What do we need to attain full antenatal coverage in Rwanda?

More pregnant women in Rwanda are going for antenatal care than in previous years, according to the latest Rwanda Demographic and Health Survey. Antenatal care or prenatal care refers to healthcare provided from the start of pregnancy until the day the baby is delivered. ALSO READ: How routine prenatal visits are preventing emergencies that used to kill mothers The 2025 findings show that 78 percent of women completed at least four antenatal care visits during pregnancy, up from 47 percent in 2019–2020. Health authorities have promoted four antenatal visits as the minimum for a safe pregnancy and childbirth, but four visits are no longer the global standard. ALSO READ: Antenatal care key in addressing maternal, infant mortality - MoH The World Health Organisation (WHO) now recommends at least eight antenatal care contacts, spaced throughout pregnancy, to facilitate earlier check-ups, closer monitoring, and enhanced support for both mothers and babies. How can Rwanda meet the WHO’s target? Dr. François Regis Cyiza, Director of Maternal and Child Health Facilities at the Rwanda Biomedical Center (RBC), said Rwanda began aligning its antenatal care services with WHO’s target after the Ministry of Health revised its guidelines in 2020 to adopt the recommendation of eight antenatal care contacts. “The implementation started in November 2023, and during the 2024/2025 fiscal year, from July 2024 to June 2025, 25 percent of pregnant women completed all eight visits,” Cyiza stated. He explained that the coverage is still limited because the programme is at an early stage, but efforts are ongoing to strengthen community education and mobilisation on the benefits of completing all contacts. Dr. Cyiza added that expanding antenatal care services to lower-level facilities, including health posts, is expected to help increase coverage. Dr. Stephen Rulisa, an obstetrician and gynecologist at the University Teaching Hospital of Kigali (CHUK), said that many women skip antenatal care visits not because of cost, but because they don’t understand their importance. “Women need to be taught the value of antenatal care; it’s not that they can’t afford it, many have insurance, however, the problem is that they don’t know why these visits matter,” he noted. He said people are more likely to use health services when they understand their purpose and stressed the need to educate women on the importance of completing antenatal care visits. “To meet the WHO target, countries need strong health systems, enough trained staff, and the necessary supplies at every facility. Early engagement is necessary, with the first contact in the first trimester, and communities must be informed so women understand the importance of attending all visits. Flexible approaches, such as using midwives, community health workers, and outreach services, are essential to reach women in remote areas,” WHO states. What has driven the improvement? Dr. Cyiza noted that increased knowledge, attitude, and practices of the community on the importance of antenatal care through community health workers, health providers in health centers, and local leaders have caused an improvement. “Community education through radios and television, combined with local leaders taking ownership through Imihigo, where antenatal care indicators are among the key performance targets to work on and report quarterly, has made a difference,” he said. Dr. Cyiza added that there is continuous mobilisation of the community to seek maternal and child health services through the biannual maternal and child health week campaign. He said improved geographical accessibility to health services has been achieved by building new health centers and upgrading first-generation health posts to second-generation posts, bringing maternal and child health services closer to people in remote areas. “I think the progress we have seen in antenatal care is because of the awareness campaigns and the increasing trust people have in the health system. Now, they know they can go to a health facility and actually get care, and that has made a difference,” Dr. Rulisa said. Dr. Rulisa explained that many women start antenatal care but do not complete all the recommended visits. In most cases, early check-ups reassure them that everything is fine, leading them to skip subsequent appointments. “Women assume that since their first visits were normal, there is no need to return. This shows a gap in how health professionals communicate. When a woman comes, you shouldn’t just explain her situation at that moment, you also need to explain what could happen if she doesn’t return, even when everything looks fine. After two visits where everything is okay, it’s easy for her to assume she will always be okay,” Dr. Rulisa said. He also noted that not completing all recommended antenatal visits is one reason Rwanda’s stillbirth (when a fetus dies after the 20th week of pregnancy) rates remain high, even as maternal health improves. “Stillbirth is not about what happens during delivery; it’s about antenatal care and how closely the pregnancy is monitored. Many of the conditions that lead to stillbirth can be detected before delivery, and whatever caused the baby to die should have been detected during pregnancy. Closer follow-up, especially in the last trimester, is important to preventing these outcomes,” Dr. Rulisa said.

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What do we need to attain full antenatal coverage in Rwanda?