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

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.