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'''OVERVIEW''' | '''OVERVIEW''' | ||
Rwanda is a country that has shown remarkable progress related to sexual and reproductive health care in the past few decades. You can legally obtain oral contraceptives (birth control pills) without a prescription, and condoms are widely sold in pharmacies, kiosks, bars and markets. Other contraceptive methods, such as IUDs and injectables, are also available. Furthermore, you can obtain the emergency contraceptive pill (morning after pill) without a prescription. The country provides universal health care coverage for HIV patients, and aggressive efforts have been made to reduce HIV transmission from parent to child in the country. While we're not sure if PrEP is available in Rwanda, PEP should be available. Menstrual hygiene is a challenging issue in Rwanda, where many women have inadequate access to menstrual products and may miss school during their periods. We have provided more information on this topic in the "Menstruation" section. Regarding pregnancy, women are entitled to 12 weeks of maternity leave with full pay, though this right may not translate to all workers and all work environments. Finally, abortion is permitted in some cases, which are detailed in the "Abortion" section. Overall, Rwanda, like all countries, experiences challenges and hurdles related to women's health care. However, it has also demonstrated focused and effective strategies to rebuild its health care infrastructure and tackle immediate issues of concern, such as HIV transmission from mother to child. | |||
==Contraception (Birth Control)== | ==Contraception (Birth Control)== | ||
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Contraceptive Use Worldwide 2015]</ref> | Contraceptive Use Worldwide 2015]</ref> | ||
Despite notable progress, there is room for improvement related to contraceptive accessibility and education. In Rwandan schools, there exists no comprehensive sex-education,<ref>[http://www.newtimes.co.rw/section/read/65697/ Sex education remains unspoken in secondary schools]</ref> though efforts have been made to improve teacher training in sex-education by UNFPA, as of 2016.<ref>[http://rwanda.unfpa.org/en/news/new-curriculum-promote-sex-education-schools New curriculum to promote sex education in schools]</ref> Furthermore, nearly half of all pregnancies (47%) in Rwanda are unintended, as of 2013.<ref>[https://www.guttmacher.org/fact-sheet/abortion-rwanda Guttmacher Institute: Abortion in Rwanda, April 2013]</ref> There are significant issues related to sexual trauma, sexual violence and bodily autonomy experienced by many Rwandans, following the Rwandan Civil War | Despite notable progress, there is room for improvement related to contraceptive accessibility and education. In Rwandan schools, there exists no comprehensive sex-education,<ref>[http://www.newtimes.co.rw/section/read/65697/ Sex education remains unspoken in secondary schools]</ref> though efforts have been made to improve teacher training in sex-education by UNFPA, as of 2016.<ref>[http://rwanda.unfpa.org/en/news/new-curriculum-promote-sex-education-schools New curriculum to promote sex education in schools]</ref> Furthermore, nearly half of all pregnancies (47%) in Rwanda are unintended, as of 2013.<ref>[https://www.guttmacher.org/fact-sheet/abortion-rwanda Guttmacher Institute: Abortion in Rwanda, April 2013]</ref> There are significant issues related to sexual trauma, sexual violence and bodily autonomy experienced by many Rwandans, following the Rwandan Civil War and Rwandan Genocide, as well. To speak broadly, sexual and reproductive health care options have expanded since 2000, yet education, accessibility and sensitivity are still major issues that the country continues to grapple with. | ||
According to a Kigali local: "The stigma of birth control has diminished as the country develops, and especially as a lot more young Rwandans return home after doing their studies abroad. It's a lot more common now to openly admit that you are on the pill, for example. However, there is a huge difference in class here. Middle-class or Rwandans (or those that have returned recently from US, Europe, or Canada) are totally fine going on birth control. Among the majority of the population (still living in relative poverty), pre-marital sex is still frowned upon, and as a result, contraceptives are viewed as promiscuous. Condoms are promoted (moth male and female), but for 'good, God-fearing' people, it is not good to be seen with a condom on you, as this seen as a signal that you are sleeping around." (March 2018) | |||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* In Rwanda, you can find '''condoms''' distributed in boutiques, pharmacies, kiosks, bars, health facilities, outreach centers (like community-based distributors) and online stores. The condoms provided in the public sector tend to be generic, non-brand condoms. If you go to the social-marketing centers, you may get condoms that are under the name "Prudence Plus." Overall, Rwanda doesn't have a high level of diversity in the condom sector yet, and only a few main brands are for sale. They tend to be most readily available in urban boutiques, but stock-outs can be an issue experienced by all vendors and facilities at times.<ref>[http://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@ilo_aids/documents/legaldocument/wcms_132562.pdf Rwanda National Policy on Condoms]</ref> If you want to purchase condoms online, you can find Moods and Kama X condoms sold on the [https://www.kasha.rw/product-category/love-sex/ Kasha website] for 1000 RWF per pack, as of February 2018. | * In Rwanda, you can find '''condoms''' distributed in boutiques, pharmacies, kiosks, bars, health facilities, outreach centers (like community-based distributors) and online stores. The condoms provided in the public sector tend to be generic, non-brand condoms. If you go to the social-marketing centers, you may get condoms that are under the name "Prudence Plus." Overall, Rwanda doesn't have a high level of diversity in the condom sector yet, and only a few main brands are for sale. They tend to be most readily available in urban boutiques, but stock-outs can be an issue experienced by all vendors and facilities at times.<ref>[http://www.ilo.org/wcmsp5/groups/public/@ed_protect/@protrav/@ilo_aids/documents/legaldocument/wcms_132562.pdf Rwanda National Policy on Condoms]</ref> If you want to purchase condoms online, you can find Moods and Kama X condoms sold on the [https://www.kasha.rw/product-category/love-sex/ Kasha website] for 1000 RWF per pack, as of February 2018. | ||
* You should be able to find '''oral contraceptives (birth control pills)''' sold in pharmacies and online retailers, like [https://www.kasha.rw/product-category/love-sex/ Kasha]. Some of the brands you can expect to see are Diane-35, Microgynon, Microlut, Neogynon, Lo-Femenal and | * You should be able to find '''oral contraceptives (birth control pills)''' sold in pharmacies and online retailers, like [https://www.kasha.rw/product-category/love-sex/ Kasha]. Some of the brands you can expect to see are Diane-35, Microgynon, Microlut, Neogynon, Lo-Femenal, Ovrette, and Yasmine.<ref>[http://ec.princeton.edu/ Princeton EC Website]</ref> <ref>[Conversation with pharmacy in Kigali, May 2018]</ref> | ||
* You can find ''' | * You can find '''intrauterine devices (IUDs)''' in Rwanda. You can get an IUD inserted at [http://legacyclinics.rw/ Legacy Clinics] for 10,000 RWF, as of March 2018. Furthermore, on the [https://www.kasha.rw/product-category/love-sex/ Kasha website], you can purchase the SMB copper IUD for 14,000 RWF or the Mirena IUD for 90,000 RWF, as of February 2018. | ||
* You can find '''contraceptive shots/injectables''' in Rwanda. | * You can find '''contraceptive shots/injectables''' in Rwanda. One pharmacy in Kigali told us that they sold Confiance, an injectable that lasts for 3 months for 500 RWF, as of May 2018.<ref>[Conversation with pharmacy in Kigali, May 2018]</ref> Furthermore, on the [https://www.kasha.rw/product-category/love-sex/ Kasha website], you can purchase a 3-months supply of Depo-Provera for 700 RWF, or you can purchase Norigynon injectables for 1000 RWF (1-month supply) or 2000 RWF (2-month supply), as of February 2018. | ||
* You can find '''contraceptive implants''' in Rwanda. On the [https://www.kasha.rw/product-category/love-sex/ Kasha website], you can purchase the Implanon implant, which lasts 3 years, for 5000 RWF, or you can you can purchase the Jadelle implant, which lasts 5 years, for 5000 RWF, as of February 2018. | * You can find '''contraceptive implants''' in Rwanda. On the [https://www.kasha.rw/product-category/love-sex/ Kasha website], you can purchase the Implanon implant, which lasts 3 years, for 5000 RWF, or you can you can purchase the Jadelle implant, which lasts 5 years, for 5000 RWF, as of February 2018. | ||
* According to a local source, the '''contraceptive ring (Nuvaring)''' is available in Rwanda, but we'll need more information to confirm. | |||
===Resources & Organizations=== | ===Resources & Organizations=== | ||
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===Costs=== | ===Costs=== | ||
* In a conversation with one pharmacy in Kigali, we were told that they sold Confiance (contraceptive injectables) for 500 RWF, and they sold Microgynon for 1000 RWF (as of May 2018).<ref>[Conversation with pharmacy in Kigali, May 2018]</ref> | |||
==Emergency Contraception (Morning After Pill)== | ==Emergency Contraception (Morning After Pill)== | ||
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===Laws & Social Stigmas=== | ===Laws & Social Stigmas=== | ||
In Rwanda, it appears that you can obtain emergency contraceptive pills (morning after pills) without a prescription. | In Rwanda, it appears that you can obtain emergency contraceptive pills (morning after pills) without a prescription at pharmacies. However, due to the price of ECPs at pharmacies, it is often too expensive for most Rwandan locals. | ||
Emergency contraception is included in police protocol for survivors of rape or sexual violence. However, Rwandan laws related to emergency contraception are rather vague and don't clearly defined what is permitted. For example, the National Family Planning Policy does not include information related to emergency contraception and Rwanda’s Health Sector Strategic Plan for 2009-2012 also does not mention emergency contraception. Yet, Rwanda’s National Training Module for Family Planning (March 2008) does include a chapter on emergency contraception. This leads to a muddled understanding of emergency contraception that translates into confusion on hospital floors. In 2009, a survey found that only 13% of Rwandan clinics had guidelines related to EC, and many of these facilities did not have EC available in the rooms that they had dedicated to working with victims of sexual violence. However, the Yuzpe method of emergency contraception (i.e. using regular birth control pills as EC) was available in 62% of the surveyed facilities.<ref>[http://www.cecinfo.org/custom-content/uploads/2013/09/Rwanda_2013.pdf COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION IN RWANDA]</ref> | |||
===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* In Rwanda, you can purchase emergency contraceptive pills (morning after pills) without a prescription. You can find them at pharmacy and health centers. Some of the brands you can expect to see are Pill 2 | * In Rwanda, you can purchase emergency contraceptive pills (morning after pills) without a prescription. You can find them at pharmacy and health centers. Some of the brands you can expect to see are NorLevo 1.5mg, Pill 2, Pill 72.<ref>[http://www.cecinfo.org/country-by-country-information/status-availability-database/countries/rwanda/ ICEC: EC Status and Availability: Rwanda]</ref> <ref>[Conversation with pharmacy in Kigali, May 2018]</ref> You can also buy NorLevo (emergency contraceptive pill) online at [https://www.kasha.rw/product-category/love-sex/ Kasha]. For one tablet, you pay 6000 RWF if you buy it online, as of February 2018. | ||
* If you cannot obtain dedicated emergency contraception, you can use regular oral contraceptives (birth control pills) as replacement emergency contraception. To do this, you can take Ovrette (Take 40 pills within 120 hours after unprotected sex), Neogynon (Take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later), Lo-Femenal (Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later) or Microgynon-30 (Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).<ref>[http://ec.princeton.edu/ Princeton EC Website]</ref> Note that, in 28-day packs, only the first 21 pills can be used. For updated information on how and when to take birth control pills as replacement ECPs, please visit the [http://ec.princeton.edu/ Princeton EC Website]. | * If you cannot obtain dedicated emergency contraception, you can use regular oral contraceptives (birth control pills) as replacement emergency contraception. To do this, you can take Ovrette (Take 40 pills within 120 hours after unprotected sex), Neogynon (Take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later), Lo-Femenal (Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later) or Microgynon-30 (Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later).<ref>[http://ec.princeton.edu/ Princeton EC Website]</ref> Note that, in 28-day packs, only the first 21 pills can be used. For updated information on how and when to take birth control pills as replacement ECPs, please visit the [http://ec.princeton.edu/ Princeton EC Website]. | ||
* You can also use an intra-urine device (IUD) as emergency contraception. Consult with your physician or local health care provider to find more details. | * You can also use an intra-urine device (IUD) as emergency contraception. Consult with your physician or local health care provider to find more details. | ||
===Costs=== | ===Costs=== | ||
You can expect to pay between 6,000 RWF to 15,000 RWF for the emergency contraceptive pill (morning after pill), as of May 2018. This is very expensive for most local Rwandans, so most people cannot afford it. | |||
==Sexually Transmitted Infections (STIs/STDs)== | ==Sexually Transmitted Infections (STIs/STDs)== | ||
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Generally speaking, Rwanda has shown remarkable progress in rebuilding its HIV/AIDS resources in the past few decades. The Rwandan genocide destroyed the HIV treatment infrastructure in the country, which needed to then be rebuilt from the ground up. Since that time, Rwanda has focused on trying to prevent more HIV infections, especially from mother to child. In 2016, it was estimated that about 220,000 people (adults and children) in Rwanda and about 3.1% of adults in Rwanda are living with HIV.<ref>[http://www.unaids.org/en/regionscountries/countries/rwanda UNAIDS Country factsheets - RWANDA 2016]</ref> The country provides universal health coverage for HIV patients, though the effort to ensure that everyone is covered is still ongoing.<ref>[http://www.aidsmap.com/Abolishing-HIV-in-Rwanda/page/2845701/ Abolishing HIV in Rwanda]</ref> You can watch a PBS special on Rwanda's efforts to prevent HIV transmission and ensure that HIV-positive people are properly medicated [https://www.pbs.org/newshour/show/rwanda-torn-genocide-became-global-anti-aids-leader here]. | Generally speaking, Rwanda has shown remarkable progress in rebuilding its HIV/AIDS resources in the past few decades. The Rwandan genocide destroyed the HIV treatment infrastructure in the country, which needed to then be rebuilt from the ground up. Since that time, Rwanda has focused on trying to prevent more HIV infections, especially from mother to child. In 2016, it was estimated that about 220,000 people (adults and children) in Rwanda and about 3.1% of adults in Rwanda are living with HIV.<ref>[http://www.unaids.org/en/regionscountries/countries/rwanda UNAIDS Country factsheets - RWANDA 2016]</ref> The country provides universal health coverage for HIV patients, though the effort to ensure that everyone is covered is still ongoing.<ref>[http://www.aidsmap.com/Abolishing-HIV-in-Rwanda/page/2845701/ Abolishing HIV in Rwanda]</ref> You can watch a PBS special on Rwanda's efforts to prevent HIV transmission and ensure that HIV-positive people are properly medicated [https://www.pbs.org/newshour/show/rwanda-torn-genocide-became-global-anti-aids-leader here]. | ||
From a Kigali local: "Tests for STI/STDs are very easy to get at the many medical centers around town. It can be costly at some of the private clinics, but you can also find cheaper options at public hospitals. HIV tests are cheap, and people are encouraged to get tested. Among the Rwandans I know, getting tested is a completely normal thing --- it is not shameful. People will even go with their partner, as part of the dating ritual. Again, this is what I know from the Rwandans I spend time with, and these are middle-class." (March 2018) | |||
===Testing Facilities=== | ===Testing Facilities=== | ||
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===Support=== | ===Support=== | ||
* Centre Hospitalier De Kigali: This hospital seems to be the main provider of HIV treatment in Rwanda. They provide antiretroviral medication, such as Combivir, Epivir, Crixivan, Sustiva. They may also have Videx and Zerit. In the past, the monthly cost of combination therapy was 130'000 Rwandan Francs (ca. 700 DEM), but we're not sure about | * Centre Hospitalier De Kigali: This hospital seems to be the main provider of HIV treatment in Rwanda. They provide antiretroviral medication, such as Combivir, Epivir, Crixivan, Sustiva. They may also have Videx and Zerit. In the past, the monthly cost of combination therapy was 130'000 Rwandan Francs (ca. 700 DEM), but we're not sure about the current price. The doctor in charge at the CHK is Dr. Kogame (internist).<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=150 RWANDA - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref> | ||
* University Hospital, Butare: They have antiretroviral medication in stock, but they're probably more expensive than Centre Hospitalier De Kigali.<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=150 RWANDA - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref> | * University Hospital, Butare: They have antiretroviral medication in stock, but they're probably more expensive than Centre Hospitalier De Kigali.<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=150 RWANDA - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref> | ||
* You can find antiretroviral medication in some pharmacies in Kigali, but they may be more expensive than obtaining them from Centre Hospitalier De Kigali.<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=150 RWANDA - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref> | * You can find antiretroviral medication in some pharmacies in Kigali, but they may be more expensive than obtaining them from Centre Hospitalier De Kigali.<ref>[http://www.hivtravel.org/Default.aspx?PageId=143&CountryId=150 RWANDA - REGULATIONS ON ENTRY, STAY AND RESIDENCE FOR PLHIV]</ref> | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* If you have a '''yeast infection''', you can try to ask the pharmacist for Fluconazole, which treats fungal infections. If they don't have Fluconazole, they may have something that is similar. | * If you have a '''yeast infection''', you can find medications over-the-counter at pharmacies. No prescription is required and the medications tend to be rather affordable. You can try to ask the pharmacist for Fluconazole, which treats fungal infections. If they don't have Fluconazole, they may have something that is similar. | ||
* If you have a '''urinary tract infection (UTI)''', you can find medications over-the-counter at pharmacies. No prescription is required and the medications tend to be rather affordable. | |||
* Regarding the '''HPV vaccine''', Rwanda has had a nationwide vaccination program in place since 2011. The program targets all girls in Primary 6 (ages 11-12 years old) for vaccination, and the vaccination consists of three doses to be considered complete.<ref>[http://www.hpvcentre.net/statistics/reports/RWA.pdf Human Papillomavirus and Related Diseases Report - RWANDA, 2017]</ref> | * Regarding the '''HPV vaccine''', Rwanda has had a nationwide vaccination program in place since 2011. The program targets all girls in Primary 6 (ages 11-12 years old) for vaccination, and the vaccination consists of three doses to be considered complete.<ref>[http://www.hpvcentre.net/statistics/reports/RWA.pdf Human Papillomavirus and Related Diseases Report - RWANDA, 2017]</ref> | ||
* Regarding '''Pre-exposure Prophylaxis (PrEP)''', it doesn't appear to be widely available yet in Rwanda, as of February 2018.<ref>[https://www.prepwatch.org/ PrEPWatch World Map]</ref> However, Health Development Initiative (HDI) and AVAC, a US-based NGO, are working to raise media awareness and influence policymakers in support of PrEP access and awareness in Rwanda.<ref>[https://www.avac.org/sites/default/files/resource-files/PREP%20Brochure%20final.pdf Health Development Initiative - PRE-EXPOSURE PROPHYLAXIS TO END HIV]</ref> | * Regarding '''Pre-exposure Prophylaxis (PrEP)''', it doesn't appear to be widely available yet in Rwanda, as of February 2018.<ref>[https://www.prepwatch.org/ PrEPWatch World Map]</ref> However, Health Development Initiative (HDI) and AVAC, a US-based NGO, are working to raise media awareness and influence policymakers in support of PrEP access and awareness in Rwanda.<ref>[https://www.avac.org/sites/default/files/resource-files/PREP%20Brochure%20final.pdf Health Development Initiative - PRE-EXPOSURE PROPHYLAXIS TO END HIV]</ref> | ||
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===What to Get & Where to Get It=== | ===What to Get & Where to Get It=== | ||
* [http://www.bahopolyclinic.com/ Baho Polyclinic]: This medical center was established in 2009 and has multiple ob/gyns on staff. It was recommended by a Kigali local. A consultation is typically around 13,000 RWF (as of March 2018). Address: KN 4 Avenue 36, Nyarugenge, Kigali Rwanda. Email: info@bahopolyclinic.com. Phone: 3130. Mobile: (+250)789339974. Hours: Mon - Sun: 24/7 Hours. | |||
* [http://legacyclinics.rw/ Legacy Clinics]: This specialty clinic has four gynecologists. The average cost of a gynecological exam is 28000 rwf (as of March 2018), and the cost of a pap smear is 30900 rwf (as of March 2018). Recommended gynecologists: Dr.Mohamed Okasha (male gynecologist) has been recommended by a Kigali local. You can walk in, call them or book an appointment online. Address: KK 3 Rd, Kigali, Rwanda. Hotline: 8000. TEL: +250-788382000/ +250-723382000/ +250-733682000. Email: info@legacyclinics.rw. | * [http://legacyclinics.rw/ Legacy Clinics]: This specialty clinic has four gynecologists. The average cost of a gynecological exam is 28000 rwf (as of March 2018), and the cost of a pap smear is 30900 rwf (as of March 2018). Recommended gynecologists: Dr.Mohamed Okasha (male gynecologist) has been recommended by a Kigali local. You can walk in, call them or book an appointment online. Address: KK 3 Rd, Kigali, Rwanda. Hotline: 8000. TEL: +250-788382000/ +250-723382000/ +250-733682000. Email: info@legacyclinics.rw. | ||
* Kigali Medical Center: This clinic is located in Kimironko. Dr Heba (female gynecologist) has been recommended by a Kigali local who says "she's great" and paid 13,000 for a visit. Address: KG 78 St, Kigali, Rwanda. | * Kigali Medical Center: This clinic is located in Kimironko. Dr Heba (female gynecologist) has been recommended by a Kigali local who says "she's great" and paid 13,000 for a visit. Address: KG 78 St, Kigali, Rwanda. | ||