During the London Summit on family planning in 2012, Rwanda committed to ensure the availability of family planning services in every village (Imidugudu), among others.

Five years later, a lot has been achieved in terms of ensuring that family planning services can be easily accessed.

Long-lasting contraceptive methods, including permanent ones, and high quality integrated family planning services can be easily accessed across the country.

However, the challenge of ensuring that couples embrace family planning is far from over. We still have women giving birth to unplanned children.  Some of the reasons why some couples shun modern family planning methods is linked to the ‘side effects.’

Modern methods of family planning are sometimes associated with certain side effects as some women time and again complain of issues such as mild headaches, irregular bleeding, dizziness and nausea, among others. This is the reason why some opt for natural methods.

A recent visit to Busogo Health Centre in Musanze District indicated that some women refrain from the use of modern methods of family planning, while a good number opt for natural means.

Natural family planning is a form of birth control which doesn’t involve medication or use of devices. Some of the natural methods include cycle beads, breastfeeding, withdrawal and abstinence.

At Busogo Health Centre, about five per cent of women use natural methods of family planning.

CycleBeads

Asuma Nikuze, a community health worker at Busogo, explains that using CycleBeads is one way of family planning, or preventing pregnancy, by simply tracking one’s ovulation cycle. In other words, it involves tracing dates in which a woman is more fertile and those dates when she is less fertile.

CycleBeads is a colour-coded string of beads representing a woman’s menstrual cycle.

She says that even though most women use modern methods some of them actually prefer the natural means, only that they find it hard to keep track of the cycle.

Nikuze believes that women should have access to a full range of contraceptive options, including natural ones, such that they are able to make choices when they are aware of all the possible options.

"Women are provided with different choices when they go to the health centre and all methods including natural and artificial methods are explained to them. It’s upon them to choose what they prefer. Most go for modern methods but some choose the natural ones, especially CycleBeads,” she says.

Explaining how the method works, Nikuze says, a woman places a rubber ring on the red bead the day she starts her period and moves the ring one bead forward in the direction of the arrow every day. When the ring is on a coloured bead, there is less likelihood of pregnancy. When the ring is on a white bead (that is day 8 to 19), then she is in her fertile period and there are high chances of getting pregnant if she has unprotected sexual intercourse.

Livingstone Niyongabo, a health supervisor at Busogo Health Centre, says CycleBeads is really effective in the prevention of pregnancy. He, however, notes that it’s only eligible for those women who have a regular menstrual cycle.

A regular cycle is when the length between first day of the period and the first day of the next period is equal for a significant number of months.

"Some women are not eligible for this method because they have irregular cycles. Forgetting to move the bead can lead to a poor calculation. Also, since this method requires both the man and the woman to agree to refrain from sexual intercourse during ovulation days, it is sometimes hard,” he says. 

Lactational amenorrhea method

Niyongabo cites another natural method for birth control which is lactational amenorrhea method (LAM), also referred to as breastfeeding- as-birth-control.

Anyone can use this method, especially when they breastfeed exclusively before six months, but after that period, one should opt for other birth control methods. When a mother exclusively breastfeeds, the body naturally stops ovulating, he explains.

According to research done by Geneva Foundation for Medical Education and Research, a form of breastfeeding to achieve contraception is more than 98 per cent effective during the first six months following delivery. Based on years of data from thousands of women in more than a dozen countries, the research also suggests that LAM may be dependable for longer, perhaps up to a year after giving birth.

According to the research, during breastfeeding, ovulation is inhibited by a series of physiological responses to nipple stimulation. More frequent or intense suckling sends nerve impulses to the mother’s hypothalamus that disrupt normal signals to the pituitary controlling hormone secretion; the resulting abnormal pattern of LH secretion is inhibitory to ovarian activity.

When breastfeeding diminishes with less frequent breastfeeding and/or more frequent supplemental feeding, the chance of ovulation and subsequent pregnancy rises, the research indicates.

The study results suggest that lengthening the six-month criterion to nine or even 12 months after delivery might be possible under certain conditions, although more research is necessary before changing this criterion.

Coitus Interruptus

This method of family planning is distinct from other natural methods in that it is male-controlled. It prevents pregnancy by preventing contact between the sperm and the egg.

Dr Rachna Pande says that this method, also known as the withdrawal method, is where the male partner withdraws before depositing semen in the vagina. However, she says, this requires a strong will.

"Moreover, few drops of semen which are present in pre-ejaculate secretions can also fertilise the ovum if spilled in the woman’s sexual organ,” Pande says, adding that the effectiveness of this method depends largely on the man’s ability to withdraw prior to ejaculation.

Abstinence

This is also another form, and it involves total desistance from intercourse, Dr Pande points out. Refraining from penetrative sex provides 100 per cent protection from pregnancy, and guarantees prevention of transmission of sexually transmitted infections.

"This again requires a strong will, otherwise if forced; it can lead to frustration, lack of concentration and sexual perversions as well. However, abstinence is good for contraception as there is no risk of pregnancy involved,” she says.

Would you go for natural or modern birth control methods?

I would say natural methods. Some of the women I train in the Poor Women Development Initiative prefer the natural ones only that they at times fail to use them efficiently. They refrain from modern methods because they fear risks associated with them. I think what’s missing is sensitisation on what family planning really is without holding back any information.

Cressence Mukantabana, Women’s Activist

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Family planning as a whole is a tough issue to deal with, so choosing a method that works best for you is hard. Besides that, all methods are not a 100 per cent safe but I would say modern ones are more reliable.

Beatha Mukarurangwa, Mother

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I would choose modern methods because they are dependable, if you compare them to the natural ones. Aside from them having risks which are also minimal, one can be sure to get the desired results.

Aidah Kayitesi, Housewife

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Natural family planning methods can be very effective and accurate when used properly, so I think I would go for these since they are safe and carry limited risks.

Vianney Muhawenimana, Businessman

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I would go for modern methods. I know some would rather choose natural, or worse, not use any family planning method at all because of the endless myths or side effects. Natural methods are good but they are hard to keep up with.

Jeanette Nyirabahizi, Farmer

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Natural methods are the best; they enable couples to plan for births without any artificial substances used. They can be tricky to use but as long as the couple communicates well, they are the best.

Ambrose Asiimwe, Intern