Family planning remains one of the most effective ways to control population growth, but most importantly, it helps women avoid unplanned pregnancies and ensures that people have children they can afford to support.
Rwanda began deploying family planning services in 1981 with the creation of the Office National de la Population (ONAPO). This initiative aimed to address the challenge of rapid population growth, as ignorance and illiteracy at the time led people to have children beyond their means.
As a result, malnutrition and child stunting were common, with many people refusing to use family planning services, which were then associated with various myths and stereotypes that discouraged their use.
At the 1994 International Conference on Population and Development (ICPD) in Cairo, developing countries were encouraged to integrate family planning into reproductive health services and scale access to these services.
After the 1994 Genocide against the Tutsi, the Rwandan government prioritised improving access to contraceptives and other family planning services, particularly at the grassroots level.
This effort included increasing the number of service delivery points and expanding the range of contraceptive methods available.
Since its introduction, family planning has evolved over the decades to include new methods and technologies, which require countries to regularly update their approaches.
Recent data from Family Planning 2030, and the World Health Organisation (WHO), shows that Rwanda is among 85 low - and lower-middle-income countries that continued to make progress in family planning in 2024.
Data from the first half of the year indicates that at least 380 million women and girls were using modern contraception in these countries.
The data also showed that in the same countries, 143 million unintended pregnancies were prevented, 144,000 maternal deaths were averted, and 29 million unsafe abortions were avoided from July 2023 to July 2024.
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However, with the world rapidly evolving, advocates argue that countries must regularly update their family planning strategies to accommodate new demands, changes in consumption, and innovations.
While Rwanda has made progress, some challenges still hinder access to services and awareness. Conservative beliefs, misconceptions about the effects of family planning, and illiteracy are among the challenges still present.
For example, Solomon Muhawenawe, a resident of Remera, Gasabo, and father of six, says he cannot use family planning methods because they go against God's will, which he believes is to procreate and multiply.
Despite having no stable income to support his growing family, he believes that God will provide for their needs.
"God will provide for them what to eat and school fees," says the 42-year-old, devout Seventh-day Adventist, who does not intend to stop having children until he has at least eight, like his father.
Apart from religious beliefs, Muhawenawe holds several misconceptions about family planning, many of which are untrue, to justify his decision not to use family planning services.
"I heard that some of those contraceptives can cause cervical or uterine cancer or other conditions such as hormonal imbalance because they are not natural," he explains.
Today, family planning is considered one of the most important human rights, allowing individuals and couples to make informed decisions about whether to have children, how many, and when.
It is also seen as a key factor in contributing to gender equality and women's empowerment, particularly because it gives women the right to decide whether to get pregnant.
As family planning evolves, new user-centered methods are constantly being developed, requiring countries to regularly update their strategies.
Today's conversation around family planning also includes the issue of who can access services. Activists argue that even young adolescents, without parental accompaniment, should be given access as a means of preventing unwanted early pregnancies.
This has sparked debate, with rights activists advocating for family planning services to be available in schools, while religious leaders and conservatives oppose this idea.
Where does Rwanda stand?
Rwanda's revised family planning approach focuses on expanding access to a diverse range of modern contraceptive methods, including implants, hormonal IUDs, and injectables, many of which are available at the community level through community health workers.
Dr. François Regis Cyiza, Director of Child and Maternal Health Programmes and Community Health Division at the Rwanda Biomedical Centre (RBC), says that to improve access, services have been decentralized to all levels of health facilities--from health posts to health centers and hospitals.
"At the community level, we have community health workers who provide short-term methods, including injections (for 3 months), pills, condoms, and cycle beads," Dr. Cyiza explains.
Rwanda has also integrated family planning services into antenatal care and maternity services, offering counselling, education, and family planning services to mothers postpartum.
These initiatives are part of Rwanda's efforts to increase family planning uptake, particularly in rural areas where people might have less access to education.
Dr. Cyiza says the government has invested in providing outreach family planning services, especially for long-term and permanent methods, with the aim of reaching at least 60 percent of women of reproductive age (15 to 49 years).
Measuring impact
Using contraception methods, Rwanda aims to lower its fertility rate to 3.2, meaning that a woman of reproductive age would have, on average, three children by the end of 2024. However, this target has not yet been met.
Nonetheless, Rwanda has been able to significantly reduce its fertility rate over the past three decades. Comparing data from 2000 to 2022, the fertility rate in 2023 stood at 3.6, down from 6.3 in 2000.
"The census of 2022 showed that the fertility rate was 3.6 in 2023, compared to 6.3 in 2000," explains Cyiza, adding that the government is leveraging community approaches to create more impact.
"Our overall recommendation to the community is to ensure that all women of reproductive age have the freedom to decide when and how to engage in safe sex, have a wanted and planned pregnancy with good spacing between children," he says.
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"The number of children should be proportional to the family's and the country's economic development so that we can have a healthy and prosperous family and nation," he adds.
Regarding adolescents, Dr. Cyiza said that Rwanda has improved access to contraceptives for young people, although the numbers remain very low.
According to the Rwanda Demographic and Health Survey (DHS) of 2019/2020, only 2.9 per cent of adolescents aged 15-19 had access to modern contraception methods in 2020.
Cyiza acknowledges that the figure is low compared to the number of teenage pregnancies in the country.
In the first half of 2024 alone, RBC recorded 10,480 pregnancies, including 55 cases involving children aged 12 to 14, and 2,446 cases involving teenagers aged 14 to 17. The rest were young women aged 18 to 19.
In 2023, Rwanda recorded 22,055 teen pregnancies. The number has been steadily rising since 2017, when there were 17,331 cases. It increased to 23,622 in 2019, then slightly declined to 19,701 in 2020, only to rise again to 23,534 in 2021.
This growing issue is one that activists say needs to be addressed by improving access to contraceptives for young people who are sexually active.
Despite these challenges, Rwanda's family planning programme has been recognised as successful due to the increased use of modern contraceptives in the country. Injectables comprise the largest share of methods used, at 24 per cent, followed by pills and implants (both at 8 per cent).
The country aims to increase access to family planning services for women and girls to 64 per cent by the end of 2024 and to 65 per cent by 2030.
Anne Kairaba, Director of the Rwanda Initiative for Sustainable Development (RISD), commends the gains Rwanda has made, ranking the success of family planning at 70 per cent.
Kairaba notes that at least 90 per cent of women of reproductive age are aware of family planning methods, which is a significant achievement. However, she observes that the same can not be said for young girls.
"Among young girls aged 12 to 20, I would rate the success at only 53 per cent, given the high levels of unwanted pregnancies and early marriages," Kairaba says. "The recent lowering of the marriage age from 21 to 18 is having a very negative impact on young girls."
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She also points out the stigma surrounding the use of birth control among young girls, which remains strong.
"There is a need to increase awareness among both women and men, as well as girls and boys, for more effective family planning approaches," she argues.
Access to health centres, especially for married women, also plays a significant role in the success of family planning strategies. Kairaba suggests that improving proximity to these centres can motivate women to seek services.
What the Church says
The issue of family planning remains contentious among advocates and religious communities, particularly regarding its use by young people.
Archbishop Laurent Mbanda of the Anglican Church of Rwanda asserts that traditional Christian views prioritize abstinence over contraception, advocating for education and awareness instead.
"Many believers encourage teens to wait to engage in sexual activity. So, sex education is important here. I personally think young people need to be equipped to make informed choices," Archbishop Mbanda says.
He adds that some believers fear providing contraceptives may be seen as endorsing sexual activity outside of marriage, which could lead to an increase in sexual behaviour among teens.
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"Christian churches should encourage and emphasise the joys of family life, providing good education and support," he says. "We need to reinvent biblical teachings about sexuality and relationships, ensuring these are not seen as taboo."
He believes churches can play a role in supporting family life, parenting, and providing resources where needed.
As the world evolves, calls for increased access to contraceptive care continue, factoring in new methods and drugs that provide long-acting contraception without the need for a trained provider to remove them.
However, advocates stress that this should be accompanied by ensuring access to all who need it, including those as young as 15, who may be at risk of early, unwanted pregnancies. This issue remains contentious.
