Rwanda has experienced an impressive increase in contraceptive use during the last several
years. While it was one of the lowest contraceptive use countries in 2005, five years after it
has become one with the highest contraceptive prevalence rate (CPR) in Sub-Sahara Africa.
Between 2005 and 2010, the CPR has risen from 17 % to 52%. Unmet need dropped by half
and the total fertility rate (TFR) by 25% from 6.1 to 4.6 births per woman ((National Institute
of Statistics of Rwanda [NISR] et al., 2012). These achievements have gone far beyond the
national objectives for 2010, which were fixed at 26.3% for the CPR and 5.5 births for the
TFR (Ministry of Health [MOH], 2006). This dramatic increase which is uncommon in SubSahara
Africa has drawn attention and has raised curiosity after the mechanisms that have
driven the change in demographic behaviour and outcomes.
Which barriers to contraceptive use have been removed? Did the demand for modern
contraceptive change as well? To what extent were the conditions for this change specific for
Rwanda, and could other countries learn from the Rwandan experience?
To respond to these questions, this thesis examines the demand for and the barriers to
family planning in Rwanda in 2005, a period of low contraceptive use and high unmet need,
and analyses the progress made thereafter between 2005 and 2010 with the aim of informing
and guiding the policymakers to design and implement efficient future family planning
policies enabling to sustain and accelerate the ongoing change. The research has the
following objectives:
• To understand the level and structure of the demand for family planning in Rwanda in
2005 and to identify the barriers to meet that demand.
• To uncover the factors which have contributed to the contraceptive increase between
2005 and 2010, to the drop in unmet needs and to assess whether these factors vary
across communities and regions within the country.
To understand the context of this research, we present the background of Rwanda and the
evolution of its population in the last five decades. We also describe the problems resulting
from high density and brush the strategies undertaken to control population growth. Finally,
we present the theoretical framework and introduce the analytical questions that will be
answered in the successive chapters.