It was around 10:30 on a week day when I visited Remera Health Centre, right behind Kigali Metropolitan Police. At least two dozen people are seated in the waiting area. As I proceeded into the building, outside every room there were a couple of patients waiting for their turn to meet service providers. One particular room with an inscription “kuboneza urubyaro,” which is Kinyarwanda for “birth control” swarmed with women carrying babies on their backs. And then further down the hall, there was room 32, which was marked “ubujyanama,” Kinyarwanda for “counseling.” Even the hallway was empty, something unexpected given the services they provide which include reproductive health services; information and services on prevention, diagnosis, counseling, treatment and care, among others to the youth. All these services are provided free of charge. Francine Uwayezu, the counsellor at the health centre is the service provider in this office, and she has been since 2018. On a given day, she receives about three people every working day, she says. And the majority of her clients want to test for HIV and birth control. “We should not be helping only three people! But I think this gap is because the youth don’t know we offer these services yet and how we do it. But we try our best to popularise it,” Uwayezu said. While one would judge a low uptake in contraception among teenagers, a project implemented in collaboration with the United Nations Population Fund (UNFPA) indicates that one in five or 20.8 per cent of Rwandan women are first-time mothers by the age of 19. Other available studies show that a large number of young people are already engaging in sexual relationships that put them at risk of contracting sexually transmitted infections and unintended pregnancies, among others. The signs are crystal clear. Teenage pregnancy has been on the rise for years, with 17,337 teenagers conceiving in 2017, 19,832 in 2018, 23,544 in 2019, 19,701 in 2020 and 23,000 last year. Although no one denies the danger these screaming numbers implicate, activists share the same opinion that the government has not exhausted its options when it comes to reducing them. While the law on relating to Human Reproductive Health in Rwanda grants every person the right to medical services and information related to human reproductive health, its Article 7 stipulates that every person who has attained the majority age has the right to decide in relation to human reproductive health issues. The majority age in Rwanda being 18 years, anyone younger needs parental consent to access those services. Although Uwayezu says some parents walk their children to the “youth’s room” for contraception, activists have on several occasions urged the government to rethink this provision, since teenagers are not always comfortable talking about reproductive health with their parents. Also, available data indicates that nevertheless, teenagers are having sex, and not always forced. Chantal Umuhoza, a feminist and reproductive health activist in Rwanda believes that given the country’s cultural and religious context where premarital sex is a taboo, “no young people can openly ask their parents to consent to them using contraceptives,” she said. “Lowering the age of access to contraceptives or completely removing the provision requiring parental consent to access contraception will not end teen pregnancies but would significantly contribute to reducing the numbers,” Umuhoza added. Umuhoza said that only a holistic approach to this problem would make a difference. “In an addition to laws punishing defilement and rape, more focus should be put into early childhood education and through comprehensive sex education on genders and power and how to create equal and respectful relations from an early age,” she noted. This was echoed by Celestin Hategekimana, a parent, religious leader and expert in gender and development. While he believes that a comprehensive sex education should be adopted in primary schools and religious groups, he also understands the need to avail contraceptives to teenagers to protect them from danger. “We need to avail information, first of all, but also tell them that if they are cowards and want to go ahead and have sex, here are options they have to protect themselves,” Hategekimana said. “He added that denying teenagers their need to know and use contraception may result in tragedies that may look like punishments, such as having children they cannot take care of. “They may even use dangerous methods that could result into death,” he said. Apart from a wide range of problems teenage mothers are likely to face such as school dropouts, postpartum depression and poverty, among others, their babies are also more likely to be born pre-term, have lower birth weight, and they have a higher neonatal mortality.
