Rwanda has reduced both under-five mortality and maternal mortality by approximately three-quarters. This achievement has been attributed to improved maternal health care over the years. But despite this milestone, some women still prefer to travel out of the country to give birth.

Melisa Agasaro (not real name) delivered her first baby at a hospital in Australia and her second born in the US. Agasaro had a reason for choosing to travel far to give birth. She was diagnosed with a potentially life-threatening health condition, gestational diabetes, that couldn’t easily be dealt with in the country.

"I travelled to the US to have my second born in 2013, my pregnancy was a little bit complicated and the doctors here couldn’t trace the issue. When I went to the US, I was diagnosed with gestational diabetes, they also checked other complications but the condition was at a dangerous stage, so I was put on medication immediately,” the mother-of-two narrates.

She says she got outstanding care while in America.

Agasaro is just one of the many women who decide to have their babies abroad for various reasons. Some expecting women travel to give birth abroad as a matter of choice while others have no option since their condition cannot be managed locally.

For Lillian Mugabo, some women actually go abroad to give birth because of the way some local hospitals treat expectant mothers.

Referring to her experience, the mother of two supports women who choose to go abroad because she wouldn’t wish for any other woman to experience what she went through.

Mugabo had her second child two months ago, but the pain she experienced made her doubt the nurses who attended to her, and she wondered if they were skilled enough.

Vestine Uwamahoro echoes similar sentiments. She says that the process of giving birth is agonising enough and that a woman in labour deserves the best care from anywhere she believes she can get it.

"I wouldn’t say our system is bad, but I think those who go to other countries in most cases are seeking special care from more qualified doctors,” she says.

Uwamahoro, however, says that her preference would be to get services in her home country because it is also advancing and she doesn’t see the reason for extra expenses when she can get the same services back home.

For Claire Akaliza, the biggest problem is the nurses who don’t care. 

"The nurses make the whole process a nightmare, that’s why some women choose to go to other countries,” she says.

But Doreen Umwali, a businesswoman says that many women do it out of fashion. "Some women want to copy what a friend has done, like if I were to have a baby in the US, another would want to do the same. But do they even know why I did that? I could be married to an American, hence, an easier process because we have the requirements needed. Some women go through a very tough time just to ensure they have their baby abroad,” she says.

Umwali adds, "The health system here is doing well. I never had any problem with my two babies. However, I guess they have their reasons. But just because they choose to do so, doesn’t mean the problem is with our system. Some do it because they’re married to foreigners, others it is some sort of ‘competition’, and others, because they can afford it. Simple.”

Lydia Inamahoro, a mother of one, says that the care and support abroad is so advanced, that is usually the winning factor.

"But another thing is the automatic citizenship you get for the child. Making it easier when they are older when applying for school,” she says.

However, regardless of the reasons, what does it say about our health sector? Why do mothers have mixed reactions about the maternal care in the country?

Dr Teckle G. Egiziabher, a gynaecologist at Rwanda Military Hospital, doesn’t agree with women who shun giving birth at home claiming that the healthy sector is not good enough. 

He says that though some women choose to go to other countries like Kenya to deliver, hospitals here are managing and deliveries are done safely.

"The care here has no issues, it’s good and it’s improving day by day. I have worked in Kenya, Somalia and here in Rwanda and I am well conversant with all these systems, you can deliver well anywhere here in this country,” he says.

Dr Egiziabher explains that there are complications that just come naturally in the process of giving birth and that these can happen regardless of where one is.

"Our system has greatly improved and no system can be a hundred percent perfect. Whether it’s in the USA, Kenya or some other country, complications can at some time happen,” he adds.

Dr Jean Nyirinkwaya, the CEO of Hospital La Croix Du Sud, is of a similar view; he believes that something else is pushing some women to have their babies abroad and that it’s nothing related to the health care system.

"They go there because they prefer to but our system is fine. I believe we are doing well because even in the rural setting, women access good maternity services,” he says.

Nyirinkwaya wonders why some women go abroad yet, to him, its better being home when going through such a significant period.

"I think it’s even better giving birth back home where your family can be closer to you and provide all the needed care and attention that is required for a new mother,” he says.

Dr Nyirinkwaya says that Rwanda is improving in almost all sectors, and that includes maternal health services.

"Our country has so far improved in almost all fields, for example, we are bringing in better equipment and the health system is improving day by day and I trust that we can do better,” he adds.

"We are building our country from scratch and we are aiming at making it better. We are doing whatever we can to see that our system gets more advanced and this is yielding results because we now see some people coming from Nairobi and even Kampala to give birth in Rwanda,” Nyirinkwaya says.

Andre Gitembagara, the president of the Rwanda Nurses and Midwives Union, agrees with the experts, explaining that the women who choose to give birth in other countries mostly do it out of choice but not that they are running away from poor services.

"Our system is doing well; the care is good and the doctors are experienced and know what they are doing. Some go to the USA or United Kingdom for ‘prestige’ and because they can actually afford to,” he says.

Gitembagara, however, points out that health conditions related to illnesses such as cancer or heart complications where patients choose to seek treatment from other countries is understandable because the country isn’t advanced enough to handle all cases of such ailments, and with that, even the hospitals give the patients a transfer, otherwise, the maternity section has no issues.

Why do some women choose to have their babies abroad?

I think women have valid reasons for that decision. I know some who had serious complications during pregnancy and preferred to seek special medical attention abroad. Others are motivated by the nationality children obtain at birth, especially for countries like the US.

Denise Rwakayija, Training Manager - MTN Rwanda

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Our health system is advancing and I am proud of that.  I think people should be more trusting of it. I don’t know why some women choose to go abroad but I guess they do because they can afford to and may be because of prestige.

Martha Nyange, university student

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The women I know who have done that did so for two reasons; one, because they want dual citizenship for their kids and because the health care system abroad is more reliable. I think that in the end, they just want the best for their kids. Having dual citizenship is an advantage for anyone and accessing the best health care they can afford also makes sense.

Katie Carlson, women’s activist

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I think it’s because Rwanda’s health system is on a low compared to countries like the US, among others. Some prefer to go abroad because they think in case of urgent special treatment before, after or even when giving birth; it will be provided immediately and handled well. Also some women think experts are only found in foreign countries and they believe they will be well taken care of.

Kate Mariella, journalist

editorial@newtimes.co.rw