Both artificial and natural methods are used to help women to avoid unplanned pregnancies. Some women prefer using natural methods to artificial ones to avoid side effects such as getting overweight or thin, loss of appetite and abnormal bleeding, among others.

Cycle beads are one of the natural contraceptive methods that help women to count their menstrual cycle days and get aware of their fertility period, and then abstain or use protection to plan or avoid pregnancies.

But like Chantal Tuyizere, a mother of three, many mothers confess that in as much they like this natural method, they can’t handle the responsibility that comes with using them.

"I have many things to do and think about, so I can’t concentrate on counting beads. It’s also tricky to explain to my husband that we can’t have sex because I am in a fertile period. It’s quite difficult even if it doesn’t bring side effects,” says Tuyizere.

Statistics show that worldwide natural methods can be 97 per cent effective for couples who can easily recognize the fertile phase and use the method correctly.

Timothy Dusabe, a medical assistant at Dusabane Clinic in Kinyinya, says they receive about 30 women with family planning concerns weekly, though no one asks about beads.

"We propose this method to them, but they are always reluctant to try it out. I think it’s because they don’t have enough information about natural methods. Besides, most of them don’t even know how to monitor their menstrual cycles,” he says.

Valentine Mukarukundo, a health practitioner at Kinyinya Health Centre in charge of family planning, says she has personally used beads cycle for birth control for three years now without experiencing any problem.

However, she also says her clients don’t like the method.

"We show them all available methods, but most come after discussing the choice with their partners. What we do is to make sure all methods are available, and we give them all related information they need to take the right choice,” says Mukarukundo.

On average, they receive about 100 newcomers in the family planning section every month, but very few of them choose beads cycle.

"It’s tasking to count beads every day or to follow instructions, especially when it comes to using protection during sexual intercourses during fertile periods,” she says.

Mukarukundo says natural methods such as cycle beads are the best choice because unlike artificial methods, they don’t have any side effects.

"Some artificial methods of family planning cause women to bleed for months; others get vertigo or become overweight if they don’t stop using the particular method,” says Mukarukundo.

For this reason, she urges women to try it as it excludes all possible side effects. "But they have to bear in mind that when you choose it, you have to pay strict attention to instructions as far as this birth control method is concerned,” she says.

How to know fertility days

Annonciata Nyirakarera, the in-charge of counselling at Health Development Initiative (HDI), says before starting to use cycle beads, women should first know the status of their menstruation cycle and fertility period.

A woman must monitor her menstruation cycles for six to eight months to establish the longest and shortest among them, she says.

Nyirakarera explains that for the longest month she subtracts 11 days, while for the shortest, she removes 18 days in order to know her fertility period.

"For instance, if the longest cycle in eight months had 30 days and the shortest had 28, she subtracts 11 from 30 which equals to 19 days, and then takes 18 from 28 which equal 10. This means that the fertility period for this woman is between the 10th to 19th days of her cycle. As a matter of fact, this woman should avoid sexual intercourse or use contraception during this period of fertility,” she explains.

Who should use cycle beads and how

Nyirakarera says every woman with a menstruation cycle between 26 and 32 days is allowed to use beads cycle for birth control. The menstruation cycle normally begins on the first day of menstruation.

Cycle beads are composed of 32 beads; 12 white, 18 chocolate beads, one red bead, one dark brown (or black) bead, a ring and a flesh to show the direction of the cycle.

The red bead means the first day of menstruation. As the days pass, a woman is supposed to move the ring to the next bead in the direction of the flesh.

Since the red one is at the end of all chocolate beads, a woman can have unprotected sex and doesn’t get pregnant.

Nyirakarera explains that the white beads symbolise fertility and the woman should continue to move the ring but as far as it remains in white she can get pregnant.

In this period, she should use protection during sexual intercourse or abstain if she wants to avoid pregnancy.

When white beads are over, a woman may have unprotected sexual intercourse and there is no risk of getting pregnant.

Dangerous signs

The black bead is like an emergency sign if a woman gets menstruation before 26 days. It’s something abnormal and is a symptom of a serious health issue.

When menstruation comes between the 26th and 32nd day, a woman is supposed to move the ring and put it on the red bead to indicate start of a new cycle.

It’s also alarming when a woman counts all 32 beads and still menstruation doesn’t occur. In these two cases, a woman must consult a doctor for further check up.

The Rwanda Demographic and Health Survey 2014-15 showed that more than half of currently married women were using a contraceptive method, with 5 per cent of them using natural methods.