One of the success stories in Rwandan health is the Country’s Family Planning program. Over the last decade, uptake of modern family planning methods has increased from less than 10 % a decade ago to an average of 53 % last year.
This extraordinary story is anchored in the miracle of modern Rwanda’s recovery from the genocide of 1994. Despite the success, Rwanda is far short of meeting her medium term target of 70%. Unmet need for family planning methods is estimated at 38%.
That one of the strategic challenges Rwanda faces is a population growth rate not commensurate with the growth of its economy is evident. It is also widely shared across Rwanda and Internationally. The challenge is to have a population Rwanda’s Economy can support. Although Rwanda is one of the most densely populated countries on the planet, there are countries, not much bigger than Rwanda, that are able to support a bigger population.
Rwanda’s population policy, of which family planning and spacing is but one component, is carefully crafted and calibrated to match population to growth. The target being to reduce fertility from the current 5.5 to below 3, and population growth to just above the replenishment rate of 2.2. It also aims at growing the economy at an average of 8% per year.
The consensus on the need for family planning did not begin with the Post Genocide Government. President Habyalimana’s Government recognized the need and set up a well funded program under ONAPO. Like everything else they did however, this program was failed by the pervasive corruption in the Country then. Habyalimana also used the pretext of overpopulation to refuse millions of Rwandan refugees the right of return, sowing the seeds of conflict. Then he carried out genocide.
The Rwanda Government’s population policy is diametrically different. First, it is based on voluntary consent, not coercion. Second, it is predicated on the inalienable right of all Rwandans to their homeland and property. Third, it emphasizes sustainable and sustained economic growth as a critical component.
The development of a middle class is inevitably associated with a reduction in fertility. Fourth, it invests in education for all, including, in particular, the education of the girl child. Fifth, it offers a wide array of family planning methods to those who need them. Sixth, it is based on an unapologetic advocacy and awareness campaign on the need for couples, families and individuals to take charge of their own sexuality and reproductive health. Seventh, inevitably, it exploits the synergies available with the fight against HIV/AIDS and Sexually transmitted diseases.
Eighth, it builds partnerships with Communities, the Private Sector, Civil Society and Faith Based Organizations. Ninth it places a premium on equity and finally, it is among Rwanda’s development priorities.
That is the lens with which Vasectomy for men and tubo ligation for women should be seen. I will say this again. There is no target for male vasectomy, just as there is no target for tubo ligation for women. However, over the next three years, we have an opportunity to sensitize men on their need to fully participate in family planning, which has too often been left only to Women. This sensitization also includes the means available to them, including Vasectomy.
In our fight against HIV /AIDS, we intend to reach at least 700,000 men with circumcision, a procedure that has been proven, inter alia, to reduce the risk of infection by 60%. This program provides another opportunity for men to participate in planning their families, alongside their spouses and partners.
Permanent and semi permanent methods of family planning, including vasectomy, are not for everyone. Those who need them are counseled, and the methods are not available to individuals who have not yet had the opportunity to build a family. Informed consent is de rigueur.
Vasectomy is not castration. Those who equate the two are simply male chauvinists. I find no softer words for them. Rwandan women have taken advantage of tubo ligation for years with no outcry from those who today proclaim themselves champions of anti vasectomy. If this is not male chauvinism, then I don’t know what is!
Furthermore, it is not true, as some have said, that these programs are aimed at the poor. As a matter of fact, one of the pertinent criticisms of Family Planning in Rwanda was that the tools were only available to the wealthier quintiles in urban areas. That is why we have embarked on a Community Based Distribution of tools of family planning using Community Health Workers.
Those who say the program is only aimed at the poor should be dismissed with the contempt they deserve. I believe the poorest of the poor should have access to the family planning methods the more well to do in our society as well as the Rwandan Diaspora have had for years. The claim that the Vasectomy drive is aimed at some specific section of Rwanda’s society is too contemptible to be dignified with a response. I also condemn, in the strongest possible terms, those who have begun writing about the HIV status of individuals, in the media and online blogs and publications. I call on all Rwandans to decry this practice.
It is illegal, unethical, and an abomination. The decision to go public about one’s HIV status should be left to the Individual. Humanity demands no less. I salute the courage of those who have chosen to do so, including the Association of People Living with HIV/AIDS.
While the two are not to be equated in any way shape or form, I expect that the same respect will continue to be accorded those who choose vasectomy and tubo ligation. The decision belongs to the Individual and their family. The rest of us have no business being involved in it.
I will end where I begun. The Rwandan Government’s Family Planning Policy, is evidence based, ethical, and is participatory. It is built on many pillars, family planning being one, albeit important one. It has no room for rigid ideologies, or Unhelpful political posturing. There is no left, right, or center in this program, just the reality of the imperative to match Rwanda’s population growth with her capacity to provide her sons and daughters with the Wealth and dignity they deserve.
The Author is Rwanda’s Minister of Health