Rwanda’s 2010 Demographic and Health Survey Shows Remarkable Drop in Fertility and Child Mortality

by Carl Haub, senior visiting scholar

The Rwanda 2010 DHS is the latest in a regular series of DHS surveys that began in 1992, although hostilities had delayed the next survey until 2000.  The 2010 survey interviewed 13,671 women ages 15 to 49 and 6,329 men ages 15 to 59 from September 2010 to March 2011. The total fertility rate (TFR — the average number of children would bear in her lifetime if the birth rate of a particular year were to remain constant) obtained in the survey was 4.6 for the three-year period preceding the survey. For urban women, the TFR was 3.4 and for rural women, who were a 85 percent of the sample, 4.8. The TFR saw its fastest decline in the 2010 DHS. From the 2007-08 Interim DHS to the 2010 survey, the TFR fell by 1.1 children nationwide — by 1.3 in urban areas and 0.9 in rural areas in a period of only four and a half years. This is sharpest drop in a sub-Saharan TFR I can ever remember seeing. As an indicator of future fertility plans, 56.2 percent of women with three living children said that they not wish to have any more children as did 76 percent of those with four living children. It is clear that the large family size of  eight children per woman is truly a thing of the past.

Note: TFRs are for the three years before the surveys. 2007-2008 data from Interim DHS.

Source: National Institute of Statistics of Rwanda, Ministry of Finance and Economic Planning, Ministry of Health Rwanda, MEASURE DHS, ICF Macro, Demographic and Health Survey 2010, Preliminary Report.

In the survey, 51.5 percent of currently married women said that they were using some form of family planning, 45.1 percent a modern method. Injectables were by far the most frequently used, as such “spacing” methods are in much of Africa,  with 23.1 percent of women saying that they used them. That method  increased from 15.2 percent in the 2007-08 survey. The next two methods were implants (6.3 percent) and the pill (7.1 percent).

As seen before in other African surveys, infant and child mortality has declined dramatically. The infant mortality rate in the five years before the 2010 DHS was 50 infant deaths below age 1 per 1,000 live births, down from 73 in the 5 to 9 years before the survey and 109 in the 10 to 14 years before the survey. There was a similar decline in mortality in the child death rate, ages 1 to 4, to 27 deaths per 1,000 five years before the survey, from 64 five to nine years before the survey, and 99 10 to 14 years before it.

Of children under age 5, 44.2 percent were stunted (height-for age) and 11.4 percent were underweight. But 46.5 percent of rural children were stunted, compared with 27.3 percent in urban areas. The World Health Organization recommends that breastfeeding should be supplemented with solid/mushy food at the child’s six months of age. At four to five months of age, 75.7 percent were exclusively breastfed but that figure dropped to 19.5 percent at ages six to eight months. The proportion of young children receiving all required vaccinations was found to be very high. Among children ages 12 to 23 months, 90.1  percent had received all child vaccinations.The proportion was only slightly lower in rural areas than in urban. Fully 82.2 percent of mothers were able to produce a vaccination card so that mother’s memory did not have to relied upon in those cases.

Levels of prenatal care and delivery assistance from a skilled provider (doctor, nurse, midwife, or other health personnel) were very high. Around 98 percent of mothers who had given birth up to five years before the survey had had prenatal care. Of those, 58.3 percent had had two to three visits and 35.7 percent had had four or more visits. Again, the figures were quite close for both urban and rural mothers. But the proportions receiving prenatal care from a skilled provider, as well as births occurring in a health facility were much lower. Of births in the past five years, 69 percent had delivery assistance from a skilled provider and a nearly identical proportion, 68.9 percent of births, were in a health facility. There were differences between urban and rural areas with 82.4 of urban women having a skilled attendant at delivery and 82 percent of births in a health facility. Comparable figures for rural areas were 67.2 percent and 67.1 percent, respectively. Protection from neonatal tetanus, at 70.7 percent, needs improvement.

Rwanda, one of Africa’s most densely populated countries, has made great progress in its goal of lowering fertility, particularly in recent years. The same cannot be said for its neighbor, Burundi, however.

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