PIP: Pronatalist attitudes are traditional in Rwanda, a country in which more than 90% of the population lives by peasant agriculture and the Catholic church is strong. A rapid change in thinking will be inevitable if the country is to attain its goal of food self-sufficiency and to improve the health of its mothers and infants. Population densities were already high in Rwanda in the early 20th century, and they have become much higher. The total population increased from an estimated 2 million around 1940 to 4 million in 1970 and about 6 million in 1984. If the current rate of growth of 3.7% is maintained, the population will exceed 10 million before the year 2000. Already the size of the average farm is only .4 hectare. The health situation is equally alarming. Infant and child mortality rates are each about 125/1000 live births. The high death rate among mothers is partly due to too many births, too closely spaced. At age 49 a Rwandan woman will have given birth to an average of 8.5 children. Prematurity, malnutrition, and diarrhea and other diseases take their toll on the children of chronically exhausted mothers. Family planning alone will not solve the problems; better prenatal care, medical surveillance of infants and young children, improved obstetrical facilities, vaccination programs, oral rehydration programs and a range of other services are needed. The government of Rwanda created the Scientific Consultative Council for Sociodemographic Problems in 1974 and the National Office of Population (ONAPO) in 1981. ONAPO is responsible for promotion and provision of family planning services. A project to increase acceptance of family planning in the 2 prefectures of Butare and Gikongoro and to integrate family planning into maternal-child health services has received support from the German government since 1986. The 1st phase of the project, in 1986-87, involved informing the population and political-administrative authorities of Gikongoro of the benefits of family planning. Seminars were held with authorities from different sectors, during which ways were suggested of incorporating population communication into their usual activities. After some preliminary difficulties with Catholic health centers, which account for almost 1/2 of the health facilities in Gikongoro, the idea of family planning began to gain acceptance, on the condition that all contraceptive methods including natural methods be included. Much opposition to family planning still exists at the level of the base population. By 1986, 8 state and 3 protestant health centers were offering family planning services in Gikongoro. The number of women using contraception increased from 400 to 1600. Injectable methods are preferred. The frequent side effect of amenorrhea is welcomed because of the prevalence of anemia. Family planning training was provided for health personnel at all levels.