Annelet Broekhuis

Demand and Unmet Need for Means of Family Limitation in Rwanda

CONTEXT Rwanda is the most densely populated country in Africa, with substantial annual population growth. The current government seeks new policies for family limitation as a way to facilitate more sustainable development. METHODS Data from the 2005 Rwanda Demographic and Health Survey were used for a two-step analysis; binary logistic regression was used to identify factors associated with desiring to stop childbearing and having unmet need. RESULTS Eighty-seven percent of women aged 15-49 approve of family planning, but only 64% believe that their partner approves of it. There is a high level of unmet need for family limitation; 58% of women who want to stop childbearing do not use modern contraceptives. Demand was lower among women who did not approve of family planning, those who did not know their partners attitude toward family planning and those who had discussed family planning with their partner fewer than three times. Unmet need was higher among women who did not approve of family planning, those who believed their partner did not approve of family planning or who did not know his attitude, and those who had never discussed family planning with their partner or had done so only once or twice. CONCLUSIONS Negative attitudes toward family planning and failing structures of provision are the dominant constraints on the use of modern contraceptives in Rwanda. Community-based family planning services could greatly expand access, especially in underserved provinces.

Free Education in Rwanda: Just One Step towards Reducing Gender and Sibling Inequalities

In 2003, Rwanda introduced free education as part of government policy to improve school enrolment in general and the attendance of deprived children in particular. However, in addition to school fees, other factors hamper school careers of children. Shifts in attendance were analysed using binary logistic regression on data from the 2000 and 2005 Integrated Household Living Conditions Surveys. The results show that although the policy has been very successful, the objective has not been achieved. We find a strong effect of the sibling position of the child in the household and its relation to the household head. Substantial numbers of orphans/foster children in Rwanda do not profit from the free education policy and part of the children leave before completing school, in particular girls. Free education is only one step towards a more equitable distribution of educational opportunities.

Changes in fertility decline in Rwanda: A decomposition analysis.

After having stalled in the 1990s, fertility in Rwanda resumed its downward trajectory between 2005 and 2010. The total fertility rate declined from 6.1 to 4.6 and modern contraceptive use increased. However, it is unclear which determinants lay behind the previous stall and the recent strong drop in fertility. This paper contributes to an ongoing debate on the impact of social upheavals on fertility decline. We use a decomposition analysis, focusing on the change in characteristics and reproductive behaviour of women and their contributions to levels of fertility during 1992–2000 and 2000–2010. Results show that due to widowhood and separation the proportion of women who were married decreased between 1992 and 2000, but their fertility increased in the same period due to replacement fertility and an unmet need for family planning. After 2000, postponement of marriage and lower infant mortality contributed to lower fertility, but the most important effect is the overall lower fertility due not only to improved family planning provision but perhaps also to the sensitizing campaigns of the Rwandan government.

Variations in Desired Family Size and Excess Fertility in East Africa

This contribution studies the variation in desired family size and excess fertility in four East African countries by analyzing the combined impact of wealth, education, religious affiliation, and place of residence. The findings show an enormous heterogeneity in Kenya. Wealthy and higher educated people have fertility desires close to replacement level, regardless of religion, while poor, uneducated people, particularly those in Muslim communities, have virtually uncontrolled fertility. Rwanda is at the other extreme: poor, uneducated people have the same desired fertility as their wealthy, educated compatriots, regardless of their religion—a case of “poverty Malthusianism.”. The potential for family planning is high in both countries as more than 50% of the women having 5 children or more would have preferred to stop at 4 or less. Tanzania and Uganda have an intermediate position in desired family size and a lower potential for family planning. Generally, the main factor that sustains higher fertility is poverty exacerbated by religious norms among the poor only.

Fertility Decline in Rwanda: Is Gender Preference in the Way?

In 2007 Rwanda launched a campaign to promote 3 children families and a program of community based health services to improve reproductive health. This paper argues that mixed gender offspring is still an important insurance for old age in Rwanda and that to arrive at the desired gender composition women might have to progress beyond parity 3. The analyses are twofold. The first is the parity progression desire given the gender of living children. The second is gender specific replacement intention following the loss of the last or only son or daughter. Using the Demographic and Health Surveys of 2000, 2005, and 2010, we show that child mortality does not lead to extra parity progression beyond three, while having single gender offspring does and even more so when this is the result of the loss of the last son or daughter.

Role of conflict in shaping fertility preferences in Rwanda

Conflicts affect the social and economic conditions that could account for the stall in fertility decline in sub-Saharan Africa. In Rwanda the total fertility rate decreased very rapidly to 6.1 in the eighties but stalled at that level in the nineties. Part of the stall can be attributed to a lack of fertility control, but the question is whether social upheaval also affects fertility preferences. We identify three mechanisms through which the Rwanda conflict has led to a preference for larger families: mortality experience, modernization, the attitudes of third parties. Using data from DHS, we tested the contribution of these mechanisms to the preference for small, medium or large families. With the exception of sibling mortality, there is a strong impact by these mechanisms on the preference for large families, yet they do not fully account for the shifts in preferences over the years. Resume

Do Poverty Reduction Programmes Foster Education Expenditure? New Evidence from Rwanda:

The Rwandan Government has implemented various education policies that contribute to higher enrolment in education, but has become aware that these policies might be less effective for children from poor families. This study investigates the contribution of poverty reduction programmes on education expenditure of households. Using a multi-level regression analysis, combining district data on labour markets with detailed expenditure data on 7,230 households, it teases out the effects of several social protection programmes. The results show that access to health insurance and to waged work are positively related, while direct financial or in kind support are negatively related to paying into the children’s schooling. Non-agricultural employment opportunities in particular seem to stimulate education investments. Reducing the vulnerability of households might provide more equal access to these opportunities.

The effect of pregnancy spacing on fetal survival and neonatal mortality in rwanda: A Heckman selection analysis

Most studies on birth intervals and infant mortality ignore pregnancies that do not result in live births. Yet, fetal deaths are important in infant mortality analyses for three reasons: ignoring fetal deaths between two live births lengthens the measured interval between births, implying that short intervals are underestimated; the recommended inter-pregnancy interval (IPI) after a fetal loss is shorter (6 months) than after a live birth (24 months), as the effect of IPI on outcomes might differ according to the previous type of pregnancy outcome; fetal death will selectively reduce the population at risk of neonatal mortality, leading to biased results. This study uses the Heckman selection model to simultaneously estimate the combined effect of IPI duration and the type of pregnancy outcome at the start of the interval on pregnancy survival and neonatal mortality. The analysis is based on retrospective data from the Rwanda Demographic Health Surveys of 2000, 2005 and 2010. The results show a significant selection effect. After controlling for the selection bias, short (60 months) intervals after a fetal death reduce the chances of pregnancy survival, but no longer have an effect on neonatal mortality. For intervals starting with a live birth, the reverse is true. Short intervals (<24 months) do not affect pregnancy survival but increase the odds of neonatal mortality. If the previous child died in infancy, the highest odds are found for neonatal death regardless of the IPI duration.

The Effects of Interpregnancy Intervals and Previous Pregnancy Outcome on Fetal Loss in Rwanda (1996–2010)

In 2005, a WHO consultation meeting on pregnancy intervals recommended a minimum interval of 6 months after a pregnancy disruption and an interval of two years after a live birth before attempting another pregnancy. Since then, studies have found contradictory evidence on the effect of shorter intervals after a pregnancy disruption. A binary regression analysis on 21532 last pregnancy outcomes from the 2000, 2005, and 2010 Rwanda Demographic and Health Surveys was done to assess the combined effects of the preceding pregnancy outcome and the interpregnancy intervals (IPIs) on fetal mortality in Rwanda. Risks of pregnancy loss are higher for primigravida and for mothers who lost the previous pregnancy and conceived again within 24 months. After a live birth, interpregnancy intervals less than two years do not increase the risk of a pregnancy loss. This study also confirms higher risks of fetal death when IPIs are beyond 5 years. An IPI of longer than 12 months after a fetal death is recommended in Rwanda. Particular attention needs to be directed to postpregnancy abortion care and family planning programs geared to spacing pregnancies should also include spacing after a fetal death.