Unmet Need and Demand for Smaller Families in Rwanda

(November 2013) Rwanda faces development challenges that stem from several factors: low per capita income, the legacy of the social and political upheaval experienced in the 1990s, and high population density. Low contraceptive use and high rates of fertility among Rwandan women contribute to the country’s population growth and high population density. These factors strain economic and natural resources and potentially contribute to ethnic tensions, such as those that fueled the country’s 1994 genocide, during which up to 1 million Rwandans were murdered. As recently as 2005, only one in 10 married women were using a modern method of contraception; and, at the country’s highest fertility levels in 1983, Rwandan women could expect to have, on average, 8.5 children over a lifetime.

Family planning programs have the potential to slow fertility and population growth. In Rwanda, contraceptive use has been on the rise in recent
years, while fertility rates have been rapidly declining. Between 2005 and 2010, Rwanda experienced one of the fastest declines observed in the history of the Demographic and Health Surveys (DHS), at a rate of 25 percent. These changes may be attributed to the Rwandan government’s
leadership, renewed commitment to family planning, and its ambitious goals for fertility decline and contraceptive use, as outlined in the 2008 Economic Development Poverty Reduction Strategy.

Rwanda’s national population policies of the 2000s also promoted employment and education, especially for girls. Among young women, increases in education, along with improved living standards within households, contributed to the fertility decline during the late 2000s.

Decentralizing the health care system and increasing the number of private health centers and hospitals, shifting service delivery closer to the clients, and integrating family planning into all health services have helped support increases in contraceptive use. Government-implemented programs, such as performance-based financing, also motivate clinics to serve more clients, because additional funding is based on the number of clients. Despite this progress in 2010, only 45 percent of Rwandan married women were using modern methods of contraception, while nearly 20 percent of those who wanted to limit or space their births were not using contraception. These numbers suggest that more can be done to reach the family planning targets outlined in recent government policies.

A paper published in 2009 by Dieudonné Muhoza Ndaruhuye and colleagues provides insight into factors associated with Rwandans’ use of family planning and the country’s population dynamics. Using data from the 2005 Rwanda DHS, the authors looked at four possible explanations for unmet need for contraception and demand for family planning services among reproductive-age women living with a partner: women’s characteristics, their partner’s characteristics, women’s exposure to family planning information, and women’s attitudes and their partner’s perceived attitudes toward contraception. This PopPov network research brief summarizes the paper’s findings.