When birth becomes a battle inside Rwanda’s struggle for safe motherhood and girls’ reproductive health

By Telesphore KABERUKA  

At 5:47 a.m., a soft cry rises from inside the dimly lit maternity room of Shyogwe Health Centre, in the catchment area of Kabgayi Level II Teaching Hospital. A nurse, sweating but smiling, gently places a newborn baby boy on his mother’s chest. The mother, 22-year-old Clarisse Niyonsaba, exhales as though releasing years of fear. “I didn’t think I would make it,” she whispers. Her voice trembles, not because of the pain of labour she has just endured, but because of a deeper journey: three years of silent reproductive-health challenges she never understood, never named, and never sought help for.

Clarisse is one of thousands of young Rwandan women navigating a rapidly changing reproductive-health landscape, one shaped by digital services, expanding healthcare access, persistent stigma, and the rising vulnerabilities of adolescents facing pressure from society, culture, and poverty.

Her story embodies the progress Rwanda has made, yet also reveals the hidden gaps that still cost lives.  Some young mothers say they don’t where to go, not because they miss but because of a hidden burden weighing on them.

At 18, Clarisse became pregnant unexpectedly. “I was scared… mostly because I knew nothing about pregnancy,” she says. Her boyfriend fled. Her parents, embarrassed, sent her to stay with an aunt in another district, Gatsibo. She dropped out of school.

Although Rwanda has made notable strides in reducing maternal mortality, teenage pregnancy continues to rise in certain districts, leaving young mothers cut off from school, income, and information about safe motherhood.

Health workers say the problem isn’t only access, it’s also knowledge. “Girls arrive here with complications that could have been prevented if they had SRHR information early,” says Joselyne Mushimiyimana, a midwife with 17 years of experience. “Some don’t know danger signs; some hide their pregnancies until it is almost too late.”

Unsafe abortions: a quiet emergency behind closed doors

Behind the maternity ward of a hospital in the eastern province of Rwanda, a small room sits in silence. It is the post-abortion care room.

Here, health workers quietly treat girls and women suffering from incomplete abortions.

“They come late, bleeding, infected, terrified,” says Dr. Mutuyimana Léon, a specialist in reproductive. “Many are adolescents. Many were afraid to seek help earlier.”

Though Rwanda has expanded access to post-abortion care and clarified legal grounds for abortion, the stigma remains powerful. Girls still resort to unsafe methods, putting their lives at risk.

“Fear is killing our daughters,” Dr. Mutuyimana adds. “Fear of judgment. Fear of being called immoral. Fear of being alone.”

Family planning progress meets misconceptions

At a nearby second generation health post, Valens Niyigena, a father of three, carries his two-year-old daughter on his back. He is here with his wife, Vestine Mukundente, for her routine family-planning appointment.

“People say family planning makes women sick,” he says, laughing. “But look at us, we can now plan our future.”

Rwanda has one of Africa’s strongest family-planning programs, yet misconceptions persist, especially among rural men. Vestine, who uses a long-acting contraceptive method, says the service changed her life. “I can work. I can rest. I can raise my children well,” she says.

But for others, access is not the challenge, permission is. “I want to use contraception,” a 17-year-old student later says, “but my partner says it means I am cheating. So I hide it.” Her story underscores an uncomfortable truth that reproductive health isn’t just medical. It is deeply social.

Adolescent SRHR, a crisis of confidence

In a youth center in Ngoma District in the eastern province, a group of adolescents debate sexual health. Some are shy. Some are curious. All are searching. “Where can we get accurate information?” one asks.

A peer educator, Doreen, steps forward. “Here, on WhatsApp groups, in youth corners… but also in schools,” she says. “The problem is that many young people don’t trust adults to guide them.”

According to youth mentors, adolescents often rely on friends or social media, sources that are unreliable, incomplete, or dangerously misleading. “Even when services are available, shame stops many from using them,” Doreen explains.

Gender-based violence as a reproductive health issue too

At an Isange One Stop Centre, Amina Saidat (an anonymous name), a survivor of intimate-partner violence, recounts how abuse affected her health. “My husband refused to let me use family planning,” she says. “He beat me when I tried.” She became pregnant four times in five years.

Gender-based violence remains one of the silent drivers of poor reproductive health outcomes. Women who cannot make decisions about their bodies cannot make decisions about their health. At Isange, counsellor Beata Mukamana explains: “GBV is reproductive health. A woman cannot protect herself from pregnancy, STIs, or violence without autonomy.”

Digital services are expanding but the digital divide excludes many

Though Rwanda’s digital health services are improving, rural women often struggle with technology.

At Nyagatare town market, Josephine, a 56-year-old farmer, tries to renew her family’s health insurance using Irembo. Her cracked phone freezes. She frowns. She presses again. “I don’t understand these things,” she admits.

Without digital literacy, even available services remain inaccessible, especially for women, elderly people, and rural youth.

Where progress meets possibility

Rwanda today boasts empowered community health workers, modern health centres, improved maternal-care infrastructure, and strong national policies. However, the stories of Clarisse, Amina, the 17-year-old student, and Josephine show that gaps remain human, not just infrastructural. As midwife Joselyne puts it: “Saving mothers is not only the work of hospitals. It is the work of communities, families, and men.”

As Clarisse holds her newborn son, she stares at him with quiet determination. “I want him to grow up in a Rwanda where girls don’t fear asking for help,” she says. “Where we don’t suffer in silence.” Rwanda has established a strong legal and policy framework for reproductive health. The National Policy on Reproductive Health (2019) and the Adolescent Sexual and Reproductive Health Strategyprovide access to information and services for all, including adolescents. The Law Relating to the Prevention and Punishment of Gender-Based Violence (2008, amended 2018) protects women’s rights and autonomy. The 2012 revised Penal Code allows abortion under specific conditions, and the government ensures post-abortion care is available nationwide.