Brenda, a first-time mother, made her family planning choice based on hearsay, overlooking crucial details about how contraception works. This decision led to prolonged difficulties conceiving after she stopped using contraception. When seeking medical advice, she learned that she would need to wait for the hormones to leave her system or possibly take medication to restore her hormonal balance. ALSO READ: How family planning trends have evolved in Rwanda over the years Brenda, whose real name has been withheld, gave birth to her daughter in November 2022 at a hospital in Gasabo District. Before discharge, a healthcare provider spoke to her and her husband about the importance of family planning and outlined available methods. However, there was no medical assessment to determine the best option for her body. When asked why she was not tested for the most suitable contraceptive method for her body, she responded, “I don’t know why they do not test.” Although the couple appreciated the information, they decided to delay making a decision. “I feared making an uninformed choice,” Brenda said, “especially given my condition after my first birth.” By March 2023, after discussions with friends and acquaintances, she opted for Depo-Provera, a birth control injection taken every three months. “I heard from my friends that it didn’t have major side effects, and I liked that I only needed to take a shot every three months instead of taking a daily pill,” she explained. What she did not know was that hormonal contraceptives like Depo-Provera can delay conception even after discontinuation. ALSO READ: 6 challenges hampering family planning uptake Brenda stopped receiving the shot in December 2023, hoping to conceive again. However, months passed without success, creating tension in her marriage. “After some months of trying, my husband started to suspect that I was still on family planning. He kept asking why I was against our plan to have another child. I explained that I had stopped using it and had no idea why I wasn’t conceiving, but he seemed unconvinced. I urged him to be patient, assuming it might just be too early,” she said. By February 2025, after a year of unsuccessful attempts, she consulted a doctor. “The doctor told me that the hormones were still in my body and that I had two options: wait or take medication to restore hormonal balance,” Brenda said. She chose treatment and is currently undergoing the process of hormone regulation. ALSO READ: How Rwanda’s family planning methods transformed maternal, child health Brenda’s concerns extend beyond choosing a contraceptive method based on hearsay rather than medical evaluation. She also lacked comprehensive information about the nature and potential side effects of the method she selected. The New Times has found that cases similar to Brenda’s are common, with many women experiencing side effects due to uninformed contraceptive choices. From Brenda’s perspective, she believes there is a strong possibility she will never use family planning again due to her personal experience and the accounts of her female friends. She mentioned hearing stories of women who experienced severe side effects, including complete infertility. Brenda further says that she might only reconsider family planning when she definitively decides not to have more children. ALSO READ: Rwanda FDA warns about illegal family planning medicines A 2019 report by the World Health Organisation noted that many women discontinue contraceptive use due to health concerns and side effects, leading to unintended pregnancies. The report, titled “High rates of unintended pregnancies linked to gaps in family planning services,” analyzed data from 36 low and middle-income countries. It found that 65 per cent of women with unintended pregnancies were either not using contraception or relied on traditional methods, while an additional 31 per cent were using short-acting modern methods. The report emphasised that long-acting contraceptives could have prevented the majority of these unintended pregnancies. It also highlighted that unintended pregnancies stem from multiple factors, including lack of contraception, discontinuation due to side effects, contraceptive failure, and incorrect or inconsistent use. WHO estimates that unintended pregnancies result in approximately 25 million unsafe abortions and 47,000 maternal deaths annually. Additionally, inadequate antenatal care and limited delivery assistance for women with unintended pregnancies contribute to more than two million neonatal deaths each year. To address these challenges, WHO advocates for improving the quality of family planning services, strengthening contraceptive counseling, and ensuring continuous support for contraceptive users to enhance adherence and effectiveness ALSO READ: New contraceptives increase family planning options What experts say According to Dr. Francoir Regis Cyiza, Director of the Health Facilities Programs Unit in the Maternal, Child, and Community Health Division at the Rwanda Biomedical Centre (RBC), healthcare providers follow the 2022 guidelines and standards for family planning services. These guidelines apply to all individuals of reproductive age, starting from 15 years and above, including couples. He emphasizes that healthcare professionals ensure individuals are well-informed before making a decision. It is the couple or a person needing family planning who makes the choice of method after being informed of all available options, their benefits, and possible side effects. This follows an eligibility assessment conducted by the provider using the adapted WHO tool, the Medical Eligibility Criteria Wheel, he explains. Dr. Cyiza adds that healthcare providers screen clients for potential side effects during follow-up visits and determine whether medical intervention or a change in method is necessary. “For any client on family planning, before and after receiving a method, she is counseled or educated about possible side effects, and is advised to report back if she experiences any unusual symptoms or signs,” he said. However, Brenda’s experience suggests that this is not always the case. “I received follow-up shots at a different hospital than where I got my first one, and there was no checkup or follow-up questions about side effects. They just provided the service I asked for,” she said. ALSO READ: The daunting effects of teenage pregnancy Cyiza calls on healthcare providers to conduct thorough counseling and assessments for clients. “Health providers should ensure they counsel, examine the client thoroughly, and use the Medical Eligibility Wheel adequately for any method and ensure they educate the clients on possible side effects and how they may support in case these emerge.” He said. He warns against misinformation from peers, which may lead individuals to discontinue family planning methods unnecessarily. For adolescents between the ages of 15 and 18, additional safeguards are in place. “For women between 15 and 18 years, to get the family planning method, they should choose the method by themselves, and the parent or legal guardian must consent for her to allow the provision of the method,” Cyiza clarifies. ALSO READ: Battle taken to schools as govt records 22,000 teen pregnancies Making an informed choice It is crucial for women to be proactive in their contraceptive decisions, as some might be unaware that their options are often considered by medical providers without thorough individual assessment. Seeking personalised medical advice and, if necessary, undergoing relevant health evaluations—even at a personal cost—can help prevent potential complications. Asking detailed questions about any chosen method is essential, as the consequences of making an uninformed decision may be far more significant than the cost of a medical consultation. Dr. Stephen Rulisa, a physician at the University Teaching Hospital of Kigali (CHUK) pointed out that many women do not undergo medical assessments before choosing a family planning method. Often, the decision is based on personal preference rather than medical consultation. He urges individuals to seek thorough medical advice and undergo necessary tests to minimise health risks. “Hospitals should routinely check for pre-existing conditions such as high blood pressure or heart disease before prescribing hormonal contraceptives. Blood pressure screening is a basic hospital test, but some women are not tested for any health conditions before being given family planning methods,” he notes. Rulisa stresses the importance of proactive decision-making. “Doctors may sometimes forget important details. It’s crucial for both healthcare providers and patients to ensure all factors are carefully considered before making a choice,” he concludes. ALSO READ: Teenage access to contraception is a necessity Understanding family planning methods Dr. Rulisa stresses that family planning choices should consider several factors, including: Duration of pregnancy prevention: “One of the key considerations is how long a person wants to prevent pregnancy,” says Dr. Rulisa. “Some methods are short-term, while others last for years.” Health conditions and side effects: He warns that not all methods are suitable for everyone. “Hormonal contraceptives can have side effects such as weight gain or loss, irregular bleeding, or prolonged delays in conceiving after discontinuation. Some conditions, like high blood pressure or heart disease, may also limit the options available to certain women.” However, these effects do not occur in every woman, and alternatives are available if side effects become problematic. Rulisa stresses that individuals hoping to conceive immediately after stopping contraception should avoid hormonal methods, as residual hormones can delay pregnancy. “Hormonal methods cannot guarantee immediate conception after discontinuation. The hormones remain in the body for a certain period, which varies from person to person. This is why it is important to be informed before choosing a method,” he said. 1. Hormonal methods Hormonal contraceptives work by preventing ovulation, thickening cervical mucus, or thinning the uterine lining. However, they may not be suitable for women who wish to conceive immediately after stopping contraception, as hormones can linger in the body for an extended period. Examples of hormonal contraceptives include: Birth control pills, Injectables (Depo-Provera), Hormonal implants (effective for 3 to 5 years), Vaginal rings (inserted monthly), Hormonal intrauterine devices (IUDs) (such as Mirena and Skyla, effective for 3 to 7 years) ALSO READ: Disability advocacy group backs bill on contraception for 15-year-olds 2. Barrier methods Barrier methods physically block sperm from reaching the egg and offer protection against sexually transmitted infections (STIs). These include: Male and female condoms (short- or long-term use), Spermicides (chemical agents that kill sperm, used alone or with diaphragms) 3. Intrauterine devices (IUDs) IUDs come in hormonal and non-hormonal forms. The copper IUD (e.g., Paragard) is non-hormonal and effective for up to 10 years. 4. Natural methods Natural contraceptive methods rely on tracking ovulation and include: Fertility awareness methods (tracking body temperature, cervical mucus, or menstrual cycles), Withdrawal method (considered less effective by scientists), Lactational Amenorrhea Method (LAM) (exclusive breastfeeding suppresses ovulation). While natural methods have no significant side effects, their effectiveness depends on strict adherence. For instance, condoms may break, or users may miscalculate ovulation periods. ALSO READ: How Ngoma’s new health center boosted family planning efforts 5. Permanent methods Permanent contraception, also known as sterilization, is intended for individuals who no longer wish to have children. These procedures include: Tubal ligation (cutting or blocking the fallopian tubes in women), Vasectomy (cutting or blocking the vas deferens in men). 6. Emergency contraception Emergency contraception is used after unprotected sex to prevent pregnancy and includes: Morning-after pills (most effective within 72 hours), Copper IUDs (inserted within five days of unprotected intercourse). ALSO READ: Activists: Law on reproductive health should allow minors access to contraceptives Rwanda’s family planning goals Despite challenges, Rwanda’s family planning program is regarded as successful, largely due to the increased adoption of modern contraceptives. Among these, injectables remain the most widely used method at 24 per cent, followed by pills and implants, each at eight per cent. Recent data from Family Planning 2030 and WHO shows that Rwanda is among the 85 low and lower-middle-income countries making steady progress in family planning. The country has integrated contraceptive services into antenatal and maternity care, providing counseling and education to postpartum mothers. In the current fiscal year, Rwanda aims to reduce the percentage of married women with unmet family planning needs from over 13 per cent in 2024 to eight per cent by 2029. The country is also working to expand access to contraceptive services for women and girls to curb teenage pregnancies.
