Papias Bizumuremyi from Bukure in Gicumbi District has a six-month-old baby, and expects to have another in five years.

"The reason we have given ourselves a five-year gap is to have another child when we are more financially stable,” Bizumuremyi says.

This is because of the high cost of living, so two children is the ideal number, the couple says.  

"Parents should plan for every child to avoid facing financial problems, which in the end affects the wellbeing of the child,” Bizumuremyi adds.

Louise Nahumuremyi, also a Bukure resident, is expecting her third child. She says the family planning pills she was using before didn’t work out, making her conceive unexpectedly.

"After my second born, I had a plan of 10 years before giving birth again, but it did not work out and I ended up conceiving before that,” she says.

Although society may be aware of birth spacing, many still have little information regarding birth control and child-spacing. 

Understanding child-spacing

Child-spacing is the practice of waiting between pregnancies. A woman’s body needs to rest following pregnancy, medics say.

They say that after having a baby, it is ideal for a woman to wait at least 18 months before getting pregnant again, to maintain the best health for her body and her children.

Dr Corneille Killy Ntihabose, Director-General of Byumba Hospital, says the 18-month (one and half years) rest period is called birth-spacing.

He says when the time between pregnancies is less than 18 months; the mother’s body may not be ready to have a healthy baby.

He says that when a woman does not wait at least 18 months between pregnancies, there is an increased risk of having a poor birth outcome (such as premature birth or a low birth weight baby).

"Too little time between pregnancies increases the mother’s risk of premature birth. The shorter the time between pregnancies, the higher the risk,” he notes

He further says that premature babies are more likely to have health problems than babies born on time.

Ntihabose cites that the body needs time to fully recover from the last pregnancy before it’s ready for the next.

He, however, advises that it’s ideal for one to use birth control until they’re ready to get pregnant again.

Examples of birth control to be used, he says, include IUDs, implants, the pill, and condoms among others.

Health impact 

Dr Theodomir Sebazungu, a gynaecologist at University Teaching Hospital of Kigali (CHUK), says before the period of 18 months, there are conditions that are associated with infant mortality and other short-term and long-term health complications.

The first condition that results from this, he says, is having a premature baby.

He notes that this means the baby is born too soon, before 37 weeks of pregnancy.

"These babies are more likely to have health problems and have to stay in the hospital longer than babies born on time,” he says.

Another effect, he says, is low birthweight. This is when the baby weighs less than two kilograms.  

When a woman gives birth before 18 months, Sebazungu says, the baby could also risk being small for gestational age.

He says that this means that the baby is smaller than normal, based on the number of weeks it has been in the womb.   

"Babies with these health conditions are more likely to have long-term health problems, or even die,” he notes. 

Choosing contraceptive methods

Ntihabose says a woman’s health status (including high blood pressure, cholesterol, diabetes, anaemia, or other conditions), body mass index, habits (such as smoking), and other considerations are all important factors in choosing a contraceptive method.

These same factors are also important to address when choosing to get pregnant, Ntihabose says.

He goes on to add that there are a number of methods women and men may adopt to ensure better spacing to avoid an unplanned pregnancy.

For instance, the medic says the couple may choose to avoid having sex during the fertile days of a woman’s cycle.

He says one can choose a barrier method of birth control to keep the male’s sperm from the woman’s egg (such as a male condom, female condom).

Alternatively, the Ntihabose says that a woman may choose a medication or a hormonal method (such as the pill, injections, patch, implants or the ring, among others).

"Each method varies in degree of effectiveness. All of these methods are reversible and allow the woman to resume trying to get pregnant after the healthy 18- month birth spacing period,” adds Ntihabose.