Scaling up family planning ‘an uphill but winnable battle’

It is common saying that you can lead a horse to water, but you can’t make him drink.

It is not just the access to quality family planning services that is the most challenging problem for family planning in Rwanda.

Instead, poor mindset about reproductive health is and sensitisation to develop the right kind of mindset to achieve family planning goals is what needs to be done, experts have said.

Nearly 4000 delegates at the on-going four-day family planning meeting in Kigali, who include political leaders, scientists, researchers, religious leaders, policymakers, advocates, and youth representatives, are sharing best practices and discussing concrete steps to achieve global family planning goals.

But what do you do if some partners won’t use any of the well-known contraceptive methods to control births while they clearly see that the more children they will have, the more they will have to pay for their food and education?

That’s pretty much the challenge that policymakers and health workers in Rwanda have as they work to advance the country’s goal to promote family planning.

They say that in order to achieve the goal of having manageable families in the country, an extensive sensitisation campaign is needed to change citizens’ mindsets both in their understanding of the need to control births and how to choose the best contraception methods.

The Government has no clear cut targets in as regards acceptable fertility rate but it has targets about the use of contraception.

Prime Minister Edouard Ngirente told the on-going International Conference on Family Planning (ICFP) in Kigali that Rwanda’s target is to increase contraceptive uptake to at least 60 per cent by 2024 as per the National Strategy for Transformation (2017-2024).

That’s against a low baseline at the moment because the use of modern contraceptive methods increased from 4 per cent in 2000 to 48 per cent in 2015.

So, how do you shore up the uptake of contraceptive methods in order to achieve purposeful family planning?

From a Rwandan community health worker to a cabinet minister, the answer is the same; sensitisation and education about family planning and reproductive health in order to change people’s mindsets.

Five contraceptive methods are currently the most commonly available in Rwanda to control births; including condoms, pills, injection, implants, and intra-uterine devices (IUD).

Experts say that all Rwandans need to understand is that once you decide you want to control births, all you need to do is to seek advice from doctors and any other health workers, including your community health workers, in order to get help.

They can help you choose the most comfortable method to use depending on how your body reacts to different contraceptive methods.

Languida Mukagayaza, a community health worker in Byumba Sector’s Nyamabuye cell in Northern Province’s Gicumbi District, told The New Times on Tuesday that poor mentality is the biggest challenge to family planning.

“People are yet to understand that they need to plan every birth. Once people understand the benefits of family planning, they can deal with any kind of side effects and they can’t fail to choose any of the several contraception methods that are in use,” she said.

Mukagayaza is one of over 58,000 community health workers in the country who have been deployed by the Government at all village levels in order to provide basic healthcare, including reproductive health services.

“Sensitisation is everything in this area of reproductive health. Constant sensitisation is needed because a lot of advice is needed for someone to be comfortable with different methods of family planning,” she said in an interview on the sidelines of the family planning meeting.

Rwanda’s leadership has been highly supportive of family planning in recent years, investing in its network of community health workers, running communication campaigns to drive demand and behaviour change, and providing training on long-acting and permanent contraceptive methods.

But the efforts remain a drop in the ocean, given the great need for family planning services in a country that aspires to be a middle income economy which remains one of the most densely populated nations in the world.

The State Minister in charge of Public Health and Primary Health Care, Dr Patrick Ndimubanzi, said that education and sensitisation will continue to be the most crucial part of any efforts to promote family planning in Rwanda.

“Taboo around reproductive health makes it difficult for people to talk openly about the challenges they face in using family planning services. More education about reproductive health is key to overcoming these challenges,” he said.

Ndimubanzi said that for the country to achieve its family planning goals, sensitisation needs to be found everywhere, starting from schools, hospitals, and youth centres, to the media.

An external observer who is from Japan where the fertility rate is at 1.4 seems to agree with both the minister and Mukagayaza that once the benefits of family planning are well understood through serious sensitisation campaigns, then the uptake of services to achieve that goal will be seamless.

Fertility rate in Rwanda is 4.2 children per woman.

“Sensitisation is needed for people to understand that you can feed and educate your children better with family planning,” said Yuka Shimamura, a PhD candidate at the University of Tokyo who is now based in Eastern Province’s Kayonza District doing her research in sustainability sciences.