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Africa’s most densely packed nation promotes family planning to avert crisis.
A drop in fertility, others argue, would also assuage Rwanda’s potentially destabilizing “youth bulge” — a term used by social scientists to describe national populations with a large proportion of young adults. Countries with more than 40 percent of adults aged 15 to 29 in the overall adult population were more than two times as likely to experience civil conflict during the 1990s as countries with smaller youth proportions, according to a 2003 study by Population Action International, an advocacy group.
While the “youth bulge” theory does not ascribe causal links between demography and conflict, its proponents argue that large pools of youths — often with few outlets for employment — tend to be susceptible to recruitment by actors bent on violence.
In post-genocide Rwanda, advocates said, this is all the more reason to support family planning — a message embraced by the government of President Paul Kagame.
Across the country, according to the ministry of health, authorities are committed to giving all women access to modern contraception — including short-term methods such as condoms, pills and injectables and long-term methods like implants and male vasectomy. Though clients are now served at hospitals and health centers, the government has recently trained a network of 3,000 community health workers who provide door-to-door counseling and services in the most remote areas — all free of charge.
In addition, the government publicity machine has joined the effort by putting up billboards that promote condom use. An official order from the president requires local authorities to mention reproductive health every time they address their constituencies.
Rwanda is a largely Catholic country and 40 percent of its health centers are managed by the Catholic Church, which do not provide modern methods of family planning. But the Catholic centers, Nzabonimpa said, have now agreed to refer clients to facilities that do.
Despite many remaining challenges, the national effort appears to be working. Family planning use has increased quickly from just 4 percent in 2000 to 51 percent in 2010, according to government data.
One beneficiary of Rwanda’s family planning efforts — and a sign the country might yet avoid a Malthusian plight — is Beatrice Uwimana, a 30-year-old mother of three.
“Three children for me is enough,” she said, awaiting a contraceptive implant at Kigali’s Muhima District Hospital. "Life here is expensive. I cannot afford more. The kids I have — I want them to be healthy, happy and well-educated.”