An examination of the barriers to and benefits from collaborative couple contraceptive use in Rwanda

Abstract

Background Supportive male involvement is strongly correlated with contraceptive use. In Rwanda, where the contraceptive prevalence rate among married women increased from 17 to 52% from 2005 to 2010, and stagnated at 53% in 2015, understanding the role of male partners in collaborative couple contraceptive use can help inform programs designed to further increase the use of contraception in Rwanda. Methods This study utilized qualitative methods in 2018, specifically 32 in-depth interviewers with mostly current users of modern contraceptive methods and eight focus group discussions with family planning providers—both family planning nurses and community health workers (CHWs). Respondents were from Musanze and Nyamasheke Districts, the districts with the highest and lowest modern contraceptive use, respectively, to explore the role of couple collaboration in family planning use in Rwanda. Data were analyzed using the thematic content approach in Atlas.ti (8). Results Findings demonstrate that some men are opposed to use of male methods of contraception, and some are opposed to any contraceptive use, which can lead to covert use. Women and providers prefer collaborative couple contraceptive use—as a result, providers advocate for and encourage male partner participation in contraceptive use. Women are most often burdened with seeking out information, initiating discussions, and sharing information discovered about contraceptive use with partners. Decision-making about contraceptive use, once discussed, can be collaborative and motivated by financial considerations. When couple contraceptive use is collaborative, benefits range from marital harmony to husband’s support of sustained use through reminders about appointments, joint counseling, and support in managing side effects. Conclusion Family planning providers at the community and clinic levels encourage collaborative contraceptive use among couples and some Rwandan couples communicate well about family planning use. Despite the positives, women are expected to source family planning information, share that information with their male partners, seek out family planning services, and use family planning. If more Rwandan male partners accepted use, used male methods of contraception, and participated even more in the work it takes to use family planning, the potential for sustained, and even enhanced, contraceptive use in Rwanda could be realized.

Utilisation of modern contraceptives by sexually active adolescent girls in Rwanda: a nationwide cross-sectional study

“…The Rwanda demographic health survey (RDHS) 2020 further reports that 15% of adolescents have begun childbearing at the age of 19 years [12]. Moreover, there is limited information on contraceptive use among adolescents in Rwanda, where most of the available studies have looked at women in general [4,10,[13][14][15][16][17]. In order to formulate evidence-based policies aimed at increasing the utilization of modern contraceptives, there is a need for more recent adolescent-focused studies.…”

Family planning demand generation in Rwanda: Government efforts at the national and community level impact interpersonal communication and family norms

“…They also help to dispel rumors circulating in the community and normalize dialogue about contraceptives. Discussing family planning in the community setting has also helped to promote male involvement and positive spousal communication [ 32 ]. Community education has played an important role in the demand and uptake of contraceptives in Rwanda as well as in Nigeria [ 10 ].…”

Perceptions of Partners’ Fertility Preferences and Women's Covert Contraceptive Use in Eight Sub‐Saharan African Countries

“…These couples may be receptive to negotiating family size and spacing. Many studies also highlight how men and women ideally see family planning as a joint decision and how it can even lead to marital stability (Harrington et al 2019; Schwandt et al 2021). Interventions targeting couples could seek to increase couple communication around family size goals and preferences, encourage safe and healthy negotiation, and compromise where spouses differ.…”

“…Interventions that encourage spousal trust may serve to counter the assumption that family planning encourages spousal infidelity. Indeed, recent studies show promise that couple interventions in the SSA region can be successful in family planning uptake (Abdulkadir et al 2020; Schwandt et al 2021).…”