The fifth edition of the International Conference on Family Planning (ICFP) hosted in Kigali this week brought together political leaders, scientists, researchers, faith leaders, policymakers, advocates, and youth who spent nearly a week sharing best practices and discussing next concrete steps to achieve global family planning goals.
Rwanda is one of the family planning success stories of recent history; the first 15 years of the 2000s saw great achievements in reducing fertility, and Rwanda’s leadership is believed to have been highly supportive of family planning.
The Government of Rwanda has committed to creating awareness on condom use through a number of approaches, including working with community health workers, promoting peer education, and distribution in high risk zones, creating access in the process.
However, the number of teenage pregnancies in various parts of the country shows how Government and parents need to put in more effort to contain the issue which leads many young girls to drop out of school.
Statistics from the Ministry of Health reveal that last year alone, 17,444 teenagers had unwanted pregnancies across the country and many eventually dropped out of school or suspended their education for a period of time.
Dr Aphlodis Kagaba, the Director of Health Development Initiative, concurs that even though the number is not alarming, compared to other African countries, there is a concern that the number is increasing despite the Government and stakeholder’s efforts.
In his view, the rise in cases of unwanted pregnancies among young girls is due to the lack of accurate information about reproductive health yet children engage in unprotected sex at a tender age.
"The number is not bad but the concern is that the number is increasing and it comes back to culture, religion, values and lack of appropriate and friendly spaces to provide services, lack of accurate information and confidence to seek services,” he says.
Sexually active teenagers and young adults are physically capable of getting pregnant, however, matters of contraception among teenagers is a sensitive topic among many adults. It is only after the pregnancy has happened that guardians discuss contraceptives.
18-year-old Natacha Teta shares that most teen girls in Rwanda don’t talk to their parents about sex, or the idea of birth control, because they will think that the parents suspect they’re having sex, which is a taboo.
"Even if it is for the sake of knowledge, you are afraid to ask your parents because they will think otherwise. Myths and misconceptions are our only consistent source of information. Most teenagers rely on peers, teachers and the internet for information,” she says.
She, however, believes that with exposure increasing in the world, girls who are sexually active are no longer children to be told to abstain and that they need protection, so they should be able to obtain birth control without parental consent.
Claude Ntambara, 19, says that the current generation is seeing so much on social media and they put it into practice, even though they are still too young for sex, and therefore cannot wait for the right time to engage in sex.
"Parents should not pretend that preaching abstinence is working. Parents need to wake up and consider the opportunities that they give to their teenagers if they gave them the liberty to use contraceptives and taught them how they work. Parents, rarely have time with their children and have handed that role to teachers,” he says.
Alice Musanabera, a parent, says that parents, some of whom don’t believe in using contraceptives, have resorted to putting their daughters on birth control because they fear it interferes with fertility. She feels sexual health education, especially on correct use of contraceptives, is important.
Her other concern is why most of the emphasis is put on the girls yet teenage boys are affected too. The Government, according to her, ought to put in place sexual and reproductive health programmes that are youth friendly, and confront the stigma and discrimination.
"It is a big risk to have a teenage father because his dreams and aspirations can be interrupted. Even though girls are mostly affected, we need to educate the boys too because not only is it their right, but they need to take caution.”
Dr Diomedes Ntasumbumuyange, the head of the obstetrics/gynaecology department at University of Rwanda’s College of Medicine, says the youth need to be sensitised on talking freely about sexual reproductive health and tackle misconception on birth control.
"Anyone who thinks he will be engaged in any sexual activity should have a condom in their pocket. Also, there is no birth control method that is suitable for an individual although condoms are the best because they have dual protection, from HIV and unwanted pregnancies and I would recommend them. However, they are not well used in most cases which is why people should be allowed to use whatever method is suitable for them,” he says.
What role is the Government playing?
Despite social resistance, the Government and rights groups advocate removal of all legislative, economic, cultural, and religious barriers to young people in accessing modern birth control methods.
The Ministry of Health and its partners have not relented in creating awareness on the importance of condom use, for there are some individuals that are yet to fully embrace the practice.
The Ministry ensured that condom kiosks are strategically placed in four HIV high-risk areas within Kigali city Gasabo-Remera, Gikondo-Magerwa, Nyarugenge-Nyamirambo and Kicukiro-Giporoso.
Imbuto Foundation, in partnership with the Ministry of Health and that of Gender and Family Promotion, last year also launched mobile reproductive health services in order to help the youth between 16 to 24 years access all necessary information, for free.
Prime Minister Edouard Ngirente told participants at the International Conference on Family Planning (ICFP) that Rwanda’s target is to increase contraceptive uptake to at least 60 per cent by 2024 as per the National Strategy for Transformation (2017-2024).
Furthermore, Comprehensive Sexuality Education has also been integrated in the new curriculum. In primary school, it is taught in Science and Elementary Technology, and Social Studies, while in secondary schools, it is in Biology and Health Sciences, General Studies and Communication Skills including History and Citizenship.
Dr Kagaba, however, believes that teenagers need access to accurate information and despite the comprehensive Sexuality Education that was initiated in 2016, it has been limited in schools yet it needs to also be taught.
He adds, however, that the medical liability law that was signed in 2013, that requires minors to get authorisation from their parents before they can get contraceptive services, still poses a big barrier.
He concurs that parents, both mothers and fathers, also need to talk to teenagers about sexual reproduction and also extend friendly services, where there is no stigma and providers do not judge them, as one of the resolutions that were made during the conference.