**_9_**

## **_Family_** _Planning Programs in Sub-Saharan Afnica_

The Office National de la Population (ONAPO) was established<sup>by decree in 1981 and</sup> the political will to support its efforts has been strong<sup>and unwavering. By the mid-1980s, with</sup> financial and technical assistance from A.I.D, UNFPA<sup>and other donors, ONAPO and the</sup> Ministry of Health (MINISANTE) had instituted<sup>family planning services in about 65 percent of</sup> the government health clinics throughout the country.<sup>In many of these, however, family planning</sup> was offered at fixed days and hours separately<sup>from other services. By late 1988, estimates from</sup> service statistics indicated a national prevalence<sup>rate of 4.2 percent, an increase from the one</sup> percent reported by the 1983 National Fertility<sup>Survey, but the gap between national policy and</sup> individual practice was formidable.

Fert.lity for the purpose of transmitting life is highly valued<sup>in Rwanda as a sacred duty</sup> to family, ancestors, and lineage (May et al.,<sup>1990). Postpartum abstinence is not practiced but</sup> other methods, principally breastfeeding fo-<sup>an average 21 months, are used for birth spacing,</sup> which is also very highly valued. Closely spaced births<sup>are severely criticized as endangering the</sup> welfare of the entire family as well as the survival<sup>of the penultimate child. The strength of the</sup> desire to postpone births suggests receptivity to contraception<sup>for that purpose, if services become</sup> widely available and fears of side effects are allayed.

The position of the Roman Catholic Church with respect<sup>to contraception has been an</sup> obstacle of considerable magnitude. About 40 percent<sup>of the people are Roman Catholic and, until</sup> December 1985, the Roman Catholic A;chbishop<sup>of Kigali was a member of the central</sup> committee of the MRND. According to May et al.<sup>(1990), fifty to sixty percent of all Rwandans</sup> use health facilities operated by the Catholic church.<sup>They offer only natural family planning</sup> methods. High-level discussions between the government<sup>and the church hierarchy have produced</sup> statements of cooperation and the intention of the<sup>church to promote natural family planning</sup> methods vigorously (Viviateur, 1988) but the constraints<sup>remain on development of a widely-</sup> available service system.

# **_The_** _Rulengeri Project_

The Ruhengeri project introduced community education<sup>and distribution of contraceptives</sup> by volunteers who belong to the network of<sup>the Centers for Development and Continuing</sup> Education (CCDFP) of the Ministry of the Interior and<sup>Community De-velopment (MININTER).</sup> Rural development in Rwanda is organized around<sup>the CCDFP's</sup><sup>_Abakangurambaga_or "wakers</sup> of the people" who provide information and advice on<sup>many development topics throughout the</sup> country at a ratio of one volunteer to as few as ten<sup>families. Rwanda's system of comrnunal labor</sup> and frequent community meetings provide forums<sup>for communication of the development</sup> messages. The Abakangurambaga are generally multi-purpose<sup>and promote community activities</sup> as directed by the CCDFP. They receive no compensation<sup>from any government body and the</sup> communities are not expected to pay them.

The plan was for ONAPO to select and train Abakangurambaga<sup>as volunteer specialists</sup> for a national information, education and communication<sup>(IEC) program. The pilot operations</sup> research project, designed and conducted in cooperation<sup>with Columbia University, was to</sup> provide an experiential as well as an experimental basis<sup>for the national program.</sup> The Ruhengeri Region chosen for the study is<sup>a mountainous area where the rural</sup> dwellers are particularly hard-pressed to reach health<sup>clinics, and contraceptive prevalence was</sup>