Presenter: NZAYIRATA Lucien

Medical student at University of Rwanda

SUPERVISORS: Prof. Calvin Wilson M.D. University of Colorado

Henry Nieder M.D. Martha’s Vineyard Hospital

Family planning in rwanda

Content

1. Case presentation

2. Back ground

3. Types of FP methods

4. Prevalence of FP in Rwanda

5. Advantages and disadvantages of FP

methods at health centers,DH

6. The barriers or challenges of FP

7. Responses to those barriers

1. Case presentation

A 3 Y.O male patient presented to the hospital for severe

malnutrition on background of failure to thrive Whose

physical examination reveals the generalized body

swelling.

The mother reported that he has 12 children and the previous

child is having 3 years and 11 months.

WHAT WILL YOU ADVISE THE MOTHER BEFORE

SHE LEAVES THE HOSPITAL?

2. Background

Family planning :

• Planning of when to have children, • Use of birth control, • Other techniques to implement such plans.

Background(ctd’)

Family planning is most usually applied to a female-male couple who wish to limit the number of children they have and/or to control the timing of pregnancy (also known as spacing children)

What do you think?

3.FP methods

1. REVERSIBLE METHODS

A. Traditional method

• Withdrawal (coitus interruptus)

• Fertility awareness methods

-Calendar-based methods

KUBARA+URUNIGI(cyclebeads)

-symptom-based methods

cervical mucus and body temperature

Examples of some traditional methods.

• The beads

• Cervical mucus

FP methods (Cont’d)

B. Modern method

B1.Long acting reversible

contraception(LARC)

• IUDS:<1%

• IMPLANTS:6%

• INJECTABLES:26%

B2. Short acting

contraceptives

• PILLS:7%

• CONDOMS:3%

Examples of some modern methods

IUDs IMPLANTS

FP methods (Cont’d)

2. IRREVERSIBLE METHODS

Tubal ligation Vasectomy

Success rate

4. Prevalence of FP in Rwanda

Prevalence cont’d

According to RDHS 2010:

URBAN Vs RURAL AREAS

• The urban area uses FP at 47% • The rural area uses FP at 45%

The use of contraception increases with

increasing education: • 60% of women with at least some secondary

education use a contraceptive method • in contrast to 43 %of women with no education.

CURRENT SITUATION IN RWANDA

CONCERNING NON REVERSIBLE CONTROL

Current situation in rwanda concerning

non reversible control Cont’d

Vasectomy 2010 → 0.0 case According to DHS 2010

Between Feb/2010 – Dec/2012 →2,523 vasectomies delivered. Tubal ligation at 0.8% according to DHS 2010

5.Advantages&desadvantages

How is FP relevant at the community level?

Advantages&desadvantages Cnt’d

1.Community Health center

advantages: • It is the nearest place • Counselling gets easier because they are in

the same community • It is costeffective • Reduces malnutrition in the community • Reducing adolescent pregnancies in the

community • Easy follow up

Advantages&desadvantages Cont’d

• Disadvantages

• Low number of technicians(nurses,trained health workers)

• Capacity building of the personel • Limited ability to control complications and

side effects • Innaccessibility of some methods and

contraceptive drugs. • Family Conflicts due to inadequate methods

Advantages&desadvantages Cont’d

• 2. District hospital

Advantages

• High capacity built of the personnel • Ability to handle the complications and side

effects • Availability of most of the contraceptive

methods

Advantages&desadvantages Cont’d

Disadvantages

• Far from the community • It is not costeffective • Difficult followup

Acceptance of permanent birth control in

Rwanda

• Women are more interested than men

• Men are not ineterested- they consider vasectomy as castretion

6. Challenges or Barriers

• Mindset: -men equate vasectomy with castration - fear of the death of the children • Rwandan culture-consider children as power and blessing. • Spiritual believes

Challenges cont’d

• Insufficient information • Insufficient health professionals on family

planning • inadequate counseling • Ignorance • Long distance • Lack of decision-making power of a single

partner

7.Response to those barriers

• Enhance education on FP

• Improve trainings to the health providers

• Promote campaigns and decentralization of FP services

• Increase the availability of family

planning methods

Key message

FP is the key to the answer of problems such as : Poverty Malnutrition Child death during delivery Everyone is an ambassador of the community!!!!

REFERENCES

• www.moh.gov.rw • Family planning strategic plan 2012-2016 • RHDS2010 report