Rwanda's Socio-Economic and Demographic Health Indicators
Senior 4 · General and Religious Studies
Rwanda's Socio-Economic and Demographic Health Indicators
Lesson 3 of 4
35 min
Look at the photograph below: several hundred students sit on the grass of their school compound for a talk on reproductive health. In one afternoon they hear accurate facts from a qualified speaker. Is that enough to change how they will behave at 17, at 19 and at 25?
National data suggest that facts alone are not enough. The Rwanda Demographic and Health Survey (RDHS) 2025 found that 8% of girls aged 15–19 had ever been pregnant, up from 5% in 2019–20,. This lesson asks what makes health education produce behaviour that lasts, and applies the answer to reproductive health.
Definition
Health education: planned learning that helps people gain the knowledge, attitudes and skills to make healthy choices. Example: a series of lessons in which students practise refusing pressure from a friend.
Health promotion: wider action that makes healthy choices easier, including services, laws and community support. Example: a health centre opening at hours when students can attend.
Sustainable health behaviour: a healthy practice that a person keeps up over years, not only after a campaign.
Reproductive health: in the words of the United Nations Population Fund (UNFPA), "a state of complete physical, mental and social well-being in all matters relating to the reproductive system". It includes safe pregnancy and birth, family planning, protection from sexually transmitted infections (STIs) and freedom from sexual violence.
Family planning: deciding freely whether, when and how often to have children, and using methods to carry out that decision.
Unmet need for family planning: the share of women who want to stop or delay childbearing but are using no method.
Total fertility rate (TFR): the average number of children a woman would have in her lifetime if she lived through her reproductive years at today's birth rates.
Public health researchers explain health behaviour with models. One of the oldest is the Health Belief Model, first developed in the United States in the 1950s to understand why people did not come for free screening. It says that a person acts when six beliefs line up (Figure 3).
Apply it to a student deciding whether to go for an HIV test. A one-off talk can raise perceived susceptibility ("young people can get HIV too") and severity. But if the student thinks the nurse will tell her parents (a barrier), or has never practised asking for a test (low self-efficacy), she will not go. Information touched two of the six boxes; the barrier box was untouched.
That is why lasting health education does more than inform.
| Feature | A one-off talk | A lasting programme |
|---|---|---|
| Content | Facts only | Facts, values and practised skills: refusing, negotiating, deciding, asking for help |
| Timing | Once | Repeated across the school years, at the age each topic matters |
| Who speaks | An outside expert | Teachers, trained peers, parents and health workers, with students taking part |
| Services | Not linked | Linked to confidential, youth-friendly services at the health centre |
| Environment | Ignores norms | Works with families, religious leaders and the community to change harmful norms |
Teenage pregnancy. Figure 4 shows how sharply the share of girls who have ever been pregnant rises through the teenage years.
The same survey found a strong link with schooling: 21% of girls aged 15–19 with no education had ever been pregnant, against 13% of those with primary education and 4% of those with secondary education.
Family planning. Figure 5 follows married women over 25 years.
In 2025, 64% of married women used a modern method, 5% a traditional method and 9% had an unmet need. Their total demand for family planning is the sum, , and the share of that demand met by modern methods is
Over the same years the total fertility rate fell from 6.1 children per woman (2005) to 4.1 (2019–20) and 3.7 (2025).
Worked example: computing a total fertility rate
The TFR adds up the age-specific fertility rates (ASFR, births per woman per year) of the seven five-year age groups from 15–19 to 45–49, and multiplies by 5 because each group lasts five years:
Illustrative rates: 0.03, 0.15, 0.20, 0.17, 0.12, 0.05 and 0.01.
Notice that the teenage rate (0.03) adds children to the total. Each early birth also starts a woman's childbearing years sooner, which is one reason teenage pregnancy matters to a country's population growth as well as to the girl.
Worked example: correlation or cause?
"Girls with no education are five times as likely to have been pregnant as girls with secondary education (21% against 4%), so schooling prevents pregnancy." Test the claim.
, so the arithmetic is right. But the link can run both ways: staying in school delays pregnancy, and a pregnancy can also make a girl leave school, so she is then counted under the lower level. A third factor, such as household poverty, may raise both the chance of leaving school and the chance of early pregnancy. The data show a strong association; to show cause you would need to follow the same girls over time.
Warning
Sexual contact with a child is abuse and a crime. In Rwanda a child is anyone under 18. Any sexual contact between an adult and a child is abuse, however it is presented: as love, as a gift, as payment of school fees or as a promise of marriage. The child is never to blame, and a teenage pregnancy can be evidence of a crime against the girl. If this is happening to you or someone you know, tell a trusted adult and call a free Rwanda Investigation Bureau line: 116 (child abuse), 3512 (gender-based violence), 3029 (Isange One Stop Centre, which offers medical, legal and counselling help in one place) or 166 (emergencies).
Warning
Common mistakes
Important
Discuss. Your school has one hour a week for a term to reduce teenage pregnancy. Using Figure 3 and the table of features, design the programme: what will students learn and practise, who will lead it, and how will it link to a health service? Say which of the six beliefs each activity targets.
UNFPA Rwanda: "Healthy and Empowered Youth project: Road to reshaping sexual, reproductive health for Rwandan youth", about 7 minutes. As you watch, sort what you see into three lists: activities that give information, activities that build skills, and changes to services.
Practice
Key points
Sources and credits
Written by Ganzaa: the opening, Figure 3 (after the Health Belief Model), Figures 4 and 5 (drawn from NISR data), the tables, the worked examples and the exercises.
Quick check
A student knows HIV is serious and that young people can get it, but fears the nurse will tell her parents. Which part of the Health Belief Model is stopping her?
