Etude des facteurs et des effets psychosociaux des grossesses chez les adolescentes au Rwanda : vers un soutien psychosocial plus efficace pour les mères adolescentes

Cette étude explore les facteurs et les conséquences psychosociales des grossesses chez les adolescentes au Rwanda, en les identifiant comme un enjeu majeur de santé publique et sociale qui impacte profondément les jeunes femmes et leurs communautés. Elle examine également les répercussions négatives des grossesses chez les adolescentes sur l’harmonie familiale et la paix au sein des communautés et propose un soutien psychosocial adapté et complet pour les mères adolescentes.

Exploring Psychosocial Factors and Effects of Adolescent Pregnancies in Rwanda: Towards a More Effective Psychosocial Support for Adolescent Mothers

This study explores the psychosocial factors and effects of adolescent pregnancies in Rwanda, identifying them as a critical public health and social concern that greatly affects young women and their communities. It also examines the negative consequences of adolescent pregnancies on family harmony and peace within communities and proposes comprehensive psychosocial support for adolescent mothers.

How Resilience-Oriented Therapy is Transforming Mental Health and Psychosocial Support Services in Rwanda

More than three decades after the Genocide against the Tutsi in Rwanda, a significant portion of the population continues to grapple with its enduring effects on mental health.

Mukagaju (pseudonym), a survivor of the Genocide against the Tutsi, suffered from PTSD for 29 years. Although the genocide ended three decades ago, in her mind, it was still an ongoing nightmare. She continuously relived the harrowing scenes of screaming, running, hiding, and the killings she witnessed during the 100 days of horror. Due to the lack of appropriate support, she turned to prayer, hoping for healing, but to no avail.

"I was unable to sleep, suffered from terrible headaches, and was terrified of being alone. I would stay awake, hyper-alert throughout the night, hiding at the slightest sound or whenever I heard footsteps near my house, believing the perpetrators were coming for me and my children," she recounted.

Over the past three decades, the Government of Rwanda has made commendable strides in addressing the mental health burden by decentralising mental health and psychosocial support services to the health centre level and integrating them into primary healthcare.

However, national efforts face significant challenges, including insufficient funding, limited awareness and understanding of mental health, pervasive stigma, and a shortage of mental health professionals. The high prevalence of mental health conditions and the low utilisation of available services further exacerbate these issues.

The 2018 Rwanda Mental Health Survey (RMHS) by Rwanda Biomedical Centre (RBC) indicated a prevalence of mental disorders at 20.49%, substantially surpassing the global average. Today, that rate is likely higher than reported in 2018. In 2023,  RBC reported that one in five Rwandans experiences mental health challenges, with 2,879 suicide attempts documented by the Health Management Information System (HMIS).  

By June 2024, HMIS identified schizophrenia and other psychotic disorders (18%), depression (10%), bipolar disorder (2%), and Post-Traumatic Stress Disorder (PTSD) (2%) as the most common diagnoses. Globally, it is projected that by 2030, mental health disorders—particularly depression—will rank as the leading contributor to the global burden of disease. Furthermore, the intergenerational trauma stemming from the genocide continues to jeopardise the mental well-being of younger generations. Despite the high prevalence of mental health conditions, only 5.6% of the population seeks services from formal mental health care systems, according to RMHS.

Resilience-oriented therapy has the potential to address the limitations of the one-on-one approach largely utilised across the country.

According to Rwanda’s health workforce statistics, the country has only 16 psychiatrists (a ratio of 1 per 862,400 people), 441 certified clinical psychologists (1 per 31,289 people), and 202 mental health nurses (1 per 68,400 people) working in public facilities. These professionals primarily employ a one-on-one approach and often prioritise pharmacological treatments over psychotherapy.

Mukagaju eventually overcame her trauma after joining a Resilience-Oriented Therapy healing group established at Rukira Health Centre in Ngoma District, Eastern Province of Rwanda, six months ago. “Today, I sleep peacefully after years of fear and hypervigilance. Nothing frightens me to the point of fleeing my home at night, because now I know we are not in the middle of the genocide. I’ve learned to control my fears whenever they arise,” she joyfully explained.

Resilience-Oriented Therapy is a psychological intervention designed to address mental health issues related to emotional regulation, identity development, behavioural self-management, and the enhancement of individual psychological resilience within a group setting. Introduced in health centres in October 2023 through a joint effort by Interpeace and the Government of Rwanda, spearheaded by RBC, the therapy aims to provide a sustainable, cost-effective solution to the challenges posed by the high prevalence of mental health disorders.

Resilience-Oriented Therapy not only addresses mental health issues rooted in traumatic events such as the genocide but also supports individuals facing conditions triggered by various life circumstances. For instance, Uwimana (Pseudonym), who attempted suicide twice due to depression after suffering mistreatment from her husband—who abandoned her while she was four months pregnant—shared her transformative experience.

"I tried to throw myself and my children into the river because I thought ending our lives was the only way out of my pain. I didn’t want to have another child after being abandoned. This group has helped me; I no longer feel stressed or depressed. I’ve found inner peace, and now I am determined to raise my children with hope for a brighter future," Uwimana said, holding her five-month-old baby, who she noted would not have been born had she not joined the Resilience-Oriented Therapy group at Nyakigezi Health Centre, Rugera Sector, Nyabihu District, Western Province.

Resilience-Oriented Therapy represents the first group-based intervention introduced within formal health facilities in Rwanda. It is currently available in 32 health centers and seven district hospitals across five districts—Musanze, Ngoma, Nyabihu, Nyagatare, and Nyamagabe—and is administered by trained psychologists or mental health nurses. To date, 446 individuals (308 women and 138 men) have benefited from the therapy.

The therapy is tailored to Rwanda’s specific cultural context, while incorporating international best practices, ensuring its relevance and effectiveness.

The therapy is tailored to Rwanda’s specific cultural context, while incorporating international best practices.

The healing process spans six months, with the group convening for weekly three-hour sessions. Through this intervention, participants acquire psychosocial skills for trauma management, emotional regulation, self-care, and resilience building, equipping them to navigate daily challenges and adapt to evolving circumstances.

Dr. Jean Damascene Iyamuremye, Director of Psychiatric Care at RBC, recognises the positive impact Resilience-oriented therapy has had on the community and advocates for its nationwide expansion. "This is an innovative approach compared to the one-on-one approach we have been using. We have observed considerable progress since its implementation. In the community, people are now more motivated to seek professional help at the early stages of their mental health challenges. They have found healing and solace, and our hope is to scale this therapy across the country. It’s a community-based intervention we deeply appreciate, as it has also enhanced the overall quality of care,” Dr. Iyamuremye remarked. Interpeace is working with RBC to scale up the intervention across the country.

Family resilience: a new intervention approach to address intergenerational trauma and enhance family harmony in Rwanda

 

A recent study testing Multifamily Healing Spaces (MFHS), a new psychological intervention approach for families, has shown strong effectiveness in resolving intrafamily conflicts, enhancing communication and problem-solving skills, and building family cohesion and resilience. The intervention also addresses the intergenerational trauma through parent-child dialogues and promotes positive parenting.

The study, a Randomised Controlled Trial (RCT) conducted between April and September 2023, assessed MFHS, a group-based psychosocial tool designed to help families confront historical traumas, improve communication, and resolve conflicts through healing dialogues. MFHS blends home-grown solutions with international best practices, tailored to the Rwandan context.

The MFHS approach was introduced as part of the societal healing programme titled “Reinforcing Community Capacity for Social Cohesion and Reconciliation through Societal Trauma Healing in Rwanda,” jointly implemented by Interpeace and local partners—Prison Fellowship Rwanda, Dignity in Detention, and Haguruka—in collaboration with the Ministry of National Unity and Civic Engagement (MINUBUMWE) and the Ministry of Health via the Rwanda Biomedical Centre (RBC). The programme is funded by the Government of Sweden.

The Genocide against the Tutsi, three decades ago, not only devastated individuals but also shattered family structures and the fabric of family life in Rwanda. Families continue to grapple with the trauma of the genocide and its aftermath, compounded by the intergenerational transmission of genocide-related legacies, which has become a significant societal challenge. This is further exacerbated by social pressures as Rwanda strives for socioeconomic development, aiming to become a middle-income country by 2035 and a high-income country by 2050.

 

The intervention promoted positive parenting, strengthened bonds between parents and their children, leading to a more cohesive and resilient family.

For Rwanda to achieve sustainable peace and development, it must prioritise healthy families, as they are the foundation of society. Yet, many families still face challenges that undermine cohesion and development. According to the Rwanda Governance Board (RGB) Citizen Scorecard report 2023, family conflict is the top challenge to family cohesion (22.3%), followed by extramarital affairs (17.2%), psychological violence (16.1%), and economic violence (14.4%). Additional issues include physical violence (8.8%) and juvenile delinquency (8.4%).

The 2023 RGB Citizen Scorecard report identifies alcohol abuse as the leading cause of family dysfunction (85.4%), followed by poor communication between family members (81.3%) and poor parenting (58.9%). These problems negatively impact family members' mental well-being, pushing some toward substance abuse, which further hinders their participation in economic activities, ultimately leading to poor livelihoods.

The Randomised Controlled Trial (RCT) was conducted with the aim to develop and evaluate a family-based intervention promoting a multisystemic approach to resilience at personal, family, and community levels, with three key objectives: strengthening family resilience, facilitating personal transformation, and restoring community trust.

A total of 95 families (283 individuals: 136 males, 147 females) from Nyagatare, Ngoma, Nyamagabe, Nyabihu, and Musanze participated. These families included genocide survivors, genocide perpetrators, ex-combatants, and returnees, all coming from disharmonious families. They were divided into 20 groups: 9 treatment groups (146 participants) and 11 control groups (137 participants). Parents and children in treatment groups participated in 18 weeks of healing dialogues in a group setting, followed by six weeks of follow-up, while the control group was placed on a waiting list. Groups were established in their communities and facilitated by two well-trained Community Dialogue Facilitators, selected from their community and whom they trust. Post-intervention data from both groups were compared with baseline data to measure the treatment's impact.

The findings revealed that MFHS significantly enhanced family resilience, with improvements in family belief systems, communication, problem-solving skills, and organizational patterns. Families in the treatment groups demonstrated a more constructive approach to deal with challenges, showcasing stronger teamwork and mutual support compared to the control group.

Regarding partner dynamics, the intervention positively affected collaboration and relationship among couples in the treatment group, reflecting improved happiness and satisfaction within the family. Couples as both partners and parents acquired social and emotional management skills which enabled them to address existing conflicts, and strengthen bonds, and develop strategies for handling future conflicts and challenges.   

 

The intervention positively affected collaboration, and relationship among couples, reflecting improved happiness and satisfaction within the family.

“I felt traumatized by the violence of my husband, as he used to beat me almost every day. I had no rights to the family property and was treated like a maid. In this group, we learned to discuss and resolve our problems as a family. He even acknowledged his misdeeds and apologised to me. I can’t imagine what would have happened if we hadn’t joined the multifamily healing dialogues,” said a participant from Nyabihu District. She added that her husband has since changed, becoming a caring husband and father who now consults her before making decisions.

The intervention also promoted positive parenting, with those in the treatment group reporting higher levels of authoritative-democratic and authoritative-warm parenting styles, which prioritise guidance and involvement of children compared to the control group, who continued to adopt authoritarian style where parents are extremely rigid and use tough rules and punishments to control their children. Through parent-child sessions, families engaged in open discussions about daily life, historical trauma, and the history of the Genocide against the Tutsi, leading to a shared vision for the future.

The findings also reveal that the intervention had additional positive impacts beyond the expected results. Families in the treatment groups significantly improved their livelihoods by learning to better manage family resources and work together toward shared goals.

Rwanda Journal - Bridges to Peace: Foundations of Healing and Resilience

Welcome to the inaugural edition of Bridges to Peace: Foundations of Healing and Resilience, a journal dedicated to exploring the transformative work of Interpeace and our partners in Rwanda. In this first issue, we embark on a journey to unravel the core values and impactful initiatives that define our mission of fostering peace, resilience, and social cohesion.   

At Interpeace, we believe in the power of collaborative effort and community‑driven solutions to address our society's deep‑seated challenges. This publication serves as a cornerstone for understanding our approach, offering insights into our programmes, method‑ ologies, and the profound impact we strive to achieve in Rwanda. As you delve into these pages, you will encounter a blend of empirical research, personal stories, and expert analysis that showcases our commitment to creating positive change. Each section is crafted to provide not only a comprehensive understanding of our interventions but also to inspire reflection and engagement.

We hope you will enjoy the read and look forward to your feedback and to sharing our ongoing progress with you in the issues to come.

Executive Summary - Development of a Family‑based Intervention for Recovery and Resilience: A multi-site randomised controlled trial in Rwanda

This report outlines the findings of a randomised controlled trial (RCT) that assessed how effective multi-family healing spaces (MFHS) were at increasing family resilience, community trust, and individual healing. The RCT rigorously tested and measured the impact of this culturally adapted intervention in a number of different Rwandan communities affected by the genocide against the Tutsi. The MFHS programme was launched by Interpeace in collaboration with Prison Fellowship Rwanda, Haguruka, and Dignity in Detention and implemented with the support of the Rwandan government. It was funded by the Government of Sweden through the Swedish International Development Agency (Sida).

MFHS have been proven strongly effective in resolving intrafamily conflicts, enhancing communication and problem-solving skills and building family cohesion and resilience. It is also effective in addressing intergenerational trauma through parent-child dialogues and promoting positive parenting.