The Quest for Maternal Survival in Rwanda – Paradoxes in Policy and Practice

Since 1990, maternal deaths have decreased by nearly half – but with stark disparities between countries. In sub-Saharan Africa, a woman’s lifetime risk of dying as a result of pregnancy or childbirth is estimated to be more than 100 times higher than for a woman in a high-income country. This study seeks to contribute to Rwanda’s goal for maternal survival by presenting the perspectives of women who nearly died (‘near-miss’) during pregnancy, as well as of their partners, recent fathers, community members and healthcare providers who work within abortion-related care.

• The study highlights paradoxical outcomes in the implementation of maternal care policies in Rwanda.
• Recent amendment to the abortion law and the priority of reducing abortion-related deaths provides a momentum for change. Yet, access to induced abortion in public maternal care was non-existent. The findings point at fear of litigation and stigma, which posed hurdles for care-seeking in early pregnancy.
• Giving birth at a health facility was perceived as mandatory but disrespectful care and distrust in public healthcare services was prominent. This may lead to delayed care- seeking and suboptimal maternal health outcomes.
• The findings revealed a perceived obligation to be accompanied by a man in order to receive care. This placed women in a dependent situation in their care-seeking.
• Men perceived themselves as being excluded and dismissed in maternal care. The current maternal health system is thus missing the opportunity to embrace men’s interest to take part in childbearing, which may also provoke distrust in the available care.