Regional Variations in Contraceptive Use in Rwanda: A Multilevel Analysis of Readiness, Willingness and Ability
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Abstract
Rwanda has shown a dramatic increase in contraceptive use between 2005 (17%) and 2010 (52%). However, the overall increase hides striking regional differences. Hence, this study aims to assess the role of regional-level factors to identify persistent barriers to contraceptive use. The research uses the Coale/Lesthaege framework that identifies three preconditions for the use of contraceptives: readiness, willingness and ability. These preconditions are measured at district level using the 2010-Rwanda Demographic and Health Survey and the 2007 Rwanda Service Provision Assessment. A multilevel logistic model is applied to regress the use of modern contraception on these factors.
The analysis shows that the overall regional variance is substantial and accounts for more than 50% of the combined effects of readiness, the need to limit or postpone births, willingness, the norms and attitudes toward contraception use. Ability in terms of access to and quality of family planning services does not add to the explanation. This should, however, be seen as a result of the improvement in access to services provision across the country. The study concludes that the regional differences in contraceptive use are due to the differences in readiness and willingness for family planning. The repositioning of family planning program has raised contraceptive uptake at national level but failed to address the regional variations. Both regional economic development and targeted family planning campaigns are vital to increase use of contraceptives in regions that are still lagging behind.
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