Demand and Unmet Need for Means of Family Limitation in Rwanda

Abstract

CONTEXT: Rwanda is the most densely populated country in Africa, with substantial annual population growth. The current government seeks new policies for family limitation as a way to facilitate more sustainable development. METHODS: Data from the 2005 Rwanda Demographic and Health Survey were used for a two-step analysis; binary logistic regression was used to identify factors associated with desiring to stop childbearing and having unmet need. RESULTS: Eighty-seven percent of women aged 15-49 approve of family planning, but only 64% believe that their partner approves of it. There is a high level of unmet need for family limitation; 58% of women who want to stop child-bearing do not use modern contraceptives. Demand was lower among women who did not approve of family planning, those who did not know their partner's attitude toward family planning and those who had discussed family planning with their partner fewer than three times. Unmet need was higher among women who did not approve of family planning, those who believed their partner did not approve of family planning or who did not know his attitude, and those who had never discussed family planning with their partner or had done so only once or twice. CONCLUSIONS: Negative attitudes toward family planning and failing structures of provision are the dominant constraints on the use of modern contraceptives in Rwanda. Community-based family planning services could greatly expand access, especially in underserved provinces. International Perspectives on Sexual and Reproductive Health, 2009,35(3):122-130 ********** Rwanda faces serious development problems. A high population growth rate--2.5% a year in the period 2000-2005--is one of them. The vast majority of the country's nine million inhabitants live in rural areas, and 90% of the population work in agriculture. The country has the highest population density in Africa (350 persons per square km) and, with a gross domestic product of USS250 per capita in 2005, it belongs to the group of very low-income countries. (1) The country's high population growth contributes to continuing pressure on natural resources, particularly land, which is thought to be one of the underlying causes of the ethnic tensions that contributed to the killing of 800,000 Rwandans in 1994. (2) The country achieved an impressive economic growth rate (6%) in 2000-2006; however, during the same period, the number of poor people increased by half a million. (1) Population issues have been on the government's agenda since 1981, when the National Office of Population (ONAPO) was created. Between 1981 and 1990, ONAPO focused on improving access to family planning services and promoting family planning through trained communicators known as abakangurambaga (awakeners of the people). (3) In 1990, ONAPO's activities were intensified when it began to provide modern contraceptives throughout the country; at this time, family planning became part of a broader national development policy that was aimed at increasing agricultural production, improving public health, and promoting the education, employment and empowerment of women. Development efforts in these fields were expected to create an environment favorable to behavioral changes that would result in lower fertility; (4) the aim was to reduce the total fertility rate from 8.6 to 4.0 and to raise the contraceptive prevalence rate from 2% to 48% by 2000. (5) Implementation of the various policies facilitated a significant increase in the use of contraceptives: In 1983, only 11% of the population used contraceptives, while in 1992 the figure was 21% (Table l). (6-9) TABLE 1. Trends in fertility and demand for contraception among all fecund women in Rwanda, 1983, 1992, 2000 and 2005 Indicator 1983 1992 2000 2005 Total fertility rate 8.5 6.2 5.8 6.1 Ideal no. …