Contraceptive use is a key measure to reduce teenage pregnancies and child mortality among girls in Rwanda. In line with this, the Ministry of Health presented a proposal before parliament on February 17 to lower the age of consent for contraceptive use from 18 to 15. The 2022 national census reported that 39,273 teenage girls became pregnant, while recent data from the Ministry of Health reveals that between June 2023 and July 2024, 8,000 girls under 18 received antenatal care, accounting for 2% of all pregnancies attended to at health facilities. ALSO READ: Govt tables bill allowing contraception for 15-year-olds As discussions on the proposal continue, one important consideration is the suitability of different contraception methods for teenagers. Do side effects differ for teenagers compared to adults? And what are the most effective and safe methods for adolescents? Dr. Kenneth Ruzindana, a consultant at Kigali University Teaching Hospital (CHUK), explained that adolescents experience the same contraceptive side effects as adults. He noted that there is a common misconception that teenagers respond differently to contraception due to hormonal changes during puberty, but scientific research has not proven this. Instead, Dr. Ruzindana pointed out that the real challenges for adolescents often arise from access to contraception, proper usage, and adherence. For example, many teens forget to take daily oral contraceptives or discontinue them without switching to another method. ALSO READ: Teen access to contraceptives splits public opinion To improve contraceptive use among teenagers, Dr. Ruzindana stressed the need for individualised choices based on health conditions, lifestyle, and personal comfort. “Selecting a method tailored to the teen’s health, menstrual patterns, and preferences enhances compliance,” he said. Dr. Ruzindana noted specific considerations for different health conditions. For instance, he advised that teenagers with migraines accompanied by visual disturbances should avoid combined hormonal contraceptives, while those with a family history of venous thromboembolism might benefit from progestin-only or non-hormonal options. Adolescents with acne, he noted, could consider combined oral contraceptives with anti-androgenic properties. Lifestyle factors also influence contraceptive choices as teens with irregular periods might find long-acting reversible contraceptives like IUDs or implants more convenient, while those with lighter periods may opt for combined hormonal contraceptives or hormonal IUDs. Some adolescents prefer non-hormonal methods such as condoms or copper IUDs due to concerns about artificial hormones, though follow-up visits are necessary to monitor side effects and adjust methods as needed, he added. Dr. Francois Regis Cyiza, the Director of Maternal and Child Health Facilities at the Rwanda Biomedical Center (RBC), said that adolescents are eligible for all contraceptive methods except for permanent procedures such as vasectomy (birth control for men) and tubal ligation (a form of birth control in which a woman’s fallopian tubes are tied or blocked). For other methods, they can use long-acting options like implants and IUDs, or short-term methods like pills, injections, condoms, and emergency contraception, he explained. While abstinence remains the first recommendation for preventing teenage pregnancies, Dr. Cyiza stressed that if abstinence is not possible, different contraceptive options are available to prevent unintended pregnancies. “Contraceptive effectiveness largely depends on correct usage, as most contraceptive methods have a success rate of 95% to 99%, but failure often occurs due to incorrect use, such as missing doses or improper application,” Dr. Cyiza noted. He advised individuals to consult a healthcare professional before choosing a contraceptive method to ensure compatibility with their health. Dr. Cyiza stressed that aside from condoms and emergency contraception, all other contraceptives should be prescribed by a healthcare provider. “Pills, injections, and implants should not be purchased without a prescription to ensure their compatibility with an individual’s health,” he noted. He also advised against unsupervised contraceptive use, which could lead to serious side effects stating; “Using a product incompatible with one’s health may increase the risk of negative effects such as headaches, dizziness, nausea, irregular menstruation, or even excessive bleeding.” Some side effects may initially occur but decrease within three to six months. However, if they persist or worsen, medical consultation is necessary, Dr. Cyiza noted. Certain medications can impact contraceptive effectiveness. For instance, individuals taking antiretroviral drugs might need to change their contraceptive method due to possible drug interactions. Antiretroviral drugs may reduce the effectiveness of some contraceptive products, requiring a switch to a more suitable method, Dr. Cyiza stated. He urged seeking professional guidance when selecting contraceptives, noting that general awareness about contraceptive methods, and detailed information should come from health personnel during consultations.
