Abstract
While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective. We undertook a qualitative study of community perceptions of reproductive health and family planning in Rwanda's southern Kayonza district, which has the country's highest total fertility rate. From October 2011 to December 2012, we conducted interviews with randomly selected male and female community members (n = 96), community health workers (n = 48), and health facility nurses (n = 15), representing all 8 health centers' catchment areas in the overall catchment area of the district's Rwinkwavu Hospital. We then carried out a directed content analysis to identify key themes and triangulate findings across methods and informant groups. Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman's matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs. As Rwanda continues to refine its family planning policies and programs, it will be critical to address community perceptions around fertility and desired family size, health worker shortages, and stock-outs, as well as to engage men and boys, improve training and mentorship of health workers to provide quality services, and clarify and enforce national policies about payment for services at the local level.
Highlights
At the 2012 London Summit on Family Planning, donors and national governments committed to providing access to modern contraceptives by 2020 to an additional 120 million women around the world who have unmet need for family planning, as well as to focusing on the human rights of women and girls and to launching a reinvigorated global platform for achievingCommunity Perceptions of Family Planning in Rwanda. f Ministry of Health (Rwanda)’s Southern Kayonza District www.ghspjournal.org universal access to family planning
Key themes emerged across interviews surrounding: (1) fertility beliefs: participants recognized the benefits of family planning but often desired larger families for cultural and historical reasons; (2) social pressures and gender roles: young and unmarried women faced significant stigma and husbands exerted decision-making power, but many husbands did not have a good understanding of family planning because they perceived it as a woman’s matter; (3) barriers to accessing high-quality services: out-of-pocket costs, stock-outs, limited method choice, and long waiting times but short consultations at facilities were common complaints; (4) side effects: poor management and rumors and fears of side effects affected contraceptive use. These themes recurred throughout many participant narratives and influenced reproductive health decision making, including enrollment and retention in family planning programs
Population pressures are compounded by the country’s young population, with 61.5% under the age 25 as of 2010,1 highlighting the importance of ensuring access to sexual and reproductive health (SRH) services as the majority of the population enters its reproductive years
Summary
Community Perceptions of Family Planning in Rwanda’s Southern Kayonza District www.ghspjournal.org universal access to family planning. This renewed commitment highlighted the challenges of achieving universal access to family planning, including in countries such as Rwanda that have seen impressive gains. Rwanda’s ambitious national development plan, Vision 2020, outlines a framework to improve population welfare, including a goal of increasing contraceptive coverage among married women to 70% by 2015.2 Rwanda’s National Reproductive Health Policy[3] and National Family Planning Policy[4,5] provide a platform for expanding access to modern contraceptives and strengthening service delivery. While Rwanda has achieved impressive gains in contraceptive coverage, unmet need for family planning is high, and barriers to accessing quality reproductive health services remain. Few studies in Rwanda have qualitatively investigated factors that contribute to family planning use, barriers to care, and quality of services from the community perspective
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