Family planning demand generation in Rwanda: Government efforts at the national and community level impact interpersonal communication and family norms

Abstract

Between 2005 and 2020, total contraceptive use among married women in Rwanda increased from 17% to 64%. The aim of this study is to better understand how the Rwandan government’s mobilization and demand generation efforts have impacted community norms and interpersonal discourse surrounding family planning. Eight focus group discussions with family planning providers and 32 in-depth interviews with experienced modern contraceptive users were conducted in 2018 in the two Rwandan districts with the highest and the lowest contraceptive prevalence rates. Results suggest that outspoken government support, mass media, and community meetings were valuable sources of information about family planning. Information received through these channels generated interpersonal dialogue about contraceptives through both conversation and observation; however, rumors and misinformation remained a significant barrier to use. A once taboo subject is now normative among married couples. Continuing to address common fears and misinformation through communication channels such as mass media and community meetings may help to further increase contraceptive uptake in Rwanda.

Utilisation of modern contraceptives by sexually active adolescent girls in Rwanda: a nationwide cross-sectional study

“…Nonetheless, the Government of Rwanda has put considerable efforts in family planing and reducing unwanted pregnancies as part of its 2030 Family Planing country commitment agenda. Evidence from RDHS shows that modern contraceptives are freely available to adolescent girls from government health facilities [33][34][35]. However, reasons for the low usage cited among adolescents include; not being married, infrequent sex and not having sex among the unmarried, and menses not returned after giving birth, breastfeeding and fear of side-effects or health concerns among those in unions [35].…”

“…Furthermore, barrier contraceptive methods like condoms are crucial for preventing sexually transmitted infections [ 1 , 2 ]. Low and middle-income countries (LMICs) have the highest unmet need for modern contraception as over 200 million women who do not want to conceive are not using a modern contraceptive method [ 3 , 4 ]. This might partly explain the annual 111 million unintended pregnancies and 35 million unsafe abortions occurring in LMICs [ 5 ].…”

“…This might partly explain the annual 111 million unintended pregnancies and 35 million unsafe abortions occurring in LMICs [ 5 ]. Access to modern contraception and adequate care for all women could reduce unintended pregnancies by 68%, unplanned births by 71%, unsafe abortions by 72% and maternal mortality by 62% [ 4 , 5 ].…”

“…The Rwanda demographic health survey (RDHS) 2020 further reports that 15% of adolescents have begun childbearing at the age of 19 years [12]. Moreover, there is limited information on contraceptive use among adolescents in Rwanda, where most of the available studies have looked at women in general [4,10,[13][14][15][16][17]. In order to formulate evidence-based policies aimed at increasing the utilization of modern contraceptives, there is a need for more recent adolescent-focused studies.…”

“She is courageous because she does not care what people think about her…”: Attitudes Toward Adolescent Contraception Use among Rwandan Family Planning Providers and Experienced Adult Female Contraceptive Users

“…Rwanda's family planning program is widely recognized as successful (17)(18)(19)(20)(21)(22)(23)(24)(25). In Rwanda in 2020, 58% of married women used modern contraceptives.…”