Breaking the cycle of generational trauma before parenthood

Rwanda’s holistic approach to mental health through family-centred care

  • 28th January 2025
  • 4 minute read
Photo: Boston College

Babies born during and after the 1994 genocide against the Tutsi in Rwanda are now adults, having babies of their own. More than one million Tutsi were killed during the genocide and hundreds of thousands of survivors were left orphaned, wounded, and/or homeless (National Commission for the Fight against Genocide (CNLG), 2017). The tragedy left a profound psychological impact not only on those who survived the genocide, but also on subsequent generations.

The nation’s journey towards healing has been long. Since 1995, the Government of Rwanda has implemented over a dozen policies and initiatives focused on mental health to support genocide survivors and the broader population. One example has been the effort to place orphans in family-based care rather than institutionalised care, and give families the psychological, social and financial support they need to make these arrangements work.

“Honouring strengths that have helped the family get through difficult times in the past.”

In 2016, the Government revised its early childhood policy, emphasising comprehensive service delivery across six pillars: child protection; nutrition; hygiene, WASH (water, sanitation and hygiene); early childhood development; and ensuring children are raised in positive and healthy environments. This policy shift resulted in a significant increase in support for Rwandan parents, with access to early childhood development services rising from 17% of Rwandan parents in 2016 to 78% in 2023.

In recent years, the intergenerational effects of the genocide have become a focus in government priorities. Rwanda has begun to address the mental health of whole family units, acknowledging the trauma today’s parents of young children experienced in their childhood, and the trauma that is being passed on to their children.

By focusing on parents and children at the same time, the aim is to break the cycle of intergenerational trauma and promote healing. This way, today’s parents can handle the ordinary stressors of parenting and have healthy relationships with their children, and those children will grow up and be able to provide nurturing, emotionally supportive environments for their own children.

Strengthening families and building resilience

One particularly effective programme playing a critical role in family care is Sugira Muryango, which means “strengthen the family”. This programme is tailored to Rwanda’s unique needs, particularly reaching rural and underserved communities. It was developed in partnership with the Rwandan government, the Research Program on Children and Adversity at Boston College, the NGO François-Xavier Bagnoud Rwanda, and the University of Rwanda Center for Mental Health, as well as local early childhood experts and community advisory boards.

Sugira Muryango was designed through a trauma- informed lens to address the mental health challenges facing parents and other caregivers, family violence, social isolation, and chronic illness. The programme explores how trauma caused by events such as the genocide, compounded by ongoing hardships such as poverty, affects parenting. Findings from the programme suggest that parents who have experienced trauma are more likely to struggle with mental health issues, which may lead to less warmth and more rejection in their parenting, thereby increasing the risk of passing emotional distress to their children (Jensen et al., 2021a).

Sugira Muryango significantly reduced harsh parenting practices, improved parent–child interactions, and strengthened family cohesion (Jensen et al., 2021b). Qualitative findings also highlight a shift towards increased engagement of fathers in caring for their children (Jensen et al., 2023). Importantly, violence against children is correlated with parental stress. When parents are calmer and more patient with their children, it is a sign that they are likely to be adequately supported and psychologically stable (Geprägs et al., 2023).

“Rwanda has begun to address the mental health of whole family units.”

One of the key strengths of Sugira Muryango is its holistic approach, involving the whole family. In addition to reducing violence towards children, the programme also focuses on reducing intimate partner violence, by equipping parents with problem- solving and conflict resolution skills.

Sugira Muryango utilises a two-generation approach to addressing trauma, focusing on both parents and children. Trauma from one generation can impact the next through disrupted emotional regulation, mental health problems, and parenting behaviours. We offer families training in emotion regulation skills, using techniques such as deep breathing and mindfulness-based relaxation exercises, as well as tools for conflict resolution, problem solving and de- escalation to manage family stress and model healthy behaviours, creating a supportive home environment.

We use a strengths-based narrative to review the history and experiences of the family. This provides an opportunity for all family members to reflect on how they have navigated past difficulties, as well as joys and important moments to celebrate in the history of the family. It also allows people who have lived through difficult events like the genocide to discuss family members who have been lost, or changes in the family due to those events, at their own pace (Chaudhury et al., 2016).

Strengths-based family narratives help people to reflect on their resilience and successes, building confidence, strengthening bonds, and honouring strengths that have helped the family get through difficult times in the past as well as orienting them towards the future.

A collective vision: healing through family care

Sugira Muryango offers valuable lessons for other countries and programmes by demonstrating the effectiveness of integrating trauma-informed care into family-centred interventions. Its strong connection with the government’s social protection workforce, IZUs, highlights how aligning with local structures ensures sustainability and community ownership. The programme shows the importance of holistic, family-centred approaches, not only to support healing from trauma but also to contribute to building resilient communities.

As Sugira Muryango moves towards greater scale and sustainability nationally across Rwanda1, it serves as a model that demonstrates how governments, communities and researchers can collaborate to promote healing, support caregivers, and ensure that every child grows up in a nurturing, supportive environment. Sugira Muryango exemplifies how prevention, family support, and strong partnerships can drive lasting change across societies.


1 The 2020 issue of Early Childhood Matters describes how the Sugira Muryango programme was developed, implemented and scaled in Rwanda.

All references can be found in the PDF version of this article.

Shauna M. Murray

Shauna M. Murray is a PhD student researching global inclusion and social development at the College of Education and Human Development in the University of Massachusetts Boston, USA. With over 15 years of experience in global health, education and early childhood development, she collaborates with communities, governments and stakeholders to support initiatives such as Rwanda’s Sugira Muryango programme. She has co-authored numerous publications and contributed to securing funding to expand locally grounded, evidence-based programmes that prioritise sustainable, community-driven solutions.

Vincent Sezibera

Dr Vincent Sezibera is a professor of clinical psychology at the University of Rwanda, Kigali, and a leading expert in trauma, mental health and resilience. With extensive experience in both research and practice, his work focuses on addressing the long-term effects of trauma, particularly in post-conflict settings, and fostering community-driven mental health solutions. Committed to capacity building, he mentors emerging researchers and works to integrate evidence-based mental health practices into healthcare and education systems in Rwanda and internationally. He has worked as researcher and capacity-building expert in a number of countries, including Benin, the Republic of Central Africa, Cameroon, Côte d’Ivoire and South Africa.

Darius Gishoma

Dr Darius Gishoma is the Mental Health Division manager at the Rwanda Biomedical Center, Kigali, where he leads national efforts to strengthen mental health services and integrate psychosocial support into healthcare systems. With expertise in trauma, community mental health, and resilience building, he has played a pivotal role in shaping policies and programmes that address Rwanda’s mental health priorities.

Gilbert Munyemana

Gilbert Munyemana is the Deputy Director General of the National Child Development Agency (NCDA) in Rwanda, where he oversees programmes and policies designed to improve the wellbeing of children and families. With a strong background in child protection, early childhood development, educational technology and social welfare, he plays a key role in advancing Rwanda’s vision for equitable access to services for vulnerable populations. He collaborates with government agencies, development partners, and community organisations to design and implement evidence-based strategies. His work focuses on strengthening systems, promoting holistic child development, and fostering sustainable solutions to support families and communities across Rwanda.

Theresa S. Betancourt

Dr Theresa S. Betancourt is Salem Professor in Global Practice at the Boston College School of Social Work and director of the Research Program on Children and Adversity. Her work addresses the psychosocial impact of adversity on children and families, resilience, and mental health services research.

She is principal investigator in an intergenerational study of war-affected youth in Sierra Leone. In Rwanda she leads implementation science research on strategies for scaling and sustaining quality in an evidence-based home visiting intervention to promote early childhood development and prevent violence. Using community-based participatory research methods, she has also co-developed family strengthening interventions for refugee families in the USA.

Topics Children Health Parenting Parents Policy Wellbeing

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