Excess Fertility and Family Planning in Rwanda: Understanding the shift to a high contraceptive prevalence country

Dieudonne Muhoza Ndaruhuye

Research output: ThesisDoctoral thesis 1 (Research UU / Graduation UU)


Rwanda has experienced an impressive increase in contraceptive use and fertility decline during the last decade. Between 2005 and 2010, the contraceptive prevalence rate (CPR) has risen from 17 % to 52%, reducing unmet need and the total fertility substantially (from 6.1 to 4.6 children per women). This sharp increase has raised many questions. 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 has examined the demand for and the barriers to family planning in Rwanda in 2005, a period of low contraceptive use and high unmet need. It analysed the progress made between 2005 and 2010 with the aim of informing and guiding policymakers to design and implement efficient future family planning policies enabling to sustain and accelerate the ongoing change. Data from the 2005 and 2010 Rwanda Demographic and Health Surveys are analysed by applying quantitative methods.
Results have shown that in 2005, excess fertility was substantial in Rwanda indicating a high level of demand for family planning compared to that in neighbouring countries (Uganda, Tanzania and Kenya). This lower fertility preference stems principally from poverty. Contrary to couples in many other agrarian African societies, Rwandan parents see a large offspring as a burden rather than as a useful workforce. Pressure on resources resulting from land scarcity and high population density, has reduced the expected benefits from children. Awareness of excess fertility was found among all segments of the population, irrespective of educational level, economic status or religious affiliation. As the demand for contraception was high and the contraceptive use was low, unmet need for family planning was the highest found in Africa. This huge unmet need was associated with various factors: attitudes towards family planning (insufficient knowledge, lack of discussion between partners on the topic, fear for negative side effects, religious objections), poverty among the majority of the population (financial constraints), and low access to family planning services as the infrastructure for reproductive health services was badly damaged during the 1990-1994 civil war, genocide and its aftermath.
The impressive increase in contraceptive use - explaining the ongoing fertility transition in Rwanda – did not arise from socio-economic development, but is linked more to poverty and deprivation that offered a fertile soil to family planning sensitizing campaigns. The study recommends further improvement in reproductive health services and continued advocacy to avoid the remaining unwanted pregnancies and to accelerate the socio-economic development that the government aspires for.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Utrecht University
  • Hooimeijer, Pieter, Primary supervisor
  • Harts - Broekhuis, Annelet, Co-supervisor
Award date22 Dec 2014
Print ISBNs978-90-393-6182-5
Publication statusPublished - 22 Dec 2014


  • Excess
  • unmet need
  • family planning
  • fertility
  • poverty
  • Malthusianism
  • Regions
  • Variations
  • Africa
  • Rwanda


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