Socio-economic factors associated with the choice of community health workers as contraceptive providers in Rwanda

Background: In 2008, Rwanda decided to enhance its community health program in order to further scale up the health system effectiveness. One of the components of the program is the community-based family planning. Between 2010 and 2015, the proportion of women using contraception from the community health workers (CHWs) increased threefold. This study aims at identify the socio-economic factors associated with the choice of CHWs as contraceptive providers in Rwanda in the period 2010-2015. Methods: The study uses a pooled dataset from the 2010 and 2015 Rwanda Demographic and Health Surveys. It is restricted to women in union aged 15-49 years. The dependent variable is the source of modern method used at the time of survey. Independent variables include demographic characteristics, socioeconomic factors, and regional variable. Descriptive statistics and multinomial logistic regression are used to assess the association. Results: The results indicate that the choice of CHWs is negatively associated with socioeconomic factors (education, economic status, residence, etc) and varies with provinces. The propensities of referring to CHWs are significantly higher among women with no or low education (odds ratio [OR]: 3.76 and 3.80), women from poor or middle households (OR: 1.20, 1.27) or among those living in rural areas (OR: 1.04) than among women with high education, residing in rich households or in urban areas. The Northern Province has recorded the highest adhesion to CHWs (OR: 2.47), followed by the Eastern (OR: 1.88) and Southern (OR: 1.69). Conclusions: The community health program gained higher approval and adoption among the lower socioeconomic segments of the population. The combined effects of high contraceptive uptake from CHWs among the poor populations and rural residents and that of their predominant share in the total population enable to assume further decline of fertility in Rwanda.