Family planning means controlling the size of your family to one with the number of children you are able to feed, educate and care for in general. Rwanda has several reasons to promote family planning. One of our most important targets right now is the fight against maternal and child mortality – this is a substantial challenge for the health sector in Rwanda. We know that birth spacing of fewer than two years is linked with a child mortality of 186 deaths for 1,000 live birth but if we manage to convince families to have birth spacinf of 4 years the child mortality will reduce to 65 deaths for 1,000 births. With respect to maternal deaths, we have the evidence that shows that a birth spacing of 3 years reduces maternal mortality by 45%.
Another important reason to promote family planning is that our economic development needs it. For example, the most recent national demographic and health survey, in 2005, shows that Rwanda has a fertility rate of 5.5. With this fertility rate we will count 21.5 million Rwandans (up from apprxomiately 11 million now) by 2035. Since we have a very young population, even if we reduce dramatically the fertility rate to 2.3 children per woman we shall still have a population of 16 million Rwandans by 2035. In not reducing the population growth we are at risk of having huge consequences on many other sectors in addition to that of health. For example, in the education sector, we have fewer than 30,000 teachers in primary school. If we continue at the same fertility rate, by 2035 we will have 3.4 million children in primary school in need of more than 76,000 teachers. Even if we reduce the fertility rate to 2.3 we will have 2 million children in primary schools in need of 46,000 teachers. This second scenario is not ideal, but certainly would be better. Fewer children in the classroom will allow us to train them better, with higher quality and better trained teachers. In other sectors, the growth of the population might outrun our economic growth and land capacity causing overexploitation, deforestation, erosion, loss of soil fertility, and an overall fall in productivity.
We are on the journey to development, and we are better today than we were before. But we may reverse all of this if we do not put family planning at the forefront of our programs. This would force us to divide the gains we have now with too many people which would create a serious negative impact on access to quality health care and to quality education ultimately oiling the vicious wheel of poverty.
That is why in our Vision 2020 and Economic Development and Poverty Reduction Strategy (EDPRS) for 2008–2012, Rwanda recognizes the impact of rapid population growth on socioeconomic development and is committed to reducing high rates of fertility through family planning.
That is also why the Ministry of Health promotes all type of safe modern methods of family planning recommended by the World Health Organization. The objective is to meet the needs and the preferences of families. This realistic and strategic approach allows us to effectively satisfy the demands for family planning, ensuring that all Rwandan couples who want to space or limit their births have the choice of and access to quality reproductive health services, including a full range of contraceptives consistently available at affordable prices.
These methods comprise, among others, vasectomy for men and tuber ligation for women. The applicants to these definitive methods have to sign a consent form as these non-reversible methods require evidence of voluntary choice after full counseling.
To raise awareness about vasectomy and tuber ligation, the Ministry of Health provides true information to the population through multimedia campaigns. Moreover family planning is discussed during community meetings such as Umuganda and meetings with committees and opinion leaders. For vasectomy, associations of men speak about how they have experienced it, and talk about it to applicants. Vasectomy is a safe and effective permanent contraceptive method that makes men play an active role in controling the family size. When compared with tubal ligation, which usually requires hospitalization and general anesthesia, vasectomy is more simply done under local anesthesia as an outpatient procedure. Men recover quicker from vasectomy (1 hour) than women do from tuber ligation.
We know why people who want to undermine Rwandan development and progress brought the controversy about vasectomy. They say we want to use that tool for bad political purposes against the rights of humanity. But this was a lie, and was aimed to serve bad politicians. Nevertheless I have a question to those who have listened with complacency to that controversy around vasectomy? And why they didn’t assoiate themselves to an identical controversy around tuber ligation – especially since tuber ligation has been performed for so many decades, and is more painful and has more side effects? Was this controversy supported by underground machismo intent?