Rwandan reproductive health
Since 2000, Rwandan reproductive health has taken numerous precautions to prevent maternal and newborn deaths among many other national health improvements.[1] From 2006 on, major changes began in rural areas to provide community-based health insurance.[1]
Health sector reforms
Rwanda has advanced their policies in six main categories: health workforce, service delivery, financing, leadership and governance, medical products, vaccines and technologies, and information.[1] Due to the 1994 Rwandan genocide, a great deal of health related infrastructure and professionals were destroyed, but the government increased the number of healthcare providers from 2005 to 2008 especially in rural areas.[1] As for financing, Rwanda has increased from $16.94 per capita in 2003 to $45.42 per capita in 2008 with funds provided to health services based on performance in pre-natal care, postpartum natal care, and transmission of HIV from mother to child.[2] The leadership and governance of Rwanda saw the need to address maternal care and reproductive health issues in order to reduce poverty in the country.[1] Additionally, the government distributed predominately mainstream drugs in order to combat HIV/AIDS.[1] For information, the government developed one database that provides healthy competition between health care providers and tracks their overall progress.[1] The increase in mutual health insurance (MHI) has also led to an increase in the use of health services.[3]
Maternal health
Half of the deaths faced in maternal health are caused by hemorrhage, sepsis and unsafe abortion, with 18% of deaths caused by unsafe abortions which makes it a critical issue in Rwanda.[1] Although, skilled care at delivery reached up to 90% in 2015, proving that Rwanda has implemented expansive health reforms and community-based insurance.[1] Interestingly, female-headed households are less likely to deliver in a health facility which can lead to complications.[4] The likelihood of a woman seeking a health facility for delivery shares a positive correlation with the level of education received, the wealth of a family, and an urban location, while it also shares a negative correlation with employment.[4] One major issue continually faced is the amount of prenatal care received- if there is none or a limited amount, a woman is likely to not even seek professional assistance during home delivery.[4]
Family planning
Family planning was strongly discouraged and widely unknown about following the Rwandan genocide and need for population regrowth.[5] However, a new national population policy was implemented by female legislators in 2003.[5] The Rwandan Ministry of Health launched a new family planning policy in 2006 to provide outreach services and performance-based incentives.[1] Part of this included the government influenced branding of Prudence Plus condoms in outlet stores.[6] These condoms are used regardless of socioeconomic status in the average household.[6] There is also a movement to provide condoms for students in secondary schools.[7] This concept is frowned upon due to cultural standards for adolescent sex, yet some schools recognize the need for condom distribution to promote healthy sexual behaviors.[7] While abortion has been legal in Rwanda since May 2012 for cases of rape, incest, and fetal impairment, many more abortions take place.[8] The average cost for an unsafe abortion is $26 while a safe abortion is cited around $53.[8] The use of the birth control pill has also been put in place since 2010 which has shown no negative results to the quality of life and/or work habits seen in women.[9]
HIV/AIDS
The community-based insurance developed in 1999 in order to protect those with financial barriers (widows, the poor, orphans, and those living with HIV) to extend health insurance to all citizens.[1] Since 2006, all citizens have had access to public health care.[1] HIV focused health care does not have any direct links to the decline of delivery in other health care services.[10] In fact, HIV treatments further improve the delivery of essential health care services, especially antenatal care.[10]