Rwanda Demographic and Health Survey (RDHS 2014-2015) shows that 28 percent of women who start using a contraceptive method discontinue it within the first year.
To consider the reasons given in the RDHS one cannot help admitting that lack of sufficient information on the various modern contraceptive methods and difficulties related to side effects and how to cope with them cause some women to go through different contraceptive methods and sometimes stop using them altogether.
However, the RDHS shows that, on a national level, 52 percent of women and 64 percent of men age 15-49 have heard a family planning message on the radio in the past few months. Eight percent each of women reported having seen a family planning message on television or in a newspaper/magazine; while 10 percent each of men reported having seen a family planning message from these two media.
Although it is obvious that a large number of Rwandans is aware of contraceptive methods, some women from the countryside claim not to have sufficient information about modern contraceptive methods.
Some residents in the districts of Rusizi and Nyaruguru confess that they start from one method to another because they ignore those that can be effective and compatible with their bodies. And sometimes, in this way they are guided by hearsay from their neighbors as they are often confused!
Thaciana Nyirahabimana, a 48-year-old woman from Nyakabuye sector, Rusizi district, testified that she had to go through almost all modern contraceptive methods to try and find the one that would be bearable by her body. “I first took the pills, but when a neighbor told me that they were not effective enough, I had to change to take the injection of three months, but unfortunately there were side effects!”, she says. She adds that donors of family planning services often do not either teach them how it works or tell them how to proceed if there are any unexpected results. The woman ended up in discontinuation.
Meanwhile, Claudine Uwase, a victim of the side effects of FP modern methods hospitalized at Mibirizi hospital in Rusizi District, regrets that some health centers administer contraceptives without helping users learn more about them and making their consultations before this administration. These same concerns are shared with Sabine Uwamahoro, a 35-year-old woman met at Munini Health Center in Nyaruguru district, adding that that was done in previous years when there were NGOs supporting the action.
“When the family planning program was sponsored by UNFPA, we were given training on these methods and we made a conscious commitment. But for the moment they are gone, things have changed. You come here, you tell them that you want some method, and they give it without advice, without testing!” she complains.
In an interview with women found at the Mashesha health center in Rusizi, and Coko health center in Nyaruguru district, they confide that some of them go through almost all modern contraceptive methods because they are diverted by related rumors, since some health centers, captured by their religious beliefs, administer them secretly and do not have the time to give advice.
Jane Mugeniwase and Pauline Kanyanzira explain it in these terms: “The health centers that are close give us these services in secret lest their leaders discover them! On this, they have no opportunity to educate us, and we start from one method to another under the guidance of neighbors or a friend, and sometimes we finally stop everything” Health officials speak out.
Habarugira Wenceslas, Health Promotion and Diseases Prevention Officer in Rusizi district, explains that those who lack information about modern contraceptive methods are people who live near health centers that are under the responsibility of the Catholic Church because it is not advocated that natural contraceptive methods. “You cannot give training on contraceptive methods that are not recognized there!” he concludes. In this district, 10 out of 18 health centers are under the responsibility of the Roman Catholic Church.
On his part, Gervais Ngagijimana, the officer of the Mashesha health center in Rusizi district mentions the lack of collaboration with local administrative institutions in the education of the population. “It seems that the Ministry of Health is doomed to fend for itself, but it cannot reach everyone” he says.
However, for them, they do their best to educate their clients about modern contraceptive methods. The women who come to the antenatal clinic and all the patients who come to the health center sometimes take short training sessions on contraceptive methods.
Health workers at each village level could contribute to the education of the population. According to Athanase Karemera, director of health in Nyaruguru district, once these are well trained, they can, in turn, train their neighbors. “There is not enough trained staff in this area, so as not everyone can be reached, we are educating health workers who are constantly close to them,” he says. With that, he hopes that little by little, the problem will be solved.
Is the government aware?
Dr. Felix Sayinzoga, Maternal Child and Health Communication Division Manager, in the Ministry of Health confides that every year, the Ministry of Health in collaboration with grassroots bodies organizes two awareness campaigns.
“Through these campaigns, people are educated on the importance of family planning in the development of the country, on the different methods of family planning, and related services are given free of charge“he says. The health centers continue this awareness especially for women who come in prenatal consultations.
Besides, he left a piece of advice “like any other medication, the FP may also have side effects, so it should not be long before you see the doctor, instead of making a unilateral decision or go ask a neighbor what to do”.
Following an assessment made by the senatorial Standing Committee on Social Affairs, Human Rights, and Petitions on what the government is doing to encourage Rwandans to adopt family planning, the Senate notices that funding for awareness campaigns in the area remains minimal.
In front of the Senate, the Director General of the National Institute of Statistics of Rwanda, Yusuf Murangwa, advised the state to heavily invest in family planning programs if it is to achieve its development targets.
The National Health Policy 2020 (RNHP), in terms of family planning, committed to carrying out advocacy with all potential actors to promote improved awareness of family planning and generalized access to family planning services for women, men, and youth; integrate family planning in maternal and child health services; develop and implement a social communication and mobilization program; and strengthen men’s participation.