Q&A  A Gynecologist Responds to Popular Questions on Contraceptive Use in Rwanda In Rwanda, the contraceptive prevalence rate is 45 percent and unmet needs for Family Planning are 19 percent, according to DHS 2010. The ServiceMag interviewed Dr. Alphonse Butoyi, a gynecologist at Kibagabaga Hospital on several issues that hinder access to family planning and contraceptive use in Rwanda. Below are the excerpts:

What is the current situation of Reproductive Health in Rwanda?
According to the DHS 2010, the average Rwandan woman gives birth to 4.6 children (total fertility rate). This has reduced from 6,1 in 2005. Maternal mortality ratio decreased from 750/100,000 live births in 2005 to 487/100,000 live births in 2010

What are the major barriers to accessing family planning in Rwanda?
The main barrier is misunderstandings sprouting from myths about contraceptive use. Several women share false information about contraceptive methods among themselves and rely on this information. They talk about false side effects such as uterine cancer, change of sexual appetite (libido), which is false. As a result, many women are afraid of using one or several contraceptive methods.

On average, how many women seek your advice regarding the use of family planning methods?
In my daily consultation, I meet about one or two in every 10 patients who ask about family planning services. However, the hospital has a special department that deals with contraception.

What is the most popular contraceptive used?
Many women use injectables (Depo Provera) because most say they do not experience side effects from it. The other preferred contraceptive is the IUCD (Intrauterine Core Device) for it follows normal physiology (doesn’t disrupt hormonal changes).

What challenges do you meet when educating women on contraceptive use?
The main challenge is to explain the mechanism and action of different contraceptive methods and their side effects. On several occasions women have said that they have asked other women for advice on using certain contraceptive methods and have received false or half information on the details of the contraceptives. Therefore, as a doctor, you have to find an appropriate and simple way to explain the various benefits and side effects and emphasize the fact that all these vary and differ from one woman to another.

Do they approach you as a couple or alone?
Women come mostly alone and rarely with husbands. It’s mostly the educated who often come as couples for consultation. When students are informed about their choices, teenagers will avoid undesired pregnancies, risky abortions and the spread of STIs.

Are you approached by youth,especially unmarried youth?
Rarely. There is no misunderstanding between them and us. However when they do, we have realized that they mostly use short-term contraceptives (pills).

What is your take on sex education in schools?
I really appreciate its value as it used to be a taboo. Information is shared at the right time and the right way. When students are informed about their choices, teenagers will avoid undesired pregnancies, risky abortions and the spread of Sexual Transmitted Infections.


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