Barriers to Contraceptive Access and Use Among Youth (15-24 years) Living in Informal Urban Settlements of Kigali, Rwanda

Background: Contraceptive use among youth below 19 years in Rwanda is still very low, as
low as 3.7%, yet their level of sexual activity is high. By 2020, 42% and 31% of women and
men respectively had initiated sex before the age of 20 years. Rwanda’s total population is
composed of 67% young people below 25 years. Low contraceptive use among this youth
population increases their risk of unintended pregnancies, sexual violence, and sexually
transmitted infections. Additionally, 61.3% of Rwanda’s population lives in informal
settlements/slums. It has been documented, for example, that those residents of urban slums in
Kenya engage in riskier sexual practices, with reduced access to sexual and reproductive health
services, and have a higher HIV prevalence than urban non-slum residents (J. Madise et al.,
2012). There is no study in Rwanda that has examined contraceptive use among youth living
in impoverished communities, herein our study described as informal urban settlements/slums.
Aim: To identify and quantify the barriers to contraceptive access and use among youth, aged
15-24 years, living in informal urban settlements in Kigali.
Methodology: This is a quantitative cross-sectional study based on a convenience sample of
323 participants from youth centers and institutions of learning who completed a structured
questionnaire.
Results: A total of 323 respondents participated in this study. Most of them were – aged 15-
19 years old (n=194, 60.1%); females (n=184, 57%); single (n=304, 94.1%); had attained or
were currently in secondary school (n=265, 82%); students (n=232, 71.8%) by occupation, and
Christians (n=288, 89.2%) by religion. The respondents demonstrated high awareness of
contraception 317 (98.1%) with the most frequent source of information being schools (72.4%).
However, their awareness was mostly limited to male condoms 302 (93.5%), so was their use
(75.2%). Most respondents (70.6%) reported the source of their contraceptives to be boutiques
or pharmacies. About 40.6% of the respondents had already had sex with the average age of
sexual initiation being 17.43 years. Perceived or real lack of confidentiality and privacy from
the service points and providers, unavailability of contraceptives in schools, restrictive laws,
fear, and concerns/myths about contraceptives and feeling embarrassed or ashamed to obtain
contraceptives were highly reported to have been barriers to access and use of contraceptives
among respondents. But statistically “pressure to birth” was the only significant barrier which
had a predictive relation with using contraceptive utilization with OR=4.286, CI [1.219,
15.068] and was associated with marital status of the respondents. Those who were married
were four times not likely to use contraceptives.
Discussion: The level of contraceptive education and services that youth are getting in
Rwanda is applaudable, but a lot still needs to be done to diversify the awareness of other forms
of contraception other than male condoms. The government collaborative initiative with local
NGOs to place kiosks/boutiques in informal settlements has improved access to contraceptives
among the youth. However, constant stocking of different forms of contraceptives which is
currently lacking is necessary for these boutiques/kiosks to serve a better purpose of their
existence. There is need to do a qualitative study to understand further the contextual barriers
faced by youth living in informal urban settlements of Kigali.