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Jessica Malter
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IN RWANDA, NOTWITHSTANDING CONSIDERABLE INCREASES, CONTRACEPTIVE USE NOT KEEPING PACE WITH DESIRE FOR SMALLER FAMILIES

Complications from Unsafe Abortion Harm Women and Drain Health Resources

Findings from the first national study on the incidence of unintended pregnancy and abortion in Rwanda show that nearly half (47%) of all pregnancies in the country are unintended. The report, Unintended Pregnancy and Induced Abortion in Rwanda: Causes and Consequences, was issued by the National University of Rwanda School of Public Health (NURSPH) and the Guttmacher Institute, which jointly conducted the study.

These unintended pregnancies are occurring despite the county's remarkable progress in increasing contraceptive use over the last decade. In 2010, 44% of married or cohabiting Rwandan women were using a modern method of contraception, compared with just 4% in 2000. However, the increase in contraceptive use has not kept pace with the growing desire for smaller families and does not extend to the increasing proportion of unmarried young women who are sexually active.

In 2010, an estimated 19% of married women (250,000) and 56% of unmarried sexually active women 15-29 years old (40,000) had an unmet need for contraception—they wanted to avoid pregnancy but were not using a contraceptive method.

The findings were presented in Kigali on April 23 at a Family Planning Day event organized by NURSPH. The event brought together key stakeholders, including Ministry of Health officials, UN representatives, leading NGOs working on health issues and reproductive health advocates, who reviewed the most recent evidence on unintended pregnancy and unsafe abortion and developed a set of policy recommendations to better address the reproductive health needs of Rwandan women. Among these recommendations were expanding provision of postabortion care; making emergency contraception widely available throughout the country; better integrating family planning services and postabortion care; and educating women and medical and law-enforcement professionals about the conditions under which abortion is legal in Rwanda.

"The study's findings indicate that Rwanda must build on the strong progress made over the last decade and further strengthen its family planning policies and programs," said Paulin Basinga, formerly with NURSPH and lead author of the report. "Expanding the range of contraceptive options available to women and targeting those women who are at highest risk of unintended pregnancy are especially important if we are to reduce the rate of unplanned pregnancies in the country."

The researchers found that approximately 22% of all unintended pregnancies end in induced abortion. Rwanda's abortion rate—25 per 1,000 women of reproductive age—is significantly lower than that of Eastern Africa (38 per 1,000), and lower than that for the African continent as a whole (29 per 1000). Although the abortion rate is relatively low, abortion still places a heavy burden on Rwandan women and the health care system because virtually all abortions occur outside of the formal health system where safety cannot be assured.

In 2009, 24,000 of the approximately 60,000 women who had an abortion suffered complications that required medical treatment. Of these, just 17,000 received adequate treatment in a health facility; thus, 30% of the women who needed care did not receive it. According to the study, this was most likely a result of insufficient access to postabortion care and reluctance on the part of women to seek treatment, which could potentially expose them to harsh judgment or even prosecution for engaging in a stigmatized and illegal act.

Poor Rwandan women, in urban and rural areas, are far more likely to experience complications (54–55%) than wealthier women in both rural (38%) and urban areas (20%). According to experts surveyed, poor women are most likely to self-induce or rely on untrained providers such as traditional healers. Abortions from these sources have the highest estimated rate of complications—61–67%.

"The Rwandan government has already started to take action to improve access to postabortion care and we hope these findings provide further guidance on how to strengthen efforts to ensure that all Rwandan women receive the care they need," said co-author Ann Moore of the Guttmacher Institute.

For more information:

Click here for the full report Unintended Pregnancy and Induced Abortion in Rwanda: Causes and Consequences, also available in French

Click here for the fact sheet Abortion in Rwanda, also available in French

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