have more women receiving advice on family planning 
before discharge than in the Maradi region (59.0%).
Table 15: Percentage of women who give birth in a facility and received counseling on 
post-partum family planning before discharge
Advice before discharge Maradi
n=32 197
Tillabéri
n=14 132
Zinder
n=38 599
Total
=84 928
Yes 59.0% 87.0% 73.0% 70.0%
No 41.0% 13.0% 27.0% 30.0%
Total 100.0 100.0 100.0 100.0
Baseline Report – USAID Kulawa Project 38
3.6.5 Newborns and postnatal care
Table 26: Number of newborns who receive postnatal care within two days of delivery 
in USG-supported programs
Maradi Tillabéri Zinder Total
Number of newborns receiving postnatal care 
within 48 days of delivery (September 2021 to 
August 2022)
15,473 6,654 31,090 53,217
Number of newborns receiving postnatal care 
within 48 days of delivery extrapolated to the 
USAID Kulawa zone*
37,844 58,146 158,437 254,427
* The results obtained from the sample were extrapolated to the entire population of the Kulawa zone by taking into account
the proportion of the newborns that received postnatal care within 48 days compared to the total number of newborns 
recorded in the sampled population; and that proportion was then applied to the entire population of newborns of the 3 
regions.
3.6.6 Service availability indicators
The indicator is the Service Availability Index which measures three tracer indicator areas: health 
infrastructure, health workforce and service utilization, using an unweighted average (see Annex 10 for 
calculation procedures). Studies show that barriers to health care utilization on the demand side exist but 
have less impact when health care services are available and accessible. This is why Niger and its partners 
are increasing their investments in health systems and ensuring that women and girls have access to health 
services. This study sought to assess the level of service availability in project areas. The general service 
availability index is a composite score of indicators calculated from three domains: health infrastructure, 
health personnel and use of services. The health infrastructure score is a composite score that includes 
three domains: facility density per 10,000 population, inpatient bed density per 10,000 population, and 
maternity bed density per 10,000 population. The service utilization score is a composite of two domains: 
outpatient visits and hospital utilization.
Table 27: Service availability indices
Indices (%) Maradi Tillabéri Zinder Total
Health Services Infrastructure Index 28.5 25.8 25.9 26.8
Health workforce index 6.8 4.1 4.6 5.3
Service utilization index 13.8 29.2 29.5 24.0
Service Availability Index 16.4 19.7 20.0 18.7
The results of the study (see Table 27) show that the overall service availability score in the USAID Kulawa 
project areas is 18.7%, indicating very low potential availability of health services. Indeed, the indices of 
infrastructure, health personnel and use of services amount to 26.8, 5.3 and 24.0 respectively against an 
Baseline Report – USAID Kulawa Project 39
expected normal value of 100. These low scores can be attributed to poor scores in the following 
subdomains:
The density of one (1) health structure per 10,000 inhabitants is well below the target value of two (2) 
health structures per 10,000 inhabitants.
The inpatient bed density of 7.4 beds is much lower than the target value of 25 beds per 10,000 inhabitants.
The density of 2.2 maternity beds per 10,000 pregnant women is also well below the target value of 10 beds 
per 10,000 pregnant women.
The health professional workforce index of 5.3 agents per 10,000 inhabitants is almost four times lower 
than the WHO target of 23 agents per 10,000 inhabitants.
The hospital utilization score is 4.6 admissions against a norm of 10 admissions per 100 inhabitants.
Analyses by region show that health services are more available in Zinder (20.0) and Tillabéri (19.7) than in 
Maradi (16.4). Indeed, the differences are due to low use of services in the Maradi region with a score of 
13.8 against 29 in Tillabéri and Zinder. It should be noted that Maradi records the highest index of health 
services infrastructure.
Since the USAID Kulawa project does not build structures, provide beds, or hire staff, project activities are 
unlikely to affect performance on this indicator.
Baseline Report – USAID Kulawa Project 40
CONCLUSION 
This baseline survey measured the baseline indicators of the USAID Kulawa project, specifically highlighting 
levels of knowledge, use, and attitudes about FP; recent fertility and prenatal care; gender-based violence 
(GEM scale); vaccination of children aged 12-23 months; and health service availability indicators. The basic 
picture of contraceptive demand and unmet need for family planning indicates that in addition to improving 
the supply of RH/FP, the USAID Kulawa project must also work to create demand. In a context of low 
contraceptive prevalence such as in Niger, the low levels of unmet need for FP would express more a 
weakness of the demand than a performance of the supply or the accessibility of RH/FP products and 
services. In summary, the project main indicators are as follows:
Low knowledge of FP and other health services: 52.1% of women and 3.7% of men demonstrated 
having a broad knowledge of modern contraceptive methods and other health services. Two things 
contribute to low knowledge of contraceptive methods: low knowledge of when a woman is most 
likely to become pregnant and the myth that if a woman has already used birth control, it is more 
difficult for her to get pregnant later. Efforts are still needed to respond to these findings in order to 
increase the knowledge of the project areas’ population on contraceptive methods.
Low modern contraceptive prevalence: 12.0% of women surveyed currently use a modern 
contraceptive method in the project area. Project activities should focus efforts on improving 
contraceptive use.
Positive attitudes towards family planning: in all the study regions, 8 out of 10 women aged 15 to 
49 (83.9%), and more than 3 out of 4 men (90.1%), have a positive attitude towards family planning. 
A positive attitude reflects positive beliefs, experiences, or emotions with regards to family 
planning.
High adolescent fertility: the rate of 278 live births per 1,000 adolescent girls now aged 20-24 is 
still high in the project area. Considering the direct links between maternal mortality and early 
fertility, efforts are needed to raise the age at first pregnancy among adolescent girls in the project 
intervention areas.
Low prevalence of prenatal consultations: 5 out of 10 women (52.6%) made at least 4 prenatal 
visits during their last pregnancies. Complete monitoring of pregnancy being the guarantee of safe 
motherhood, efforts are still necessary so that all pregnant women can benefit from a minimum 
number of prenatal consultations by qualified personnel (doctor, nurse, midwife, qualified midwife).
Low level of gender equity approval (GEM scale): 5.8% of men and 2.9% of women strongly support 
equitable gender norms. Men approve of gender equity more than women. More effort and 
Baseline Report – USAID Kulawa Project 41
commitment are expected from the USAID Kulawa project to improve indicators in the areas of 
violence, sexual relations, reproductive health, disease prevention, domestic chores and daily life.
Low achievement of child vaccination: 48.8% of children aged 12 to 23 months are fully vaccinated 
in the study regions. Conversely, 51.2% of children did not receive all the required vaccines. Efforts 
must be made by USAID Kulawa so that all children can benefit from this series of vaccinations in 
accordance with WHO recommendations, against the main vaccine-preventable diseases.
Very low health service availability score: the overall service availability score in the project areas 
of 18.7% indicates very low potential access to health services. Indeed, the indices of infrastructure, 
health personnel, and use of services amount to 26.8, 5.3 and 24.0 respectively against an expected 
normal value of 100. Efforts are still needed to improve the ratios of health facility per inhabitant; 
hospital beds per inhabitant; maternity beds per pregnant women and the ratios of health 
professionals per inhabitant.
Low contraceptive demand: nearly 20% of the women questioned would like to delay or stop 
future pregnancies. Women generally do not seem interested in limiting pregnancies and are 
generally not interested in spacing them. As knowledge of FP is low particularly among men, work 
could be directed to promote healthy timing and spacing of pregnancies, delaying the first 
pregnancy, and appropriately spacing of the subsequent ones. A key element in this regard is to 
improve knowledge about the health benefits of well-timed and spaced pregnancies, as well as 
knowledge about different FP method options to support this, including the promotion of more 
effective methods (such as the IUD and implants, which have higher protection rates and are less 
prone to misuse, such as method failure or gaps in coverage), and knowledge of how to stop use 
these methods when a woman wants to get pregnant again. Men will be very important actors in 
targeting the SBC interventions to support the delay of first pregnancies and the spacing of 
subsequent births.
Baseline Report – USAID Kulawa Project 42
ANNEXES
Annex 1: Health infrastructure sampled
Table 28: Health infrastructure
Maradi Tillabéri Zinder Total
a) Structures
Number of district hospitals 4 3 5 12
Number of Mother and Child Health Centers 1 1 1 3
Number of CSIs 27 29 27 83
Number of CSs 18 6 24 48
Total number of health structures 50 39 57 146
Total number of health structures 314 169 391 874
Population in 2022 in the USAID Kulawa zone 2,973,426 1,838,518 3,805,437 8,617,381
Number of structures per 10,000 inhabitants 1,1 0,9 1,0 1,0
Target value 2,0 2,0 2,0 2,0
Score 52.8 46.0 51.4 50.7
b) Hospital beds
Number of hospital beds 635 290 667 1592
Number of hospital beds per 10,000 inhabitants 2.1 1.6 1.8 1.8
Target value 25.0 25.0 25.0 25.0
Score 8.5 6.3 7.0 7.4
c) Maternity beds
Number of maternity beds 156 100 157 413
Population of women aged 15-49 in 2022 in the 
USAID Kulawa zone
644,311 396,441 813,783 1,854,535
Number of maternity beds per 10,000 women 2.4 2.5 1.9 2.2
Target value 10.0 10.0 10.0 10.0
Score 24.2 25.2 19.3 22.3
Baseline Report – USAID Kulawa Project 43
Annex 2: Health personnel and use of services in the facility surveyed
Table 29: Health personnel
Health staff Maradi Tillabéri Zinder Total
a) Main health professionals
Main health professionals 467 175 404 1046
Main health professionals per 10.000 inhabitants 1.6 1.0 1.1 1.2
Target value 23.0 23.0 23.0 23.0
Score 6.8 4.1 4.6 5.3
Use of services
b) Use
Outpatient consultations per year 222 454 181 256 402 956 806 666
Outpatient consultations per person/year 0.1 0.1 0.1 0.1
Target value 5.0 5.0 5.0 5.0
Score 1.5 2.0 2.1 1.9
c) Utilization
Number of hospital discharges/year 77 903 103 855 216 310 398 068
Hospital discharges per 100/year 2.6 5.6 5.7 4.6
Target value 10.0 10.0 10.0 10.0
Score 26.2 56.5 56.8 46.2
Baseline Report – USAID Kulawa Project 44
Annex 3: USAID Kulawa zone demographics
Table 30: USAID Kulawa zone demographics
Region Districts Total 
population
12-23 
months
PLW 15-49 
years
10-24 
years
Maradi
Aguié 352 248 27 980 76 329 117 190
Dakoro 902 716 71 704 195 610 300 327
Gazaoua 229 876 18 259 49 812 76 478
Guidan Roumdji 749 924 59 568 162 501 249 494
Tessaoua 738 662 58 673 160 061 245 748
Tillabéri
Balleyara 153 613 12 202 33 124 51 106
Filingué 439 795 34 934 94 834 146 317
Kollo 667 306 53 005 143 892 222 008
Say 251 818 20 002 54 300 83 778
Tillabéry 325 986 25 894 70 293 108 453
Zinder
Damagaram Takaya 345 788 27 467 73 946 115 041
Dungass 507 374 40 302 108 501 168 800
Gouré 470 025 37 335 100 514 156 374
Kantché (Matameye) 572 345 45 462 122 395 190 415
Magaria 828 367 65 799 177 145 275 592
Mirriah 727 651 57 799 155 607 242 084
Takeita 353 887 28 110 75 678 117 736
Total USAID Kulawa 8 617 381 684 495 1 854 542 2 866 941
Source: INS Niger, 2017 (https://www.stat-niger.org/projections) 
Baseline Report – USAID Kulawa Project 45
Annex 4: Key primary indicators
Table 31: Key primary indicators
Performance indicator Data collection method
1. Modern contraceptive method prevalence rate Household survey
2. Teenage birth rate Household survey
3. Service Availability Index Structural assessment
4. Percentage of children 12-23 months fully immunized Household survey
5. Percentage of health units with at least one service provider 
trained to manage and refer SGBV
Structural assessment
6. Percentage of adolescent girls and young women whose family 
planning needs are met with modern methods
Household survey
7. Number of newborns receiving postnatal care within two days of 
delivery in USG-supported programs
Structural assessment
8. Percentage of women who had four or more antenatal visits 
during last pregnancy Household survey
9. Percentage of target population with at least moderate equity 
score on the Gender Equity Men (GEM) scale Household survey
10. Percentage of providers with positive attitudes toward FP use, 
youth/adolescents using FP and other services
Structural assessment
11. Percentage of target population with better knowledge of 
FP/other health services
Household survey
12. Percentage of target population with positive attitudes towards 
FP 
Household survey
13. Percentage of audience who recall hearing or seeing a specific 
USG-supported family planning/reproductive health (FP/RH) 
message 
Household survey
14. Percentage of women who give birth in a facility and start or leave 
with a modern contraceptive method before discharge
Structural assessment
15. Percentage of women who deliver in a facility and receive pre￾discharge family planning counseling
Structural assessment
Baseline Report – USAID Kulawa Project 46
Annex 5: List of sites 
Table 32: List of sites
No Region Communes District CSI CS Villages
1 Maradi Aguié Aguié Guidan Dawaye Dan Dawa
2 Maradi Aguié Aguié Aguié Gamji sabou
3 Maradi Aguié Aguié Débi Hardo habou
4 Maradi Aguié Aguié Maiguizawa 
Kagnou Karoubni
5 Maradi Aguié Aguié Nakikarfi Nakikarfi Roubabia Peulh
6 Maradi Tchadoua Aguié Gawaro Gawaro Chantali Peulh
7 Maradi Tchadoua Aguié Danbouzou Danbouzou Guicki
8 Maradi Tchadoua Aguié Magami Magami
9 Maradi Dakoro Dakoro Kornaka Dalla
10 Maradi Dakoro Dakoro Sabon Machi Maza Tsaye
11 Maradi G. Roumdji G. Roumdji Guidan Roumdji Bagouari garin
12 Maradi G. Roumdji G. Roumdji Kouroungousao Cpt mai karfi
13 Maradi G. Roumdji G. Roumdji Guidan Roumdji Dan madatchi
14 Maradi G. Roumdji G. Roumdji Dargue Doumana ara
15 Maradi G. Roumdji G. Roumdji Guidan Roumdji Garin bagouari
16 Maradi G. Roumdji G. Roumdji Dan Tourke Garin magagi
17 Maradi G. Roumdji G. Roumdji Tiadi Dan zeina Goulougoutchi
18 Maradi G. Roumdji G. Roumdji Kouroungousao Maikarhi Guidant amani
19 Maradi G. Roumdji G. Roumdji Dan Tourke Kalangawa
20 Maradi G. Roumdji G. Roumdji Chadakori Kemro sofoua
21 Maradi G. Roumdji G. Roumdji Halbaoua Koumkoussoum
22 Maradi G. Roumdji G. Roumdji Nwala Mairigua sofoua
23 Maradi G. Roumdji G. Roumdji Chadakori Guidan tawaye
N'wala serkin toudou 
+cpt
24 Maradi G. Roumdji G. Roumdji Sae Saboua Mallumai saboua Sae saboua
25 Maradi G. Roumdji G. Roumdji Tibiri Sourra sarkin galma
26 Maradi G. Roumdji G. Roumdji Guidan Roumdji Toda peulh
27 Maradi G. Roumdji G. Roumdji Dargue Yakaou
28 Maradi G. Roumdji G. Roumdji Karazome Zongon-samaila
29 Maradi Gangara Gazaoua Dan Kolio Birnin kouka Guidan Kajé
30 Maradi Gangara Gazaoua Malam Dawey Malan dawey Malan dawey
31 Maradi Gazaoua Gazaoua Birnin Guéza Assaya Assaya 
32 Maradi Gazaoua Gazaoua Bougouzaoua Bougouzaoua El Gahia
33 Maradi Gazaoua Gazaoua Birnin Guéza Birnin guéza Hardo Issa 
34 Maradi Gazaoua Gazaoua Birnin Guéza Birnin guéza Mayaki
Baseline Report – USAID Kulawa Project 47
No Region Communes District CSI CS Villages
35 Maradi Gazaoua Gazaoua Bougouzaoua Yadagamou Yadagamou
36 Maradi Baoudeta Tessaoua Baoudeta Sarba Totsa
37 Maradi Hawan Dawki Tessaoua Hawan Dawki Tchola Toumboudouhou
38 Maradi Korgom Tessaoua Korgom Dadin sarki Dadin Sarki
39 Maradi Korgom Tessaoua Romaza Koufai Koufai
40 Maradi Tessaoua Tessaoua Gounaka Kalgo El Dawa Haoussa
41 Tillaberi Taghazar Ballayara Kossey Syrsani 
42 Tillaberi Taghazar Ballayara Csi urbain Mbama2
43 Tillaberi Taghazar Ballayara Tabla Syrsani 1 
44 Tillaberi Taghazar Ballayara Kabe Zamtourey
45 Tillaberi Taghazar Ballayara Tabla Gohinjo 2
46 Tillaberi Filingué Filingué Filingue Badebayé
47 Tillaberi Filingué Filingué Bakin toullou Bakin Toulou 2
48 Tillaberi Filingué Filingué Sabon gari Tidiba Tidiba
49 Tillaberi Fourfeye 
centre
Filingué Itchiguine Kouka 2
50 Tillaberi Imanane Filingué Bonkoukou Touwila
51 Tillaberi Imanane Filingué Diguina Gao Aljanna
52 Tillaberi Tondi Kandia Filingué Tibewa Deytagui Koura Koira
53 Tillaberi Tondi Kandia Filingué Attologa Naguizé
54 Tillaberi Tondi Kandia Filingué Damana Sourgo koara
55 Tillaberi Dantchandou Kollo Banizoumbou Carre
56 Tillaberi Dantchandou Kollo Dantchandou Falanga
57 Tillaberi Hamdoullaye Kollo Fataboki Fataboki peulh
58 Tillaberi Hamdoullaye Kollo Kollo djogono Kirou foudou beri
59 Tillaberi Karma Kollo Karma Moulkou2
60 Tillaberi Karma Kollo Goube Tondikokou
61 Tillaberi Kirtachi Kollo Babangata Tondifou Tondifou
62 Tillaberi Kirtachi Kollo Sounga Sounga peulh(ga 
kaina)
63 Tillaberi Kollo Kollo Sakey koirazeno Daitegui zarma
64 Tillaberi Kouré Kollo Boula gandatche Boula koira tegui
65 Tillaberi Liboré Kollo Sorey bene Sorey ganda
66 Tillaberi Namaro Kollo Larba touloumbo Koutoume bigaré
67 Tillaberi Namaro Kollo Larba touloumbo Koya
68 Tillaberi N'Dounga Kollo N'dounga Fondobon
69 Tillaberi Youri Kollo Youri Bouériré
70 Tillaberi Gueladjo Say T foulbe Gassangari
71 Tillaberi Say Say Tientiargou Seino Koba
72 Tillaberi Say Say Ganki bassarou Finaré Finaré
Baseline Report – USAID Kulawa Project 48
No Region Communes District CSI CS Villages
73 Tillaberi Tamou Say Django Ouro baba
74 Tillaberi Tamou Say Django Bogga
75 Tillaberi Anzourou Tillabery Kofouno Doukou koira tegui
76 Tillaberi DESSA Tillabery Kandadji Kandadji
77 Tillaberi DESSA Tillabery Famale Haoussa guabo
78 Tillaberi Kouthèye Tillabery Assani Kassani goungo
79 Tillaberi Kouthèye Tillabery Syrsane haoussa Kobague
80 Tillaberi Sakoira Tillabery Diambala Kalangou
81 Zinder Droum DS de Mirriah Gogo GARIN KALLKO
82 Zinder Dakoussa DS de Takieta Zangon Dachi Dan Jigawa 2
83 Zinder Garagoumsa DS de Takieta Gaouna Aroungouza Aloulouba2
84 Zinder Garagoumsa DS de Takieta Gaouna Tarami
85 Zinder Tirmini DS de Takieta Magrami Gafai
86 Zinder Tirmini DS de Takieta Magrami Rouan Kouka Magna oukou 1
87 Zinder Dogo Dogo DS Dungass Dina Fokouni
88 Zinder Dungass DS Dungass Dungass Dan Gora
89 Zinder Goushi DS Dungass Baboujé Majéwa Tataré BOUZALI 
90 Zinder Goushi DS Dungass Goushi Yakaouda SAROU 
91 Zinder Mallaou DS Dungass Doungouzourou Dagangam
92 Zinder Mallaou DS Dungass Baraguini Walwa
93 Zinder Gouré DS Gouré Kargueri Dalari Dagradi
94 Zinder Gouré DS Gouré Kargueri Bassori Garin Gabass
95 Zinder Gouré DS Gouré
Gamdou 
Doumdoum Challagel Kangouri 2
96 Zinder Gouré DS Gouré Kargueri Mainari- Bouzou
97 Zinder Gouré DS Gouré Zagari Bouzounkaza Zangouna
98 Zinder Guidiguir DS Gouré Abari Guizibouk 1
99 Zinder Guidiguir DS Gouré FALAMA Tegogina
100 Zinder Bandé DS Magaria Kakitama Garin liman
101 Zinder Dan Tchiao DS Magaria Dan Tchiao Bangaya Garin Jimis
102 Zinder Magaria DS Magaria Tinkim Farayé Dadin Sarki 
103 Zinder Magaria DS Magaria Mai damoussa Satoumaoua Zoudi
104 Zinder Sasoumbroum DS Magaria Sasoumbroum Goungara Madja
105 Zinder Washa DS Magaria Gayi Illala Barma Illala Habou
106 Zinder Yekoua DS Magaria Jalgawassa Dounawa Guidan Dawa
107 Zinder Yekoua DS Magaria Jalgawassa Mai Killia
108 Zinder Chirnawa Est DS Matameye
Chirnawa 
Tagabass 
Marekou Intarnatsa
109 Zinder Dan Barto DS Matameye Dan Barto Zakarawa Tsaba Toulou 
110 Zinder Doungou DS Matameye Maiwando Baban Djibji Guidan Zagagoua
Baseline Report – USAID Kulawa Project 49
No Region Communes District CSI CS Villages
111 Zinder Kantché DS Matameye Dan Goudao Kourni Bandwa DOGWON DAWA 
112 Zinder Kourni DS Matameye Kourni Ragana Haoussa Inkitchissou sani
113 Zinder Mataméye DS Matameye Katofou Gomba Bougage 
114 Zinder Tsaouni DS Matameye Ban Nama Marké Bougagé Bagudawa
115 Zinder Tsaouni DS Matameye Ban Nama Zané Galadimawa
116 Zinder Yaouri DS Matameye Yaouri Garaké Wadigawa
117 Zinder Damagaram 
Ta Kaya
DS Ta Kaya Gueza Gueza bougaje
118 Zinder Damagaram 
Ta Kaya
DS Ta Kaya Gueza Chantier Garin 
Kori
Wawiram
119 Zinder Guidimouni DS Ta Kaya Guidimouni Guéguéri Garin Gouzou
120 Zinder Guidimouni DS Ta Kaya Chanya N'goul kokao Rimka
Baseline Report – USAID Kulawa Project 50
Annex 6: Data collection tools by indicator
Table 33: Data collection tools by indicator
Indicators Target population
1. Prevalence rate of modern methods of contraception Women 15-49 years
2. Adolescent birth rate Young women aged 20-24 years
3. % of children fully vaccinated by 12 months Children from 12 to 23 months
4. Percentage of adolescent girls and young women whose need 
for family planning is met by modern methods
Women 15-24 years
5. Percentage of target audience who say wife beating is an 
acceptable way for husbands to discipline their wives
Men (15-54 years); women of 
childbearing age (15-49 years).
6. Percentage of target population with at least a moderate equity 
score on the GEM scale.
Men (15-54 years); women of 
childbearing age (15-49 years).
7. Percentage of target population with improved knowledge of 
FP/other health services
Men (15-54 years); women of 
childbearing age (15-49 years).
8. Percentage of target populations with a positive attitude 
towards FP 
Men (15-54 years); women of 
childbearing age (15-49 years).
9. Percentage of audience who recall hearing or seeing a specific 
family planning/reproductive health (FP/RH) message 
supported by the USAID Kulawa program
Men (15-54 years); women of 
childbearing age (15-49 years).
10. Percentage of women who made 4 or more visits for ANC 
during her last pregnancy.
Women 15-49 years
11. Percentage of women who gave birth in a facility and who 
received advice on FP before discharge
Women 15-49 years
12. Percentage of women and men who experienced sexual 
violence in the past 12 months
Men (15-54 years); women of 
childbearing age (15-49 years).
13. Percentage of the population with a positive attitude to report 
cases of sexual violence
Men (15-54 years); women of 
childbearing age (15-49 years).
14. Proportion of population aware of local GBV committees. Men (15-54 years); women of 
childbearing age (15-49 years).
Baseline Report – USAID Kulawa Project 51
Annex 7: Calculations of indicators of need and demand for family 
planning
Percentage of women with a) unmet need for family planning, b) met need for family planning, c) total 
demand for family planning by spacing, limiting and total, and percentage of the demand for family planning 
that is satisfied.
Definition
Percentage of currently married women, all women and sexually active unmarried women with:
1. unmet need for family planning, (by limiting and spacing)
2. women whose need for family planning is satisfied (for limiting and spacing)
3. total demand for family planning whether for spacing, limiting and total (1+2)
4. Percentage of total demand for family planning that is satisfied with any method
5. Percentage of total demand for family planning satisfied by modern methods
Coverage:
Baseline population:
a) All women
b) Currently married
c) Sexually active unmarried women
Period: current situation at the time of the survey
Numerators:
1) Unmet need for contraception: Number of women who are not using a method of contraception 
and are:
a) For spacing (v626a = 1):
fertile and say they want to wait two or more years for their next birth;
fertile and do not know if they want another child;
fertile, wants another child, but does not know when to give birth;
pregnant and wanted an ongoing pregnancy later; Or
postpartum amenorrhea and last desired delivery later
b) To limiting (v626a = 2):
fertile and does not want any more children;
pregnant and did not want a current pregnancy; Or
postpartum amenorrhea and did not want the last delivery
c) Total unmet need: Number of women with an unmet need for family planning for spacing or limiting 
(v626a = 1 or v626a = 2)
Baseline Report – USAID Kulawa Project 52
2) Met need for contraception: number of women using a method of contraception and
a) For spacing (v626a = 3):
not considered limiting (see below)
b) To limit (v626a = 4):
don't want any more children;
are sterilized; Or
say they cannot get pregnant when asked about their desire to have future children
c) Total met need (v626a = 3 or v626a = 4): number of women with a met need for spacing or limiting
3) Total demand for contraception: Number of women with a met or unmet need:
a) For spacing (v626a = 1 or v626a = 3)
b) To limit (v626a = 2 or v626a = 4)
c) Total (v626a in 1, 2, 3, 4)
4) Demand satisfied: number of women using a contraceptive method (v626a dans 3.4)
5) Demand met by modern methods: Number of women using modern contraceptive methods 
including female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, 
female condom, emergency birth control, vaginal methods, breastfeeding amenorrhea method, or 
other modern methods (v313 = 3).
Denominators:
Indicators of unmet needs, met needs and total demand:
Number of
a) All women aged 15-49 years
b) Women currently married (v502 = 1)
c) Sexually active unmarried women – including women who are not currently married or in a 
consensual union (single, divorced, widowed and separated) and who had sex in the last 30 days 
(v502 ≠ 1 & v528 in 0: 30)
Demand satisfaction indicators:
Number of
a) All women aged 15-49 years
b) Women currently married (v502 = 1)
c) Sexually active unmarried women – including women who are not currently married or in a 
consensual union (single, divorced, widowed and separated) and who had sex in the last 30 days 
(v502 ≠ 1 & v528 in 0: 30) who have either an unmet need for family planning or a met need for 
family planning (v626a in 1, 2, 3, 4)
v626a Unmet need for contraception (Definition 3)
v313 Current usage by method type
v502 Currently/formerly/never in union
v528 Time elapsed since last sexual intercourse (in days)
v005 Female individual sample weight
Baseline Report – USAID Kulawa Project 53
Indicators of unmet, met needs and total demand:
Numerator divided by the denominator, multiplied by 100.
The calculation of the numerators for the indicators of met and unmet need first considers the 
contraceptive status. Women who use contraception are considered to have a met need for FP.
For women not using contraception, determining the need for family planning involves several additional 
steps. Non-users are separated into those who are currently married and those who are not married but are 
sexually active. An unmarried woman is considered to be sexually active if the woman has had sexual 
intercourse in the 30 days preceding the survey. Unmarried women who are not sexually active are 
considered not at risk of pregnancy and therefore do not need family planning.
To assign need status to married, sexually active single non-users, these women are separated into two 
groups: (1) those who are pregnant or postpartum amenorrhea and (2) those who are not pregnant or 
postpartum. Women are considered postpartum amenorrheic if their period has not returned since their 
last live birth during the two-year period preceding the survey.
Unmarried, sexually active married non-users who are not pregnant or in postpartum amenorrhea are 
further separated into those who are considered fertile and those who are infertile. Women are classified as 
infertile if they fall into one of the following categories:
married for more than 5 years, had no children in the last 5 years and never used contraception;
answered “I can't get pregnant” to the question about wanting to have future children;
answered is “menopause/hysterectomy” for the reason of not using contraception;
answered to time since last period is > 6 months and non-amenorrheic postpartum (0-59 months);
answered to time since last period is “menopause/hysterectomy” or “never menstruated”; or
answered to time since last period is "last period was before last birth" and last birth was 5+ years ago.
Infertile women do not need family planning. Other women who do not need it include married women or 
sexually active unmarried women who are not using contraception and who are:
pregnant and wanted the current pregnancy;
postpartum amenorrhea and wanted their last delivery; or
fertile and wants another child in next 2 years
Single, married, sexually active non-users have an unmet need for spacing if they are:
pregnant and want a pregnancy later;
postpartum amenorrhea and wanted their last delivery later; or
fertile and want next child in 2 years or more, want another child but undecided when or undecided if they 
want another child.
Single, married, sexually active non-users have an unmet need for limitation if they are:
Baseline Report – USAID Kulawa Project 54
pregnant and did not want the current pregnancy at all;
postpartum amenorrhea and did not want their last delivery at all; or
fertile and does not want any more children.
Demand satisfaction indicators:
Numerator divided by the denominator, multiplied by 100.
The numerator of the satisfied demand proportion includes the number of women currently using a 
contraceptive method while the numerator of satisfied demand by modern methods includes the number of 
women using a modern contraceptive method.
The denominators include women with a met need (those using contraception whether the method is a 
modern method or a traditional method) and those with an unmet need for family planning.
Baseline Report – USAID Kulawa Project 55
Annex 8: GEM scale calculation
This index measures attitudes towards gender norms for intimate relationships or different social 
expectations for men and women, using the Gender Equitable Men (GEM) scale.
Calculated as:
N: the number of sample-weighted target people who score moderate or high on the GEM scale
D: the number of target people interviewed
Target audience: Men (15-59 years); women of childbearing age (15-49 years)
GEM scale for Niger: 4 subtopics and 24 statements in total. They are:
Domain of violence:
There are times when a woman deserves to be beaten
A woman must tolerate violence to keep her family together
It's okay for a man to beat his wife if she's unfaithful
A man can hit his wife if she refuses to have sex with him
If someone (man or woman) insults a man, he must defend his reputation with force
A man using violence against his wife is a private matter that should not be discussed outside the couple
Domain of sexual relations:
It is the man who decides what type of sexual relationship to have
Men are always ready to have sex
Men need sex more than women
A man needs other women even if everything is fine with his wife
You don't talk about sex, you just do it
It disgusts me when I see a man acting like a woman
A woman should not initiate sex
A woman who has sex before getting married does not deserve respect
Domain of reproductive health and disease prevention:
Women who have condoms in their possession are wanton or immoral
Men should be outraged if their wives ask them to use a condom
It is the woman's responsibility to avoid becoming pregnant
It is only when a woman has a child that she is a real woman
A real man produces a male child
Baseline Report – USAID Kulawa Project 56
Domain of domestic tasks and daily life:
Cleaning a baby's bottom, bathing and feeding children is the responsibility of the mother
A woman's role is to take care of her home and family
The husband decides on the purchase of the main household items
The man should have the final say on decisions in his home
A wife should obey her husband in all things
Scoring Procedure:
Each of the above items is rated on a 3-point scale, where 1 = agree, 2 = partially agree, and 3 = disagree. 
The answers to each item should be added together according to the point value assigned to the answer. 
The total point value for the GEM scale ranges from 24 to 72. Each score results in a low equity score (24-39 
points); moderate (40-56 points); and high (57-72 points). Then, associations between the GEM scale and 
variables such as condom use, contraceptive use and intimate partner violence can be analyzed. GEM scale 
scores were also compared before and after an intervention.
Baseline Report – USAID Kulawa Project 57
Annex 9: Calculation of the attitude of providers towards adolescents 
indicator
This index measures health providers' attitudes toward adolescent (15-19 years) and youth (20-24 years) 
using family planning and other adolescents sexual and reproductive health services (ASRH).
“Positive” attitudes are those that should logically lead to positive ASRH outcomes.
The themes and attitude reports listed below.
Result of the indicator calculated as follows:
Numerator: Number of providers who express positive attitudes towards youth/adolescents using FP and 
other health services
Denominator: number of providers studied in the USAID Kulawa assessment
This indicator will include providers from various settings, including doctors, nurses and midwives, from 
various service areas (e.g., MNCH, nutrition, RH/FP, etc.) depending on who is selected to participate in 
assessment of the healthcare facility on their site.
Index themes and attitude reports:
Attitudes towards FP and SRH information and services offered to young people:
6. Single adolescents seeking sexual and reproductive health services should be advised to abstain 
when requesting contraceptives.
7. Discussing sex with unmarried women and men is shameful.
8. Unmarried adolescents should not receive contraceptives because culture and religion prohibit sex 
before marriage.
9. Parents should be informed if their unmarried daughters come to a health facility to seek 
reproductive health services.
10. I would scold an unmarried teenager for asking for birth control.
11. I would refuse to provide contraceptives to teenagers before marriage.
12. It is acceptable to teach unmarried young people about contraception.
13. Reproductive health services are only available to married women.
14. Women and men of all ages should be seen atthe clinic for sexual and reproductive health services 
if they request it.
Norms and beliefs about adolescents and young people:
15. My personal beliefs guide how I provide adolescent health services.
16. Only girls should receive information on sexual and reproductive health because they are the ones 
who have the most problems related to sexual behavior.
Baseline Report – USAID Kulawa Project 58
17. If a client does not voluntarily tell me that he has been the victim of violence perpetrated by 
members of his family, I should not ask him directly because thatis none of my business.
18. By definition, boys cannot be sexually assaulted.
19. Boys and girls should not be given information about puberty as it will encourage them to engage in 
sexual behavior.
20. Educating young people on topics related to reproductive health leads to sexual immorality.
21. If a boy or a girl has a genital ulcer, it's because he or she is easy.
22. If a young woman walks into a health facility and says she was sexually assaulted, she probably did 
something to deserve it.
Attitudes towards the clinical and political environment:
23. Educational materials on sexual and reproductive health should be freely accessible to unmarried 
boys and girls.
24. Young people should enjoy the same level of confidentiality as adults when receiving sexual and 
reproductive health services.
25. Schools and institutions should work together to provide reproductive health information and 
services to young people.
26. Sexual and gender-based violence among young people should receive government attention as an 
important social problem.
27. It is important to ensure that all services provided to young people are provided in private so that 
no one else in the clinic can overhear.
Response options:
Totally disagree - 1 // Disagree - 2 // Agree - 3 // Totally agree - 4
Scoring procedures:
Subject scores are averaged to calculate total scores for main headings and subscales ranging from 1 to 4. 
Higher scores (55 -88) represent more positive attitudes towards young people and use of SRH services.
The surveys include both dependent variables (i.e., provider attitudes) and independent variables (i.e., 
provider demographics).
Baseline Report – USAID Kulawa Project 59
Annex 10: Calculation of the service availability index
The indicator is the Service Availability Index which measures three tracer indicator areas: health 
infrastructure, health workforce and service utilization, using an unweighted average.
Health infrastructure:
a) # of establishments supported by USAID Kulawa per 10,000 inhabitants / 2 * 100 (max / 100)
b) # of inpatient beds in USAID Kulawa-supported facilities per 10,000 population/25 * 100 (max. 100)
c) # of maternity beds in USAID Kulawa supported facilities per 10,000 population/10 * 100 
(max/100)
Health staff:
d) Number of basic health staff in USAID Kulawa supported facilities per 10,000 population/23 * 100 
(max/100)
Facility use:
e) # of outpatient visits per person/year in USAID Kulawa-supported facilities/5 * 100 (max/100).
f) # of hospital discharges per 100 inhabitants/year/10 * 100 (max/100).
The service availability index is calculated as follows:
[((a+b+c)/3) +d+ ((e+f)/2)]/3
“Basic health workforce” includes:
CSI: CSI manager and the midwife
Hospitals: Director of the hospital, pediatric department manager including CRENI, maternity department 
manager including FP, Hygiene Sanitation department manager, Medicine department manager, reception 
service manager
CSME: CSME director, pediatric service manager including CRENI, maternity manager including FP, 
maternal and neonatal health service manager, Hygiene Sanitation service manager.
Baseline Report – USAID Kulawa Project 60
Annex 11: Demand Satisfied for Family Planning
Table 34: Demand Satisfied for Family Planning
Maradi Tillabéri Zinder Total
WOMEN 15 - 49 YEARS
Unmet need for family planning Unmet need for spacing (%) 1.3% 1.0% 0.1% 0.9%
Unmet need for limiting (%) 2.8% 0.8% 1.6% 1.7%
Total unmet need (%) 4.1% 1.7% 1.7% 2.6%
Met need for family planning Met need for spacing (%) 23.7% 16.0% 6.2% 16.3%
Met need for limiting (%) 1.6% 0.4% 0.9% 1.0%
Total met need (%) 25.3% 16.4% 7.1% 17.3%
Total demand for family 
planning
Total Demand for FP (spacing) (%) 25.0% 17.0% 6.4% 17.2%
Total Demand for FP (limiting) (%) 4.4% 1.2% 2.4% 2.7%
Total contraceptive demand (%) 29.4% 18.2% 8.7% 19.9%
Demand satisfied for family 
planning
Demand satisfied by modern 
methods (%) 69.0% 89.8% 56.5% 74.1%
Demand satisfied by all FP 
methods (%) 86.2% 90.4% 80.7% 86.9%
WOMEN 15 - 24 YEARS
Unmet need for family planning Unmet need for spacing (%) 1.6% 0.8% 0.4% 1.0%
Unmet need for limiting (%) 0.2% 0.0% 0.0% 0.1%
Total unmet need (%) 1.8% 0.8% 0.4% 1.1%
Met need for family planning Met need for spacing (%) 19.2% 13.2% 4.6% 13.4%
Met need for limiting (%) 0.7% 0.0% 0.4% 0.4%
Total met need (%) 19.9% 13.2% 4.9% 13.8%
Total demand for family 
planning
Total Demand for FP (spacing) (%) 20.8% 14.0% 4.9% 14.4%
Total Demand for FP (limiting) (%) 0.9% 0.0% 0.4% 0.5%
Total contraceptive demand (%) 21.7% 14.0% 5.2% 14.8%
Demand satisfied for family 
planning
Demand satisfied by modern 
methods (%) 67.0% 94.2% 66.7% 75.6%
Demand satisfied by all FP 
methods (%) 91.8% 94.2% 93.3% 92.7%
WOMEN 25 - 49 YEARS
Unmet need for family planning Unmet need for spacing (%) 1.1% 1.1% 0.0% 0.8%
Unmet need for limiting (%) 4.8% 1.3% 2.6% 2.9%
Baseline Report – USAID Kulawa Project 61
Maradi Tillabéri Zinder Total
Total unmet need (%) 5.9% 2.4% 2.6% 3.7%
Met need for family planning Met need for spacing (%) 27.3% 17.9% 7.3% 18.4%
Met need for limiting (%) 2.3% 0.7% 1.2% 1.4%
Total met need (%) 29.6% 18.6% 8.5% 19.9%
Total demand for family 
planning
Total Demand for FP (spacing) (%) 28.4% 19.0% 7.3% 19.2%
Total Demand for FP (limiting) (%) 7.1% 2.0% 3.8% 4.4%
Total contraceptive demand (%) 35.5% 21.0% 11.1% 23.6%
Demand satisfied for family 
planning
Demand satisfied by modern 
methods (%) 70.0% 87.8% 53.2% 73.5%
Demand satisfied by all FP 
methods (%) 83.5% 88.7% 76.6% 84.3%
Baseline Report – USAID Kulawa Project 62
Annex 12: Synoptic sheet of indicators
Performance indicators Maradi Tillabéri Zinder Total
A- Knowledge use and attitudes about family planning 
Contraceptive prevalence rate
All methods
 Maradi Tillabéri Zinder Total
n=1011 n=920 n=709 n=2640
All women (15-49 years) 23.60% 14.80% 6.70% 15.20%
 Maradi Tillabéri Zinder Total
n=447 n=372 n=286 n=1105
All women (15-24 years) 18.30% 12.10% 8.00% 13.20%
 Maradi Tillabéri Zinder Total
n=564 n=548 n=423 n=1535
All women (25-49 years) 27.60% 16.50% 5.90% 16.60%
Modern Methods
 Maradi Tillabéri Zinder Total
n=1011 n=920 n=709 n=2640
All women 17.40% 14.70% 4.80% 12.00%
Maradi Tillabéri Zinder Total
n=447 n=372 n=286 n=1105
Women 15-24 years 12.70% 12.10% 6.30% 10.20%
 Maradi Tillabéri Zinder Total
n=564 n=548 n=423 n=1535
Women 25-49 years 20.90% 16.30% 3.80% 13.20%
Percentage of women with increased knowledge of family 
planning/other health services.
Maradi Tillabéri Zinder Total
n=1011 n=920 n=709 n=2640
66.30% 59.20% 33.10% 52.10%
 
Percentage of men with increased knowledge of family 
planning/other health services.
Maradi Tillabéri Zinder Total
n=819 n=549 n=669 n=2037
4.60% 9.50% 0.40% 3.70%
Percent of target audience with a positive attitude towards family 
planning
Maradi Tillabéri Zinder Total
91.1% 92.3% 81.2% 87.4%
Percentage of women with positive attitudes toward family planning.
Maradi Tillabéri Zinder Total
n=1011 n=920 n=709 n=2640
95.6% 96.8% 80.5% 90.1%
 
Percentage of men with positive attitudes toward family planning.
Maradi Tillabéri Zinder Total
n=819 n=549 n=669 n=2037
85.3% 85.0% 82.0% 83.9%
Maradi Tillabéri Zinder Total
Baseline Report – USAID Kulawa Project 63
Performance indicators Maradi Tillabéri Zinder Total
Percentage of women who recall hearing or seeing a specific family 
planning/reproductive health (family planning/reproductive health) 
message supported by USG.
n=1011 n=920 n=709 n=2640
32.90% 25.20% 41.80% 34.50%
Percentage of men who recall hearing or seeing a specific family 
planning/reproductive health (family planning/reproductive health) 
message supported by USG.
n=819 n=549 n=669 n=2.037
46.7% 28.2% 11.8% 28.9%
Percentage of audience who recall hearing or seeing a specific family 
planning/reproductive health message (family 
planning/reproductive health) supported by USG.
n=1830 n=1469 n=1378 n=4677
39.0% 26.3% 28.1% 32.1% 
B- Recent fertility and antenatal care
 
Adolescent birth rate (per 1000)
Maradi Tillabéri Zinder Total
n=242 n=178 n=141 n=561
47‰ 32‰ 44‰ 42‰
 
Percentage of women who had four or more antenatal visits during 
last pregnancy.
Maradi Tillabéri Zinder Total
n=781 n=563 n=475 n=1819
56.00% 50.40% 48.80% 52.20%
C- Contraceptive demand and unmet needs
WOMEN 15- 49 YEARS
 Maradi Tillabéri Zinder Total
n=1011 n=920 n=709 n=2640
Unmet need for spacing (%) 1.30% 1.00% 0.10% 0.90%
Unmet need for limiting (%) 2.80% 0.80% 1.60% 1.70%
Total unmet need (%) 4.10% 1.70% 1.70% 2.60%
Met need for spacing (%) 23.70% 16.00% 6.20% 16.30%
Met need for limiting (%) 1.60% 0.40% 0.90% 1.00%
Total met need (%) 25.30% 16.40% 7.10% 17.30%
Total Demand for FP (spacing) (%) 25.00% 17.00% 6.40% 17.20%
Total Demand for FP (limiting) (%) 4.40% 1.20% 2.40% 2.70%
Total contraceptive demand (%) 29.40% 18.20% 8.70% 19.90%
Demand satisfied by modern methods (%) 69.00% 89.80% 56.50% 74.10%
Demand satisfied by all FP methods (%) 86.20% 90.40% 80.70% 86.90%
WOMEN 15- 24 YEARS
 Maradi Tillabéri Zinder Total
n=447 n=372 n=286 n=1105
Unmet need for spacing (%) 1.60% 0.80% 0.40% 1.00%
Unmet need for limiting (%) 0.20% 0.00% 0.00% 0.10%
Total unmet need (%) 1.80% 0.80% 0.40% 1.10%
Met need for spacing (%) 19.20% 13.20% 4.60% 13.40%
Met need for limiting (%) 0.70% 0.00% 0.40% 0.40%
Total met need (%) 19.90% 13.20% 4.90% 13.80%
Baseline Report – USAID Kulawa Project 64
Performance indicators Maradi Tillabéri Zinder Total
Total Demand for FP (spacing) (%) 20.80% 14.00% 4.90% 14.40%
Total Demand for FP (limiting) (%) 0.90% 0.00% 0.40% 0.50%
Total contraceptive demand (%) 21.70% 14.00% 5.20% 14.80%
Demand satisfied by modern methods (%) 67.00% 94.20% 66.70% 75.60%
Demand satisfied by all FP methods (%) 91.80% 94.20% 93.30% 92.70%
D- Gender based violence
Maradi Tillabéri Zinder Total
Percentage of women with at least a moderate gender equity score 
on the Gender Equitable Men (GEM) scale.
n=1006 n=917 n=705 n=2628
31.20% 34.90% 43.90% 36.90%
Percentage of men with at least a moderate fairness score on the 
GEM scale
n=819 n=549 n=669 n=2037
74.20% 60.40% 78.50% 73.50%
Percentage of target women stating that hitting or beating their wife 
would be justified
n=1011 n=920 n=709 n=2640
76.30% 85.10% 86.40% 82.10%
Percentage of target men who say hitting or beating their wives is 
justified
n=819 n=549 n=669 n=2037
27.00% 43.30% 29.90% 31.10%
E- Vaccination of children (12-23 months) n=79 n=67 n=78 n=224
Percentage of children 12-23 months fully immunized 57.20% 28.70% 46.20% 48.80%
F- Service provision 
Proportion of providers with a positive attitude towards the use of 
family planning and its services by adolescents
n=84 n=71 n=99 n=254
39.20% 39.20% 46.50% 42.30%
Percentage of health units with at least one service provider trained 
to manage and identify SGBV.
n=50 n=39 n=57 n=146
61.20% 58.50% 43.50% 53.30%
Number of newborns receiving postnatal care within two days of 
delivery in USG-supported programs.
15 473 6 654 31 090 53 217
Percentage of women who give birth in a facility and start or leave 
with a modern contraceptive method before discharge
n=32 
197
n=14 
132
n=38 
599
n=84 
928
23% 37% 28% 28%
Percentage of women who give birth in a facility and receive 
counseling on family planning before discharge
n=32 
197
n=14 
132
n=38 
599
n=84 
928
59% 87% 73% 70%
Service Availability Index
n=50 n=39 n=57 n=146
16.4% 19.7% 20.0% 18.7%
Health Services Infrastructure Index 28.5 25.8 25.9 26.8
Health workforce index 6.8 4.1 4.6 5.3
Service utilization index 13.8 29.2 29.5 24.0