Online Program

“we don't know what's in our bodies”: Adolescent perspectives on reproductive health and family planning in Rwanda's southern kayonza district

Tuesday, November 5, 2013 : 3:15 p.m. - 3:30 p.m.

Didi Bertrand Farmer, MA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Fidele Ngabo, Ministry of Health of Rwanda, Kigali, Rwanda
Paulin Basinga, MD, PhD, National University of Rwanda School of Public Health, Kigali, Rwanda
Grace Ryan, BA, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Francois Kamali, Nurse, Rwinkwavu District Hospital, Rwanda
Elias Ngizwenayo, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Jacklyn St. Fleur, MD, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Leslie Berman, MPH, Partners In Health-Inshuti Mu Buzima, Kigali, Rwanda
Paul Farmer, MD, PhD, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
Michael L. Rich, MPH, MD, Partners In Health, Harvard Medical School, Brigham and Women's Hospital, Boston, MA
Background: The Ministry of Health Rwanda (RMoH) has identified gaps in reproductive health policy and education that threaten adolescents' rights to care. However, there is a lack of qualitative evidence on how social factors affect adolescents' reproductive health. This study elicited youth perspectives in Rwanda's southern Kayonza district, where communities receive enhanced services through an RMoH-Partners In Health collaboration.

Methods: 36 adolescents (18 male, 18 female) ages 13-17 not enrolled in school, and 36 of their enrolled peers participated in focus groups and surveys. Youth reflected on knowledge of reproductive health and access to services. We present a descriptive analysis of their responses in the context of a post-conflict, rural region that has experienced rapid changes in development and population growth

Results: Youth reported difficulties accessing reproductive health services due to stigma surrounding pre-martial sex. Adolescents had limited opportunities to learn about reproductive health, as educators were often reluctant to offer information. Interviewees were often unable to discuss sexual health with parents, community health workers or health care providers, and many feared consequences if their parents discovered they were involved in sexual relationships. Poverty, lack of open communication, and gendered expectations for dating behavior dominated many narratives, and rendered young women vulnerable to sexual violence and exploitation.

Conclusions: These narratives highlight the complexities of adolescent sexuality and interpersonal relationships. Our findings reinforce the importance of ensuring that young adults are able to access reproductive health services and education, in order for the RMoH to fulfill its commitment to adolescent health.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Describe reproductive health services available for adolescents in Rwanda Discuss adolescent perspectives on reproductive health and family planning in Rwanda's southern Kayonza district

Keyword(s): Adolescents, International, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a medical anthropologist who has been working for the last 15 years as a community organizer, activist for the rights of women and girls, and researcher in Paris, Haiti and Rwanda. Since 2006 I have served as Director of the Community Health Program for Partners In Health Rwanda-Inshuti Mu Buzima, where I am the Principle Investigator on several cross-site studies focusing on community health, reproductive health, and traditional healing.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.