Abstract
BACKGROUND: The use of modern contraceptive methods can reduce up to 68% of unintended pregnancies and significantly lower maternal deaths. In Rwanda, modern contraceptive use has increased from 10% to 58%. Historically marginalized people (HMPs), who make up 0.3% of the population, have faced persistent social exclusion, limited economic opportunities, and inadequate access to education and healthcare. Despite national efforts to expand family planning services, HMPs continue to experience high unmet needs, lower educational attainment, and restricted access to reproductive health services. However, data on modern contraceptive use among this group remains limited. This study aims to assess the knowledge, attitudes, and factors influencing the use of modern contraceptives among marginalized women in Rwanda. METHODS: This was a quantitative cross-sectional study conducted in 5 districts of Rwanda. Multistage sampling was used to select 385 respondents- women of reproductive age (15-49) living in marginalized communities. Data was collected using a researcher administered structured questionnaire that was developed and pretested. Date was analyzed using STATA version 18. Descriptive statistics, Chi-square test and logistic regression were used during data analysis. RESULTS: Among the 385 participants, 89.1% had poor knowledge of modern contraception, though 80% demonstrated positive attitudes toward its use. The overall usage rate was 67.9%, with implants being the most commonly used method (61.6%). Multivariable logistic regression revealed that Women aged 15-24 were 4.4 times more likely to use modern contraception compared to those aged 35 and above (AOR = 4.38; 95% CI: 1.67-11.53; p = 0.003). Similarly, women aged 25-34 were nearly 3 times more likely to use modern contraception than those aged 35 and above (AOR = 2.96; 95% CI: 1.57-6.57; p = 0.008). Married women had a 3.2 times higher likelihood of using modern contraception compared to cohabiting women (AOR = 3.20; 95% CI: 1.45-7.06; p = 0.004). Divorced or separated women were also significantly more likely to use modern contraception (AOR = 5.46; 95% CI: 2.00-14.88; p = 0.001), and those with prior modern contraceptive use (AOR = 4.88; 95% CI: 2.42-9.81; p < 0.001). Additionally, women who had discussed family planning with their partners were nearly three times more likely to use it (AOR = 2.98; 95% CI: 1.42-6.25; p = 0.004). CONCLUSION: The community of the historically marginalized people has limited knowledge of modern contraception surprisingly with high prevalence of modern contraceptive methods compared to indigenous people from other regions. Therefore, there is a need of consistently promoting Sexual and reproductive health education in this community more especially among adolescents and young adult women.