Regional Variations in Contraceptive Use in Rwanda: A Multilevel Analysis of Readiness, Willingness and Ability

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Dieudonne Ndaruhuye Muhoza


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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Muhoza, D. (2018). Regional Variations in Contraceptive Use in Rwanda: A Multilevel Analysis of Readiness, Willingness and Ability. Journal of Population and Social Studies [JPSS], 26(3), 248-261. Retrieved from


Abbott, P., Sapsford R. & Rwirahira J. (2015). Rwanda’s potential to achieve the MDGs for health. World Medical and Health Policy, 7, 101–120.
Abbott, P., Sapsford R. & Binagwaho A. (2007). Learning from success: How Rwanda achieved the millennium development goals for health. World Development, 92, 103-116.
Bawah, A. A., Akweongo P., Simmons R. & Phillips J. F. (1999). Women’s fears and men’s anxieties: the impact of family planning on gender relations in northern Ghana. Studies in Family planning, 30, 54-66.
Bongaarts, J. & Watkins S. C. (1996). Social interactions and contemporary fertility transitions. Population and Development Review, 22 (4), 639-682.
Bongaarts, J. (1997). Trends in unwanted childbearing in developing world. Studies in Family Planning, 28 (4), 267-277.
Brunie, A., Tolley E. E., Ngabo F., Wesson J. & Chen M. (2013). Getting to 70%: Barriers to modern contraceptive use for women in Rwanda. International Journal of Gynecology and Obstetrics, 123 (2013), e11-e15
Cammack, M. & Heaton T. B. (2001). Regional variation in acceptance of Indonesia’s family planning. Population Research and Policy Review, 20, 565-585.
Castle, S., Konate M. K., Ulin P. R. & Martin S. (1999). A qualitative study of clandestine contraceptive use in urban Mali. Studies in Family planning, 30, 231-248.
Cleland, G. J., Ndugwa P. R. & Zulu M. E. (2012). Family planning in sub-Saharan Africa: Progress or stagnation? Bull World Health Organ, 89, 137–143.
Coale, A. J. (1973). The demographic transition reconsidered, in International Union for the Scientific Study of Population (IUSSP) (ed), Proceedings of the international population conference, 1, 53-73. Liège: Editions Ordina.
Elfstrom, K. M. & Stephenson R. (2012). The role of place in shaping contraceptive use among women in Africa. PLoS one, 7, e40670.
Emina, J. B. O., Chirwa T. & Ngianga-Bakwin K. (2014). Trend in the use of modern contraception in sub-Saharan Africa: Does women's education matter? Contraception, 90(2), 154-161. doi:
Garson, G. D. (2013). Hierarchical linear modeling: Guide and applications. Thousand Oaks, CA: SAGE Publications Ltd. doi: 10.4135/9781483384450.
Greenland, S. (2000). Principles of multilevel modelling. International Journal of Epidemiology, 29, 158–167.
Haider, T. L. & Sharma M. (2012-2013). Barriers to family planning and contraception uptake in sub-Saharan Africa: A systematic review. International Quarterly of Community Health Education, 33 (4), 403-413. doi: 10.2190/IQ.33.4.g.
Hox, J. J. (2010). Multilevel analysis: Techniques and applications. New York: Routledge.
Hulton, L. A., Cullen R. & Khalokho S. W. (2000). Perceptions of the risks of sexual activity and their consequences among Ugandan adolescents. Studies in Family planning, 31, 35-46.
Kimani, M. (2007). Trends in contraceptive use in Kenya 1989-1998: The role of socioeconomic, cultural and family planning factors. African Population Studies, 21(2), 3-21.
Lesthaeghe, R. & Vanderhoeft C. (2001). Ready, willing, and able: a conceptualization of transitions to new behavioral forms. In: Casterline JB, editor. Diffusion processes and fertility transition: selected perspectives. Washington: National Academy Press. pp. 240-264.
Luke, D. A. (2004). Multilevel modelling (3. ed.). Thousand Oaks, CA: Sage. ISBN 978-0-7619-2879-9.
Mahmood, N. & Ringheim K. (1997). Knowledge, approval and communication about family planning as correlates of desired fertility among spouses in Pakistan. International Family Planning Perspectives, 23 (3), 122-129.
Ministry of Health of Rwanda (MOH). (2006). National family planning policy in Rwanda and its five-year strategies (2006-2010). Kigali: MOH.
Muhoza, N. D., Rutayisire P. C. & Umubyeyi A. (2016). Measuring the success of family planning initiatives in Rwanda: A multivariate decomposition analysis. Journal of Population Research, 33(4), 361–377. Doi: 10.1007/s12546-016-9177-9.
National Institute of Statistics of Rwanda (NISR) & ORC Macro. (2006). Rwanda Demographic and Health Survey 2005. Calverton, MD, USA: NISR and ORC Macro.
National Institute of Statistics of Rwanda (NISR), Ministry of Health & ICF International. (2012). Rwanda Demographic and Health Survey 2010. Calverton, MD, USA: NISR, MOH and ICF International.
National Institute of Statistics of Rwanda (NISR), Ministry of Health of Rwanda, & Macro International Inc. (2008). Rwanda Service Provision Assessment Survey 2007. Calverton, Maryland, U.S: NISR, MOH, and Macro International Inc.
Ndaruhuye, M. D., Broekhuis A. & Hooimeijer P. (2009). Demand and unmet need for means of family limitation in Rwanda. International Perspectives on Sexual and Reproductive Health, 35 (3), 122–130.
Ngome, E. & Odimegwu C. (2014). The social context of adolescent women’s use of modern contraceptives in Zimbabwe: a multilevel analysis. Reproductive Health, 11, 64.
Pritchett, H. L. (1994). Desired fertility and the impact of population policies. Population and Development Review, 20(1), 1-55.
Raudenbush, S. W & Bryk A. S. (2002). Hierarchical linear models: applications and data analysis methods (2e et 3ed.). Thousand Oaks: Sage Publications. ISBN 0-7619-1904-X. page 485.
Stephenson, R., Baschieri A., Clements S., Hennink M. & Madise N. (2007). Contextual influences on modern contraceptive use in Sub-Saharan Africa. American Journal of Public Health, 97(7), 1233-1240.
Tabachnick, B. G. & Fidell L. S. (2007). Using multivariate statistics (5th ed.). Boston; Montreal: Pearson/A & B. ISBN 0-205-45938-2.
Westoff, F. C. (2012). The recent fertility transition in Rwanda. Population and Development Review, 38, 169–178.
Williamson, M. L., Parkes A., Wight D., Petticrew M. & Hart G. J. (2009). Limits to modern contraceptive use among young women in developing countries: A systematic review of qualitative research. Reproductive Health Journal, 6, 3. doi: 10.1186/1742-4755-6-3.