Local understandings of reproductive health and family planning in Rwanda's southern kayonza district

Background: Rwanda remains one of the most densely populated countries in Africa, with a population growth rate of 2.7%. Rwanda's Vision 2020 outlines a framework for increasing family planning uptake to curb population growth, while improving population welfare. In order to increase uptake and retention in family planning programs, it is critical to understand cultural norms surrounding birth, fertility, and family composition.

Methods: We conducted semi-structured interviews with 162 male and female community members, community health workers, and health care providers. Interviews took place in Rwanda's southern Kayonza district, which is supported through a Partners In Health and Ministry of Health partnership. Participants were asked to reflect on family planning, sexuality, and reproductive health.

Results: During interviews, study participants shared information they received about family planning through national broadcasts and community meetings. Interviewees spoke of family planning as an opportunity to contribute to Rwanda's development, reflecting themes from public service announcements and health education campaigns. However, many individuals also shared experiences cycling in and out of the family planning program according to their changing fertility needs. Participants shared their efforts to reconcile desires for large families, influenced by recent memories of conflict and insecurity, with messages from the national family planning program that emphasize the benefits of reduced family size.

Conclusions: These narratives highlight the importance of understanding local, and constantly evolving, belief systems in order to develop public policies that encourage uptake and retention in family planning programs.