Clean streets, low crime rate, Boda Bodas that follow traffic rules. Rwanda has, for a long time, set an example of endless possibilities in Africa and East Africa, showing that the things that we take for granted as inherent problems that the continent has to live with are, in fact, solvable.
The latest serving from the Rwanda dish of possibilities is the Health Services Bill, which, passed in August, lowers the age to access to contraceptives from 18 to 15 – allowing young teenagers to, for the first time, access contraceptives without needing parental consent.
Despite a flawed human rights record, with the government accused of clamping down on dissent and constraining democracy, human rights and gender campaigners recognized the move to lower the age for access to contraceptives to 15 years as a great step in protecting the sexual and reproductive health of teenagers and preventing teenage pregnancies.
“The idea of girls below 18 years accessing contraceptives is not well accepted in Rwanda. We have been working to extend access to contraceptives to girls below 18 for a very long time, and we have had many setbacks, including in the mid-2000s when the Rwanda president expressed an opinion that girls below 18 should not access contraceptives,” says Chantal Umuhoza, leader of the young feminist activist group, Spectra. “The president’s statement set back our work as many saw this as the official government position.”
Chantal says that continued advocacy and the reality of rising teenage pregnancies placed Rwanda in a position where allowing girls under 18 to access contraceptives became a matter of necessity.
“We wish the age of access to contraceptives could have been lowered further. The research shows us that most girls begin sexual activity at 14 or 15. We need people to get to a place where they understand that access to this information is a human right. We still have a lot of work to do,” she adds.
Continued high prevalence of teenage pregnancy, occurring amongst five per cent of girls below 19 years, continues to stand in the way of Rwanda meeting its reproductive health goals. Rwanda has continued to show exceptional commitment to women’s health, including lifting the reservation of Article 14 of the Maputo Protocol, which recognizes the right of women in Africa to access abortion services.
And while girls under 18 in Rwanda can now access abortion services for pregnancy that is less than 22 weeks upon the request of a parental representative, it was, without the new policy on contraceptives, harder for teenagers to get contraceptives that could prevent pregnancies in the first place.
“You can imagine if a girl falls pregnant at 15 – she is allowed to seek a safe abortion, but she cannot access contraception beforehand. This is a problem,” Dr Clarisse Mutimukeye, Rwanda Chapter Lead for Women in Global Health, explained in a Health Policy Watch piece that followed a conversation on access to contraceptives for teenagers.
While Rwanda has extended access to contraceptives for teenage girls, Uganda still lives in the realm of conservatism, where abstinence is the main gospel and sex education is a controversial issue.
Towards the end of 2024, Dr Charles Olaro, the Director General of Health Services at the Uganda Ministry of Health, proposed that the government should consider a policy to allow girls as young as 15 years to access contraceptives. He provoked ire from religious and political leaders who labelled his proposal satanic and uncultured.
“We pray that the devil doesn’t find his way, and such thoughts should never come into the minds of our people because it is giving up. That is formalizing defilement,” Thomas Tayebwa, deputy Speaker of Parliament, said when the issue came up for debate.
Amuru District women representative, Lucy Akello, upon hearing about Dr Olaro’s proposal, opined that contraceptives pose risks to “young girls who have not yet given birth”, perpetuating misconceptions about contraceptives causing infertility. At around 30 percent, Uganda’s contraceptive use rate is low, and many women and girls who need contraceptives are prevented from accessing contraceptives by these misconceptions, cultural, and religious beliefs.
Hon Akello went on to make a dangerous confession, capable of influencing the women and girls she leads to have unplanned pregnancies and risking their lives.
“Even I, who has given birth, fear these things. What of the young girls? Yes, I fear, and I do not use them. I use the natural method,” she said as she questioned where the policy came from.
Dr Olaro proposed that, “It is essential that we foster an environment where youth can access information on sexual and reproductive health and contraception for those in need without stigma, discrimination, or judgment.”
The backlash that followed, including a call for his resignation by a far-right Catholic campaign group from Spain, CitizenGO, highlighted how easily waves of religious and cultural sentiment wash away women’s and girls’ rights.
Teenage pregnancy in Uganda stands at 25 percent, five times that of Rwanda. For both Uganda and Rwanda, maternal mortality remains unacceptably high.
Teenage pregnancies contribute to this high maternal mortality. In Africa, maternal mortality is the leading cause of death among girls aged 15 to 19 years. The difference is that Rwanda is waking up to face and solve its teenage pregnancy and maternal health challenges, while Uganda is pawning the lives of girls on morality arguments.
The Rwanda Health Services Bill is especially audacious because it comes at a time when women’s reproductive health and women’s rights in general are being relegated to the periphery of the development agenda. US funding cuts specifically targeting family planning services.
It was suddenly forbidden to overtly recognize the way economic, social, and political issues disproportionately affect women. Development organizations had to take out words like equity and equality to survive. Other donors, such as the UK and Germany, followed with subtle reprioritization of their funds, completing the strangulation of women’s rights and providing more space for anti-human rights and anti-women sentiments to thrive.
These sentiments hang like a cloud over this year’s UN General Assembly, where US President Donald Trump, who has overseen the obliteration of women’s rights, further entrenched ideas of unilateralism and intolerance of dissent and diversity.
At a time when the fundamentals of human rights and democracy are being questioned and defunded, Rwanda stands out for doing what is right for the future of its women and girls rather than being blown by the tide of hate and control.
Rwandan President Paul Kagame has variously emphasized that Africa should chart its own path. Amidst aid cuts and a complex global development stage, African leaders are realizing that they are in many ways on their own.
With big brother US no longer looking over their shoulder to account, and countries embracing exclusion, African countries must embrace human rights, not because someone is telling them to, but because it is the only way to ensure that people have basic conditions to enable them to contribute meaningfully to the much-needed growth of the continent.
And while human rights have long been framed and interpreted through a colonial lens, Africa’s contribution to human rights as embodied in the progressive African Charter on Human and Peoples’ rights – which went beyond human rights to addressing individual and communal wellbeing – is undeniable.
By making it easier for teenage girls to access contraceptives, Rwanda is not just honoring regional and international human rights commitments; it is making a strong statement on Africa’s ability to implement, expand, and contribute to the entrenchment of human rights.
With the Health Services Bill, girls will be saved from pregnancies that often fundamentally change the course of their future. Instead of having babies that are likely to leave them dead or with life-long morbidities, they will stay in school and achieve their dreams. The prospects are heartwarming.
Yet, many people still shudder at the idea of teenagers needing contraceptives. Parents, regardless of when they themselves started having sex, live in a morality bubble where they never talk to their children about sex.
“When you are a child, no one explains anything to you. They blame you and say what you are doing is bad without giving you any information. If someone had talked to me from when I was younger… if someone had sat me down and told me how they prevent pregnancy, my life would not have been so difficult,” says Ritah Alowo, a Ugandan girl who got pregnant at 15 and had to trade her dream of becoming a journalist for working as a maid in Jordan.
Evangelical Christian ideas that idolize sex as a gift girls serve to their husbands upon marriage, rather than a daily reality they must deal with healthily and safely, are further used to justify denying teenagers sex education and access to contraceptives.
The situation is even worse for teenagers when they are abused. Often, they are too scared to speak or seek medical interventions, including access to contraceptives that could save their lives.
Rwanda has refused to be the proverbial ostrich that buries its head in the sand. Can Uganda and the rest of Africa, too, face the reality of teenage pregnancy and expand access to contraceptives? Or shall we continue sacrificing our women and girls’ lives at the altar of culture and religion?
The author is a lawyer and women’s rights activist
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