Demographic Patterns in Rwanda at War: Part 2 - Impacts on the Use of Contraceptive Methods, Infant, Child and Maternal Mortality, Orphanhood and Migration

Andre Medici

Adriana Correa Alves

Prolonged armed conflicts could reduce the supply of contraceptive methods changing the established behavior of couples and unmarried women into use them. Contraceptive methods prevalence among married women in Rwanda was higher in 1992 than in 2005. The Rwanda’s armed conflict reduced the access to contraceptive methods. The proportion of married women with access to modern contraceptive methods felt from 13 to 4 percent between 1992 and 2000, increasing to 10% in 2005.

In 2005 traditional contraceptive methods were used by 7% of married couples in Rwanda and 10% used modern contraceptive methods. Among the sexually active unmarried women, the proportion using contraceptive methods reduced in the post war context. The rate of condom use, for example, which was 11 percent in 2000, has dropped to 4 percent in the 2005, according the Demographic and Health Surveys (DHS).

In the last two decades, maternal mortality and infant mortality reduction gained wider attention and urgency in developing countries, as two of the Millennium Development Goals. However, armed conflicts challenge maternal and child mortality reduction, because reduce the availability of prevention and curative health care services and food supply and nutrition programs for children. It also increases chronically stress motherhood, causing difficulties in coping with the multiple needs of young children.

Ghobarah, Huth and Russett (2003) found that health care systems suffer long term damage on account of conflicts, with a strong impact on increasing infant and child mortality rates. The results from the Rwanda DHS 1992, 2000, 2005 allow to draw infant and under-five mortality trends during the period before and after genocide. Between 1992 and 2000, infant mortality rates per 1,000 live births jump from 85 to 107, decreasing to 86 in 2005.

The data suggests that immediately after the genocide occurred a marked deterioration in infant and child health. Between 1992 and 2000 Rwanda experienced a sharp increase in both infant and under-five mortality rates but the 2005 data indicates that these rates have declined and returned to the levels as 1992. In conclusion, infant and child mortality trends reverted and begun to improve in the past ten years.

Maternal mortality, defined as women deaths occurred during pregnancy, childbirth, or within 42 days of the termination of the pregnancy, remained high in Rwanda during past decade. In 2005, the maternal mortality rate was about 750 deaths for every 100,000 live births. This total has declined considerably since the end of the war when maternal mortality rate were estimate in 1,071 per 1000 live births between 1995 and 1999. According to UNFPA (2003), for every woman who dies as a result of pregnancy, some 30 surviving women experience lasting morbidities as a result of pregnancy complications, including anemia, infertility, pelvic pain, incontinence and obstetric fistula.

Many of the conditions that result in maternal mortality could be treated or managed safely with proper care. However, women in developing countries often give birth without any skilled medical care, and emergency obstetric services are rare. The war accounted for much of the lack of adequate prenatal and delivery services in the Rwanda case.

Hundred thousands of adults killed during the war and high rates of maternal mortality generated one of the most devastating impacts of the armed conflict in Rwanda: the dramatic increase in the number of children orphaned. Without their families as primary safety net, orphan children are at increased risk of violence, exploitation, and other forms of abuse when deprived of the protection of adults.

According DHS 2005, 21% of children under age 18 in Rwanda had lost one or both of the parents. As a consequence of the war, the proportion of children who have lost their parents in 2005 increased significantly with the age of the child: (2 percent at age 0 to 1 year; 6 percent at age 2 to 4 years and 16 percent at age 5 to 9 years). The higher rates of orphanhood were found at teens aged between 10 and 14 (36 percent) and 15 to 17 (41 percent) due to the effects of the 1994 genocide.

The 2005 DHS data also allows observing that the parental survival status influences school attendance of children aged 10-14 years old. When both parents are alive and children live with at least one parent, 91 percent attend school. In contrast, this proportion drops to 75 percent when both parents are deceased. Even so, as observed, girls in both situations are able to attend school in higher proportion than men.

From the early nineties and during the 1994 conflict many Rwandans abandoned their homes and their lands, fleeing internal conflict and civil war. While some fled across Uganda, Congo, Burundi and Tanzania borders, and even sometimes toward more distant countries, others remained in Rwanda seeking refuge in those provinces and municipalities. Many Rwandans who fled the armed conflict received international aid in refugee camps and were eventually repatriated under the auspices of the United Nations.

The population of Rwanda is composed in its majority by native (non migrants). These constitute, indeed, 80% of the total population against 20% of migrating people. It is possible to identify important variations of migration proportions between the administrative areas. Thus, the city of Kigali, the province of Umutara, Kibungo and Kigali count with a high proportion of migrants.

The population of the city of Kigali is formed of 64% of migrants. This percentage of migrants explains itself by the role of the city status as country capital and the consequent economic advantages with facilitates de search for jobs and social infrastructure, such as health and education facilities. In addition to the economic and social reasons, it is important to add that migrants often chose to get settled in Kigali for reasons of security or anonymity.

The province of Umutara, comes in second position as recipient of migrants. Half of its population declared to have lived elsewhere earlier. The raising proportion of migrants in this province is because it was constituted as a welcome site for the repatriated population after the process of pacification. The province of Umutara had welcomed an important number of refugees from Uganda and Tanzania.

In 1994, approximately two million Hutu refugees, most of whom suffered the consequences of the genocide and feared Tutsi retribution, fled to neighboring Burundi, Tanzania, Uganda, and Zaire (now the Democratic Republic of Congo). Many of them died for epidemics of cholera and dysentery which swept the refugee camps. It was the faster and most important displacement of populations of the contemporary African history.

After the conflict end (1996) started a return migration movement to the country. This movement was as fast as the one of the departure during the conflict. The number of former refugees who went back to Rwanda between 1994 and 1997 is estimated in 800 thousands.

The exam of the migratory status according to the area of residence shows important disparities. The migrating population constitutes more of 47% of the population of the country urban. In rural areas immigrant only constitute 14% of the population.

As can be seen by figures, the men predominate in the migratory fluxes toward the urban areas whereas the women are more numerous among the rural migration. In 2005, less than 5% of total inhabitants were born abroad Rwanda and hardly 2% declared to have resided earlier abroad. The most relevant countries contributing to international immigration to Rwanda are Democratic Republic of Congo, Burundi, Uganda, Tanzania and Kenya. The majority of international immigrants are decedents of former refuges who have been repatriated especially from neighboring countries after the 1994 war and genocide in Rwanda.