Acceptability and discontinuation of Depo-Provera, IUCD and combined pill in Kenya.

This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A (IUCD), the injectable, Depo-Provera and the low-dose oral contraceptive pill, Microgynon. A non-randomised sample of volunteer participants was used. One thousand and seventy-six users were followed up for a period of one year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method specific differences in users' characteristics. The OC users were younger and had fewer children than the IUCD or Depo-Provera users. The Depo-Provera users were older, and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of IUCD and Depo-Provera users were married. IUCD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12 month period. Discontinuation rates were highest for OC users (80%) and lowest for IUCD users (20%) and intermediate for Depo-Provera users (39%). Ninety percent of OC and Depo-Provera users and 86% of IUCD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUCD has the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among the young OC users.

PIP: This paper reports on a prospective study conducted between June 1990 and June 1992 to determine method acceptability, user satisfaction, and continuation rates for three highly effective and reversible contraceptive methods currently available in Kenya: the CuT 380A IUD; the injectable Depo-Provera; and the low-dose oral contraceptive Microgynon. A nonrandomized sample of volunteer participants was used. 1076 users were followed up for a period of 1 year or up to the time of discontinuation of the method, whichever came earlier. Analysis revealed method-specific differences in users' characteristics. The OC users were younger and had fewer children than the IUD or Depo-Provera users. The Depo-Provera users were older and had the largest family sizes. Many OC users (almost 40%) were single, while almost three-quarters of the IUD and Depo-Provera users were married. IUD users were also more educated compared to OC and Depo-Provera users. Survival analysis was used to calculate cumulative life table discontinuation rates by method for the 12-month period. Discontinuation rates were highest for OC users (80%), lowest for IUD users (20%), and intermediate for Depo-Provera users (39%). 90% of OC and Depo-Provera users and 86% of IUD users said they were satisfied with their respective methods. While OCs are among the most popular family planning methods in Kenya, they are also one of the most problematic, while IUDs have shown the fewest compliance problems. Service providers need to address the issue of high discontinuation rates among young OC users.

Barriers to contraceptive use in Kenya.

This study was designed to identify and to better understand the barriers to contraceptive use among Kenyan-couples. Data were collected through structured interviews and focus group discussions among couples not planning for pregnancy and not using any effective contraceptive method. The study was conducted in the Baba Dogo urban slum area of Nairobi, and Chwele, a rural sub-location in Bungoma, western Kenya. Some important barriers to contraceptive use were identified in couples wishing to space or limit further births. Those barriers included lack of agreement on contraceptive use and on reproductive intentions; husband's attitude on his role as a decision maker; perceived undesirable side effects, distribution and infant mortality; negative traditional practices and desires such as naming relatives, and preference for sons as security in old age. There were also gaps in knowledge on contraceptive methods, fears, rumours and misconceptions about specific methods and unavailability or poor quality of services in the areas studied. This paper recommends that information and educational programmes should be instituted to increase contraceptive knowledge, to emphasise the value of quality of life over traditional reproductive practices and desires, and to improve availability and quality of services.

PIP: This article presents an analysis of interviews and focus group discussions among men and women from an urban slum in Nairobi, Kenya, and the rural Chwele in Bungoma District in the Western Province of Kenya. The systematic sample survey included 594 individual interviews with currently married individuals, where the wife was aged 15-49 years and not pregnant or using contraceptives. 80% of wives and 90% of husbands had at least a primary level of education. 125 couples were from Nairobi and 172 were from Bungoma. The pill was the most widely known method. Wives were more aware of female methods, and husbands were more aware of male methods. 21-28% of persons had ever used family planning. 72% of Nairobi wives who had ever used and 22% of Bungoma wives who had ever used relied on the pill. Almost all knew that family planning services were available but did not use these services. About 33% of individuals in Nairobi and 50% in Bungoma desired no more children. Husbands desired about four or more children than wives wanted. 34-38% of husbands and 63-74% of wives desired to wait at least 2 years before the next pregnancy. About 75% of couples agreed on whether or not they wanted to have additional children, but only 30% of Nairobi couples and 41% of Bungoma couples agreed on the timing of the next birth. 64% of couples in Nairobi and only 42% of couples in Bungoma had joint knowledge of family planning. 6% of Nairobi couples and 27% of Bungoma couples had a joint lack of information on where to obtain contraception. The focus groups revealed a greater range of reasons for nonuse of contraception. Lack of couple agreement and communication were primary reasons for nonuse. Couples had more than the desired family size of 2-4 children due to desired gender balance, parent-naming, and risk of child mortality. Confidence in family planning would be enhanced by better education.