At a time when the Rwandan government is struggling to prevent from the population bomb through raising awareness of family planning methods, social categorization is likely to limit its efforts in this program, as it somehow blocks adherence to the health mutual. If nothing is done soon to correct the shortcomings noted, the country can see its population increased by the fact that the poor do not manage to access family planning services for lack of pecuniary means related thereto.
Charlotte Mukamana, a resident of Munini Sector, Nyaruguru District, Southern Province, says she has difficulty paying for her contribution to the health mutual because she has not found herself in social classes. And this upset her family planning because she was unable to pay the full cost of this service.
“I could not find myself in the new social classes because I was not present in the meetings that put people in categories because I was hospitalized. When I went to the health center for family planning service, I was asked to pay money. And since I did not have it on me, I had to go to work to win it, but unfortunately, I found myself pregnant before I came back,” she reveals.
Aline Mugisha is a 34 year old mother with two children. She lives in Kabashashi cellule, Nyarugunga sector, Kicukiro district in Kigali city. She plans to give birth to two more children. But she does not know how she will be able to control these births since she could not join life insurance because she is nowhere to be found in the existing social classes, a road map guaranteeing access to the family planning service.
Niyonsenga Triphine, a resident of Munini District, Nyaruguru District, Southern Province, says the poor categorization has been an obstacle to her family planning because her daytime gain cannot help her with service costs.
“I do not have a home or a life but I ended up in the third category. In my job, I earn only 500 Rwandan francs. With my five children, how can we survive on this money and pay mutual fees and family planning services?”
She says. She adds that she had to give up this family planning.
Non reassuring intermittent solutions
For its part, the Ministry of Health says it is concerned about this and it is doing its best to help these women who are having problems accessing the family planning service because of lack of money or because that they have not found themselves in the social categories, or they have been placed in categories that are inadequate given their financial capacities.
“There are times when we run family planning awareness campaigns where we give free services to these poor women.”
says Joel Serucaca, In charge of the family planning program at the Ministry of Health. Serucaca goes on saying that this opportunity happens twice in a year.
However, some women doubt free family planning services at the health centers. “They give us drugs without consultation. And it’s dangerous for our life as well, “says Mukamabano Triphine.
She testimonies that often these medications are not effective because they cause them illness or do not prevent unwanted pregnancies.
“We become pregnant when we think we are protected or we become victims of side effects due to the fact that we were not consulted before taking the drugs to find out what our body can bear,” complains Belthilde Nyirarukundo from Nyaruguru, Munini sector.
Bora Cyineza Josiane, the Social Affairs Officer in Nyarugunga Sector, Kicukiro District, says that these women are sometimes assisted by benefactors mobilized during community works, to pay mutual fees for the people who have had problems with social categorization.
“We draw up a list of women who have not found themselves in the social classes, or those who have been put in classes they do not deserve and we mobilize the local benefactors, at the village and cell levels, so that they pay the mutual health fees for poor families who have been incorrectly put in the second and third social category.”
says Bora. On top of that, she gives hope that the rectification of these social categories continues.
The Ministry of Health indicates that drugs used in family planning are free. People only pay for related services. These payments are made in connection with the health insurance available to the beneficiaries. The insured by the health mutual pay between 200 and 500 Rwandan francs. For other insurances, they pay 15% of the bill and women who don’t have mutual insurance must pay the total amount which is between 2.500 to 10.000 Rwandan Francs.
The Demographic and Health Survey (DHS 2014-2015) revealed that among 100 married women, 53 are using any method of contraception and 47 of them are using any modern method of contraception.