Kenya: Use of Contraceptives On the Rise Among Kenya's
Urban Poor
By Eunice
Kilonzo in Indonesia
"I have 10 children - I do not
use contraceptives because I do not want to get cancer," says Peninah
Nyagah.Peninah, 42, says this with
conviction, and goes ahead to inform us that she knows a woman who got cancer
because she was on the daily pill.
"Years back, while pregnant
with my third child, I met this woman who told us that she had gotten cancer
because of using pills. That got me really scared."
The vegetable vendor in Soweto Slums
in Kayole, Nairobi, adds that she and her husband do not use condoms, but when
they get intimate, she goes to the chemist and buys the pack of 21 pills, but
only takes one, and then throws the rest away. Reason?
"I do not take the full pack
because I do not want to get complications."
Each time she and her husband get
intimate though, she gets pregnant. For the past six months, she has not
menstruated - her neighbours tell her that it could be early menopause, but she
has not gone to hospital for a factual diagnosis.
In another part of Soweto Slum is
yet another mother of 10.Josephine Aseyo, 36, had her first
child at 15 years."I did not know that I could
space my pregnancies or delay them," she says.
She only found out about available
family planning methods after delivering her tenth child four years ago.
"My husband and I decided that we are not going to have any more children.
I opted for the injectable, and I am glad we took that step."
All through her pregnancies,
Josephine considered using a family planning method, but did not go through
with the thought, because her husband is a casual labourer who would be away
for several months.
She says, "When he came back, he would
either leave me pregnant, or nursing a child. The injectable has given me peace
of mind."
KEY HIGHLIGHT
The shift to modern methods of
family planning is a key highlight in a survey released on November 3 last
year. The survey sampled women among the urban poor population in five areas in
the country - Nairobi, Machakos, Kakamega, Mombasa and Kisumu.
The report consists of two surveys,
one at the beginning of 2010, (also the baseline) and the other after four
years (end line). They both showed a significant increase in modern
contraceptive use in the urban areas.
In 2010, 8,850 eligible women were
enrolled in the study, and after four years, 5,217 were interviewed.
THE RESULTS
The percentage of women aged 15 to 49 reporting
current use of modern methods at the end line phase of the study is as follows:
Nairobi 55 per cent (up from 44 percent at the baseline); Mombasa 44 per cent
(up from 29 per cent at the baseline); Kisumu
59 per cent (up from 44 per
cent at the baseline); Kakamega 54 per cent (up from 46 percent at the
baseline); and Machakos 58 per cent (up from 45 per cent at the baseline).
The Kenya Urban Reproductive
Health Initiative (KURHI), also known as the Tupange project, conducted the
study. The project's main objective is to increase the contraceptive prevalence
rates (CPR) in these areas by increasing access to quality family
planning services and to
sustain use of contraceptive methods, especially among urban poor residents.
Reasons for, or against using
modern contraceptive methods:
According to the report, the
most frequently cited reasons for using a contraceptive method across the study
areas were the desire not to get pregnant, the method's safety or lack of side
effects, and the method's convenience of use. Another reason why the women
favoured one contraceptive over another was not having to use it daily - some
said they were prone to forget to take the pill within a stipulated time,
making injectables quite popular.
Women also picked a
contraceptive such as the male condom to avoid contracting HIV and other
sexually transmitted infections.The women who did not use any
contraceptive cited health concerns, fear of side-effects, and having
infrequent sex/no sex or no partner. Project Director, Tupange, Nelson Keyonzo,
says women, even the urban poor, want long-term family planning methods. He
however said misconceptions about contraceptives were a major challenge.
"We have developed and
disseminated a booklet to provide correct information on contraception to the
community and trained community health volunteers."
Preferred methods:
According to the study, most
women preferred injectables in all areas at baseline, except Kisumu, where
implants, (such as Intrauterine Devices-IUDs) had become the most prevalent
method.
The main source of IUDs in
Nairobi and Kisumu were private facilities, in Machakos and in Kakamega, public
facilities. In Mombasa, the most commonly used source for IUDs shifted from
private facilities at baseline, to public facilities at end line.The main source of injectables
remained the same between surveys in Mombasa (private facilities) and in
Kisumu, Machakos, and Kakamega (public facilities); in Nairobi,
injectables
were mostly obtained from public facilities at baseline, but private facilities
at end line.
Unmet Family Planning
Need:
Overall, the unmet need for
family planning decreased between surveys in all areas except Kakamega, where
it increased.In Nairobi, the unmet need for
family planning decreased from 16 to 9 per cent between surveys; the majority
of this decrease was for unmet need for spacing, and was observed mainly among
women in poor households.Similar results were noted in
Kisumu, where the unmet need for family planning decreased from 18 to 8 per
cent between surveys, with the majority of the decrease attributable to unmet
need for spacing, particularly among women in poor households.
The decreases observed in
Mombasa (20 to 17 per cent) and Machakos (9 to 5 percent) were minimal -- about
3 per centage points in each case.
Among women in Machakos, the
unmet need for spacing decreased from 4 per cent at baseline to 2 per cent at
end line. Kakamega is different from the
other centres in that it is the only area where the unmet need for family planning
increased between surveys, doing so by about 2 per cent points. Women in the
poorest households had a 9-percentage-point (6 to 15 per cent) increase in
their unmet need for spacing and a 2-percentage-point (13 to 15 per cent)
increase in their unmet need for limiting.
Additionally, the proportion of women in
Kakamega whose demand for FP was satisfied decreased from 87 per cent at
baseline to 85 per cent at end line.
Kenya has an unmet need for
family planning at 23 per cent. According to the 2014 Kenya Demographic Health
Survey (KDHS), at least 18 per cent of married women have an unmet need for
family planning.
The most significant decreases
in unmet need were in Nairobi (from 16 to 9 per cent between surveys) and
Kisumu (from 18 to 8 per cent). In comparison, the decreases
observed in Mombasa (from 20 to 17 per cent) and Machakos (from 9 to 5 per
cent) were minimal. In contrast, the unmet need for family planning increased
in Kakamega from 13 per cent at base line to 15 per cent at end line.
Contraceptives by ages
in the report:
Among 15 to 19 year-olds, who
are sexually active, the most prevalent method at baseline was injectables in
Nairobi, Mombasa, and Kakamega and male condoms in Kisumu and Machakos. At end
line, injectables were the most prevalent in Nairobi and Mombasa, implants were
the most prevalent in Machakos and Kakamega, and male condoms remained the most
prevalent in Kisumu.
For the 20 to 24 year-olds,
injectables were the most prevalent at baseline and end line in all cities, with
the exception of Kisumu, where implants were slightly more prevalent at end
line. The largest increases took place among 20- to 24-year-olds and were
observed in implant use in all cities except Mombasa, where injectable and male
condom use increased most between surveys.
The most prevalent methods
among 25 to 29 year-olds in all cities were implants and injectables; implant
use also increased most between surveys in all cities except Nairobi, where the
largest increase was in injectable use. Similar results were observed for 30 to
34 year-olds and 35 to 39 year-olds in all cities.
However, there are slight
differences in the methods of choice among the older women (i.e. those age 40
or older). At baseline, the most prevalent method among women between 40 to 44
years was sterilisation in Nairobi and Machakos, male condoms in Mombasa and
Kisumu, and injectables in Kakamega.
However, by end line, the most
prevalent method for this age group had become injectables in all cities except
Machakos, where daily pills predominated. The methods that increased most in
use between surveys for women between 40 to 44 were injectables in Nairobi,
Mombasa, and Kisumu and implants in Machakos and Kakamega. For women in the oldest age
group (45 to 49 years old), sterilisation was the most prevalent contraceptive
method in all cities, except in Mombasa, where implant use had increased beyond
sterilisation.
Interestingly in this age
group, Nairobi, had the greatest increase in traditional methods (4 per cent at
baseline to 10 per cent at end line); in Mombasa, it was in implants (2 per
cent at baseline to 6 per cent at end line); in Kisumu, it was in injectables
(1 per cent at baseline to 10 per cent at end line); in Machakos, it was in
sterilisation (20 per cent at baseline to 25 per cent at end line); and in
Kakamega, it was in implants (none at baseline to 5 per cent at end line).
Communication between
spouses or partners on family planning methods
The percentage of women
married or in union who reported ever discussing family planning use with their
spouse or partner increased from 68 to 81 per cent in Nairobi, 71 to 80 per
cent in Kisumu, and 70 to 80 per cent in Kakamega but decreased from 64 to 61
per cent in Mombasa and from 84 to 81 per cent in Machakos. Finally, the women were asked
if they needed permission to use a method of family planning if they wanted to.
Although 60 per cent of women in Mombasa reported needing permission to use a
contraceptive method at baseline, the proportion had decreased to 38 per cent
at end line.
Likewise, in Kisumu and
Machakos, the percentage of women reporting that they needed permission to use
a contraceptive method decreased by 8 percentage points and 24 percentage
points, respectively.
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