The use of modern family planning methods among married women in Rwanda has risen gradually over the past three decades, from 13 percent in 1992 to 64 percent in 2025, according to the Rwanda Statistical Yearbook released recently by the National Institute of Statistics of Rwanda (NISR). ALSO READ: Family planning: Essential insights for choosing the right contraception method For many women, contraceptive use depends on timing, medical advice, and agreement with a partner. Umurerwa (not her real name), a resident of Nyarutarama, began using family planning after her first child. “I started using family planning after my first child because I needed to plan for the future. The choice came from our situation and long-term goals. Someone once advised us not to have another child while we were still renting,” she explained. ALSO READ: How family planning trends have evolved in Rwanda over the years She and her husband discussed their priorities and agreed to wait before having another child, so they decided to go for family planning. After consulting a gynecologist, Umurerwa opted for an intrauterine device (IUD), which she said is one of the most reliable methods available. Medical experts say that IUD is considered one of the safest and most effective forms of reversible contraception, with a safety and efficacy rate of over 99 percent in preventing pregnancy. Umurerwa said she chose the IUD because she was confident she wouldn’t become pregnant anytime soon. However, she began experiencing recurrent infections, a side effect she had heard other women mention. “These side effects keep coming and don’t stop until the device is removed, they can come after two or three months, and then I get medicine, it goes away, then after two months it comes back. It’s very painful, but because I know what I want, I just hang in there. Although many women who use the IUD develop infections, some do not,” she said. She added that one advantage of the IUD is that it does not contain hormones, so it does not cause weight gain. However, managing the recurrent infections that came with it requires patience and persistence. “We kept the IUD for three years. We actually wanted three children, but having four would have been fine, and spacing between them was very important to our plan. After the device was removed, I conceived nine months later, but that pregnancy ended in a miscarriage at four months. Many people assume that using contraceptives can cause miscarriages, but doctors explain that it has nothing to do with it; the contraceptive was not the cause,” she said. Umurerwa conceived again five months later, without using any contraceptive method in the meantime. She said communication with her husband was crucial throughout the process. In the beginning, it was not easy, as he loves children and did not immediately understand the idea of using contraceptives. However, after they sat down to discuss their goals and the outcomes, they agreed to give it a try. She is expecting to give birth in two months and plans to resume contraception immediately after delivery, which will be by caesarean section. Umurerwa noted that a couple needs medical guidance when choosing a contraceptive method. She and her husband consulted a gynecologist to understand the different types and their side effects. She also spoke with other women about their experiences, but relied on the doctor’s advice to make the final decision. Dr. Kenneth Ruzindana, a senior consultant obstetrician and gynecologic oncologist at Kigali University Teaching Hospital (CHUK), says the rise in modern contraceptive use in Rwanda is as a result of policy direction and how services are organised and delivered. “What has driven the increase are programmatic and policy factors, including government leadership and the integration of family planning into routine health care. Community health workers deliver these services, which also reach adolescents and teens through outreach and community engagement,” he said. The health expert added that access and affordability have also influenced use. For example, family planning services are available nationwide and provided free or at minimal cost, making them easier to reach even for lower-income women. Dr. Ruzindana noted that regular community mobilisation has strengthened awareness and acceptance of family planning. The monthly community work (Umuganda), allows sharing information to the public with the involvement of community health workers and local or national leaders. These activities help normalise contraceptive use and encourage behaviour change. “Times are changing, women are more educated and can make choices for themselves. Higher literacy helps them communicate with health providers and report any side effects, and it is connected to decision-making within families. The more women are empowered, the greater their reproductive autonomy, especially in marital relationships where decisions are negotiated,” he said. Fears that continue to limit use Dr. Ruzindana said that despite progress, some married women still avoid modern contraception, fearing side effects such as weight gain, headaches, or changes in their menstrual cycle. Missed periods, irregular bleeding (amenorrhea) are among the most common concerns, particularly with progestin-only methods like injectables and implants. He added that although these effects are usually harmless, they are at times misunderstood. In many cases, women interpret them as signs of illness, cultural problems, or future infertility. In many African communities, regular menstruation is seen as a sign of health and femininity, which makes amenorrhea particularly worrying. “Awareness does not always mean understanding. Some women know about contraception but lack detailed knowledge of how methods work, how to use them correctly, or how to manage common side effects. “Misconceptions that modern contraceptives cause infertility or serious disease are still common. Decisions about contraception are influenced by partners and family members. Lack of male partner approval, or fear of conflict if contraception is used without consent, can reduce use,” Dr. Ruzindana said. He noted that expectations about family size, religious beliefs, and social attitudes toward sex influence how women view contraception. Young people face more challenges, being judged when they seek services and facing stigma around premarital sexual activity. Advice to hesitant couples Dr. Ruzindana noted that for couples unsure about contraception, the focus should be on health and planning. “Family planning is not about rejecting children, it is about planning pregnancies safely and responsibly, in a way that protects the health and well-being of the woman, the family and future children.” He added that modern contraceptive methods are safe, effective, and reversible for most users, with extensive global and national evidence showing they do not cause infertility, cancer, or permanent harm. Dr. Ruzindana noted that side effects from modern contraceptives are usually temporary and can be managed so that no single method works for everyone, and switching to a different method is common if one causes discomfort or side effects. He encouraged couples to seek guidance early and discuss any concerns with health providers. In Rwanda, modern contraception is widely available, affordable, and offered through a confidential and respectful health system. “Using these methods helps protect health and ensures that pregnancies are wanted and safely carried.”
