Although Rwanda has registered an 11 percent improvement in the uptake of family planning methods between 2015 and 2020, a number of challenges continue to hamper its plans to ensure that the services are available to everyone who needs them and in a timely manner.

Commenting on the occasion to mark the World Contraception Day, Rwanda Biomedical Center (RBC)’s officer in charge of reproductive health, Joel Serucaca, said that the increment in the uptake of family planning programs had increased from 53 percent in 2014/2015 to 64 percent in 2019/2020.

However, he explained that this number includes those who also use natural methods like exclusive breast feeding and counting safe days.

He reminded that the country’s target is to raise the number of those using modern and reliable contraceptive methods from 48 percent to 60 percent between 2018 and 2024.

RBC says that by 2019/2020, at least 14 percent had unmet family planning needs.

So what challenges continue to hamper the uptake of these services?

1- Mindset issues

Serucaca said that the views held by some people around using modern family methods triggered by cultural beliefs and poverty continue to be a challenge.

Serucaca told The New Times that there were still a number of people who believe that they can have as many children as they can because they will be cared for by the government.

"Ignorance coupled with poverty means that the thought process of some of these people requires lots of resources in terms of time and information to change their mindset. We continue to work on that but it will definitely take some time,” he said.

2- Lack of enough facilities providing these services

Serucaca also explained that there is still a challenge of human resource where health facility staff are overwhelmed and in the process prioritise what they consider more urgent issues than family planning. In the end, this also affects the quality of service provided.

He also pointed out that health posts that were stationed near faith-based hospitals are understaffed meaning that the services could be available at least once a week, discouraging those who have to make long journeys seeking them.

"The majority of the hospitals in the country are faith-based. This means that they do not offer modern methods of family planning which they say are contrary to their beliefs. However, even the health posts that we put near such hospitals to cater for those services are also understaffed,” he said.

3- Challenges in accessing medication

The Reproductive Health Programme Analyst at UNFPA Marie Claire Iryanyawera says that for family planning services to work well, there must be timely and sufficient supply of the medication and equipment required.

However, she reminded that there was a prior challenge in importing such, which was worsened by the outbreak of the Covid-19 pandemic.

"We have previously and continue to face challenges where we run out of stock of some medication and equipment like the contraceptive implant commonly known as Implanon NXT that is more than 99 percent effective at preventing pregnancy and can last for up to 3 years,” she said.

However, she reminded that new stock will be coming in this October but called for stakeholders to begin thinking about alternatives including finding home-grown solutions to produce such products locally. 

4- Insufficient data

Iryanyawera also raised the issue of insufficient data which she said can be an impediment to timely planning and budgeting.

She called on service providers in health facilities and those who provide reports on the distribution of medication to these facilities to put emphasis on using the systems in place so that accurate numbers that will inform decisions are available.

"Data is very crucial. It gives us the picture of what needs are there and how they can be met. If it is medication or equipment, we want to be sure that there is enough in stock so that we are not facing a challenge in demand that we cannot meet,” he said.

5- Challenges within the law

The National Coordinator of IMRO-Ihorere Munyarwanda Organisation Aimable Mwananawe said that there were still some challenges within the laws on access to contraception services where young adults below the age of 18 are required to be accompanied by a parent/guardian to access the services.

IMRO-Ihorere is a local Non-Governmental Organization working on Human Rights, HIV/AIDS Prevention Program, Health Promotion and Poverty Alleviation.

He said that this provision means that more young people who are sexually active continue to shy away from using these services.

In 2018, while responding to questions raised by the Senate on teenage pregnancies and prohibitive laws, the Prime Minister Eduoard Ngirente said that the Government is cognisant of the limits that the current law puts on teenagers, some of which he said could be blamed for the surge in the number of teenage pregnancies in the country.

At the time, he said that the Government is reviewing a law that will see teenagers get easier access to family planning methods.

"Yes young adults below 18 are required to go with their parents to access contraceptives yet these are the most vulnerable when it comes to unwanted pregnancies. I would like to tell you that we are changing that because we found it inconveniencing,” he said.

He also informed the senators that, besides the recognised loopholes, a number of youths had petitioned several institutions pushing for the change.

Ngirente also acknowledged that it did not make sense to ask teachers to educate young adults about reproductive health and safe sex methods when the methods are inaccessible.

6- Misinformation

Speaking on behalf of the Rwanda Interfaith Council on Health (RIC), Sheikh Suleiman Mbarushimana said that there is still need to combat misconceptions among the congregants across all religious denominations.

"We have three categories of believers. Those who believe in family planning, those who have potential to believe in it and those who still believe that using these methods is equivalent to terminating pregnancies.” he said.

To fix this, he called for information manuals that connect what the religious books say to the value and significance of planned parenthood.