Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties.

Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.

Prevalence of and factors associated with contraceptive discontinuation in Kenya.

BACKGROUND:  The overwhelming uptake of contraception in Kenya at 58% suggests huge potential for a continued increase, but discontinuation threatens efforts to achieve new targets. Further increases in contraceptive prevalence will depend more on continuation and re-adoption amongst past users because unintended pregnancies would increasingly result from discontinuation. Eliminating discontinuations from side effects and method failure could increase continuation rates by 10%. AIM:  To establish the prevalence and factors associated with contraceptive discontinuation. SETTING:  Kenya, with a successful family planning programme, but also the challenge of discontinuation rates of 31%. METHODS:  Contraceptive calendar data from the 2014 Kenya Demographic and Health Survey were used in the survival analysis approach. RESULTS:  Overall discontinuation rates were 37% (24 months) and 74% at (36 months), whilst discontinuation in need was 36%. Side effects accounted for 40% of discontinuations, whilst injection and pill recorded the highest rates. Current method emerged as a predictor of discontinuation at 24 months with the following hazard ratio (HR) at 95% confidence interval [CI]; intrauterine device (IUD) (HR = 0.466, CI = 0.254-0.857), injection (HR = 0.801, 95% CI = 0.690-0.930), implants (HR = 0.580, 95% CI = 0.429-0.784) and at 36 months, injection (HR = 0.808, 95% CI = 0.722-0.904) and implants (HR = 0.585, 95% CI = 0.468-0.730). Age (15-24 years) displayed influence only at 36 months (HR = 1.219, 95% CI = 1.044-1.424). CONCLUSION:  The study showed a close link between contraceptive method used and discontinuation and thus the need to address method-related issues in an attempt to minimise discontinuation in Kenya. Expanding contraceptive options and improving the quality of service can scale up switching and thus help reduce discontinuation and unintended births.

Adolescent fertility and its determinants in Kenya: Evidence from Kenya demographic and health survey 2014.

BACKGROUND: Adolescent fertility in Kenya is vital in the development and execution of reproductive health policies and programs. One of the specific objectives of the Kenyan Adolescent Sexual Reproductive Health (ASRH) policy developed in 2015 is to decrease early and unintended pregnancies in an attempt to reduce adolescent fertility. We aimed to establish determinants of adolescent fertility in Kenya. METHODS: The Kenya Demographic and Health Survey (KDHS) 2014 data set was utilized. Adolescent's number of children ever born was the dependent variable. The Chi-square test was utilized to determine the relationship between dependent and independent variables. A Proportional-odds model was performed to establish determinants of adolescent fertility at a 5% significance level. RESULTS: Over 40% of the adolescent girls who had sex below 17 years had given birth i.e, current age 15-17 years (40.9%) and <15 years (44.9%) had given birth. In addition, 70.7% of the married adolescents had given birth compared to 8.1% of the unmarried adolescents. Moreover, 65.1% of the adolescents who were using contraceptives had given birth compared to only 9% of the adolescents who were not using a contraceptive. Approximately 29.4% of the adolescents who had no education had given birth compared to 9.1% who had attained secondary education. Age at first sex (18-19 years: OR: 0.221, 95% CI: 0.124-0.392; 15-17 years: OR: 0.530, 95% CI: 0.379-0.742), current age (18-19 years: OR: 4.727, 95% CI: 3.318-6.733), current marital status (Not married: OR:0.212, 95% CI: 0.150-4.780), and current contraceptive use (Using: OR 3.138, 95% CI: 2.257-4.362) were associated with adolescent fertility. CONCLUSION: The study established that age at first sex, current age, marital status, and contraceptive use are the main determinants of adolescent childbearing. The stated determinants should be targeted by the government to control the adolescent birth rate in Kenya. Consequently, delaying the age at first sex, discouraging adolescent marriage, and increasing secondary school enrollment among adolescent girls are recommended strategies to control adolescent fertility in Kenya.

Busting contraception myths and misconceptions among youth in Kwale County, Kenya: results of a digital health randomised control trial.

OBJECTIVES: The objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions. DESIGN AND SETTING: A three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya. PARTICIPANTS AND INTERVENTIONS: A total of 740 youth aged 18-24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants received standard care. The intervention period was 7 weeks. PRIMARY OUTCOME: We assessed change myths believed at baseline and endline using an index of 10 contraception-related myths. We assessed change across arms using difference of difference analysis. RESULTS: Across arms, <5% of participants did not have any formal education, <10% were living alone, about 50% were single and >80% had never given birth. Between baseline and endline, there was a statistically significant drop in the average absolute number of myths and misconceptions believed by intervention arm (11.1%, 95% CI 17.1% to 5.2%), contact arm (14.4%, 95% CI 20.5% to 8.4%) and control arm (11.3%, 95% CI 17.4% to 5.2%) participants. However, we observed no statistically significant difference in the magnitude of change across arms. CONCLUSIONS: We are unable to conclusively state that the text message intervention was better than text message 'contact' or no intervention at all. Digital health likely has potential for improving SRH-related outcomes when used as part of multifaceted interventions. Additional studies with physical and geographical separation of different arms is warranted. TRIAL REGISTRATION NUMBER: ISRCTN85156148.

Demand satisfied by modern contraceptive among married women of reproductive age in Kenya.

BACKGROUND: Demand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs. MATERIALS AND METHODS: Performance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014-2018 was used. PMA2020 surveys are cross-sectional including women 15-49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15. RESULTS: Of the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15-19 and 45-49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0-13.8% over the 5-years, p<0.001. Married adolescent 15-19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7-79.4% over the 5-years, p<0.001, with increase in long acting reversible contraception/permanent methods from 19.9-37.2% and decrease in short acting methods from 49.9-42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence. CONCLUSIONS: Results show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions.

Exploring contraception myths and misconceptions among young men and women in Kwale County, Kenya.

BACKGROUND: Myths and misconceptions around modern contraceptives have been associated with low contraceptive uptake in sub-Saharan Africa and Kenya in particular. Addressing persistent contraceptive knowledge gaps can make a significant contribution towards improved contraceptive uptake among young women. This qualitative study therefore sought to explore and understand young people's knowledge of modern contraception and to identify their key concerns regarding these methods. METHODS: We used focus group discussions (FGD) with vignette and writing activities to explore key myths and misconceptions around the use of contraceptives. Six FGDs (three for young men and three for young women) were conducted with a total of 28 young women and 30 young men from Kwale County, Kenya. We included 10 discussants aged 18-24 per FGD, one FGD had 8 participants. Predefined codes reflecting the discussion guides and emerging issues in the FGDs were used to develop the thematic coding framework. Our analysis followed a pattern of association on the key preset themes focusing on myths and misconceptions around contraceptive use. RESULTS: Results are presented under four key themes: awareness of contraception, myths and misconceptions around contraception, males' contraceptive narratives and young people's preferred sources of contraceptives. Both men and women participants reported basic awareness of contraceptives. A mixture of biological and social misconceptions were discussed and included perceptions that modern contraception: jeopardized future fertility, could result in problems conceiving or birth defects, made women promiscuous, was 'un-African', and would deny couples their sexual freedom. Compared to female respondents in the study, young men appeared to be strong believers of the perceived socio-cultural effects of contraceptives. On preferred sources of contraceptives, respondents reported on two main sources, pharmacies and public hospitals, however, they could not agree on which one was suitable for them. CONCLUSIONS: This study revealed the presence of a mixture of biological and social myths and misconceptions around contraception, with young men also strongly adhering to these misconceptions. The low level of contraceptive knowledge, particularly on contraceptive fears as revealed by the study demonstrate critical gaps in sexual and reproductive health (SRH) knowledge among young people. Improved SRH literacy to address contraceptives' fears through appropriate and gender specific interventions to reach out to young men and women with factual SRH information may therefore contribute to increased uptake of SRH services including modern contraceptive methods.

Use of long-acting reversible contraception among adolescents and young women in Kenya.

The Kenya Demographic and Health Survey (KDHS 2014) revealed changing patterns in the contraceptive use of young women aged 15-24, shifting from injectable methods to implants. Long-acting reversible contraception (LARC) is user friendly, long-term, and more effective than other modern methods. It could be a game-changer in dealing with unintended pregnancies and herald a new chapter in the reproductive health and rights of young women. This study determined the factors associated with LARC use among adolescent girls and young women to expand the evidence of its potential as the most effective method of reducing unwanted pregnancies among the cohort. This study analysed secondary data from KDHS 2014 using binary logistic regression. The findings showed a rise in LARC use (18%), with identified predictors of reduced odds being aged 15-19 [OR = 0.735, 95% CI = 0.549-0.984], residence (rural) [OR = 0.674, CI = 0.525-0.865], religion (Protestant/other Christian) [OR = 0.377, CI = 0.168-0.842], married, [OR = 0.746, CI = 0.592-0.940], and region (high contraception) [OR = 0.773, CI = 0.626-0.955], while the number of living children showed increased odds for 1-2 children [OR = 17.624, CI = 9.482-32.756] and 3+ children [OR = 23.531, CI = 11.751-47.119]. This study established the rising popularity of LARC and identified factors that can be addressed to promote it. Its increased uptake could help Kenya achieve the International Conference on Population and Development 25's first and second commitments on teenage pregnancies and maternal and new-born health, thus promoting the health, wellbeing, educational goals, and rights of this critical cohort. This study can guide the accelerated efforts needed in Kenya's march towards the five zeros of unmet need for contraception, teenage pregnancies, unsafe abortions, preventable maternal deaths, and preventable neonatal/infant deaths.

Trends and factors associated with long-acting reversible contraception in Kenya.

Background: Kenya has 12 million female adolescents and youths aged 10-34 years whose reproductive behavior will determine the growth and size of its population for the next decade. The anticipated momentum of births can be slowed by the use of long-acting reversible contraception (LARC) methods as they are more effective, need no user adherence, and hence have no risk of incorrect or inconsistent use. However, in spite of the many health and social benefits, LARC is underutilized because of myths and misconceptions. Kenya is in the ultimate decade towards Vision 2030 and investing in LARC can save costs of health care and accelerate the achievement of the development goal. The objective of this study was to establish factors associated with LARC use, with a view of establishing the potential for increasing demand. Methods: The study was national and used secondary data from the three waves of the Kenya Demographic Health Survey from 2003, 2008/09 and 2014 in a sample of all women of reproductive age who reported currently using modern contraceptive methods at the time of interview. Descriptive and logistic regression analysis was employed to profile and examine LARC users. Results: LARC use was low but picking up rapidly, especially among contraceptive users of higher social economic status in a major shift between 2008/09 and 2014. Consistent factors that influenced its use were age, wealth, and number of living children, while education and residence were of influence some of the time. Conclusions: There is huge unexploited potential for more LARC uptake based on the identified predictors of its use. Scaling up of LARC uptake is critical to deal with issues of poor user adherence, incorrect and inconsistent use, and method failure that characterize short-acting contraception, resulting in increased unintended pregnancies, incidences of unsafe abortions and maternal and infant mortality.

Age schedules of intra-provincial migration in Kenya

Background: Migration today is a complex process determined by inter-related historical, geographical, economic, sociological and political factors. There are linkages between life-course transitions and patterns of movement necessitating estimation of migration propensities by age, sex and other characteristics. However, analysis of age specific migration propensities has been limited in developing countries.Data source and methods: Data was derived from the 2009 Kenya population and housing Census via the IPUMS data Series. The standard 7-parameter age migration schedule due to Rogers and Castro (1981) was fitted using Microsoft excel workbook using solver.Results: Large volumes of movements occur between ages 17 and 24.The peak ages at migration are similar to those observed in Asian migration patterns. The age pattern for all the regions had two peaks contrary to the standard with four.Conclusion: The results suggest that the main contributory factors behind migration schedules are schooling, labour force and associational moves

Increased use of injectable contraception in sub-Saharan Africa.

National surveys show a remarkable upsurge in the use of injectable contraceptives in east and South Africa, in contrast to central and West Africa and certain other regions. Data are analyzed here from 95 surveys conducted since 1980 in 38 sub-Saharan African countries, to determine past injectable trends in the context of alternative methods and to explore related issues. In eastern and southern countries injectable use has risen to about 15%-20% of married women, equaling about 40% of all contraceptive use, with some countries above that. Increases in total use have followed increases in injectable use; that and other evidence is clear that the injectable has not merely substituted for the use of pre-existing methods but has given a net increase to total use. Rural use patterns are not much different from urban ones; however the middle and higher wealth quintiles have especially moved toward injectable use. In west and central countries traditional methods are still paramount, with modern methods increasing slightly, but total use remains quite low there. So far no plateau has appeared in total injectable use, though one may be emerging in its share of all use as other methods also increase. Most use is supplied through the public sector, which raises long-term cost issues for health ministries and donors. Many sexually active, unmarried women use the method Discontinuation rates are quite high, and alternative methods need to be kept readily available.

Investigating the association between HIV/AIDS and recent fertility patterns in Kenya.

Findings from previous studies linking the HIV/AIDS epidemic and fertility of populations have remained inconclusive. In sub-Saharan Africa, demographic patterns point to the epidemic resulting in fertility reduction. However, evidence from the 2003 Kenya Demographic and Health Survey (KDHS) has revealed interesting patterns, with regions most adversely affected with HIV/AIDS showing the clearest reversal trend in fertility decline. While there is suggestive evidence that fertility behaviour in some parts of sub-Saharan Africa has changed in relation to the HIV/AIDS epidemic, more rigorous empirical analysis is necessary to better understand this relationship. In this paper, we examine individual and contextual community HIV/AIDS factors associated with fertility patterns in Kenya, paying particular attention to possible mechanisms of the association. Multilevel models are applied to the 2003 KDHS, introducing various proximate fertility determinants in successive stages, to explore possible mechanisms through which HIV/AIDS may be associated with fertility. The results corroborate findings from earlier studies of the fertility inhibiting effect of HIV among infected women. HIV-infected women have 40 percent lower odds of having had a recent birth than their uninfected counterparts of similar background characteristics. Further analysis suggests an association between HIV/AIDS and fertility that exists through proximate fertility determinants relating to sexual exposure, breastfeeding duration, and foetal loss. While HIV/AIDS may have contributed to reduced fertility, mainly through reduced sexual exposure, there is evidence that it has contributed to increased fertility, through reduced breastfeeding and increased desire for more children resulting from increased infant/child mortality (i.e. a replacement phenomenon). In communities at advanced stages of the HIV/AIDS epidemic, it is possible that infant/child mortality has reached appreciably high levels where the impact of replacement and reduced breastfeeding duration is substantial enough to result in a reversal of fertility decline. This provides a plausible explanation for the patterns observed in regions with particularly high HIV prevalence in Kenya.

Determinants of transitions to first sexual intercourse, marriage and pregnancy among female adolescents: evidence from South Nyanza, Kenya.

The timing of transitions to sexual activity, marriage and childbearing in sub-Saharan Africa is undergoing profound changes. This study investigates the determinants of adolescent transitions in South Nyanza, a socioeconomically deprived setting in Kenya where adolescent reproductive health is a particular concern. The analysis is based on Cox regression of timing of first sexual intercourse, first marriage and first pregnancy, using data from a survey of 1247 females aged 12-19 years. The results show that higher household socioeconomic status and educational attainment are associated with delayed onset of all three transition events. Furthermore, mother's higher educational attainment is protective for initiation of sexual intercourse while rural residence is protective for pregnancy experience. Other protective factors include communication with parents or with fellow girlfriends. However, discussing sexual matters with boyfriends, high internal locus of control, and gender bias are associated with early onset of the three transition events.

Size of newborn and caesarean section deliveries among teenagers in sub-Saharan Africa: evidence from DHS.

This paper uses DHS data from 20 countries in sub-Saharan Africa, collected in the late 1990s and early 2000s, to examine perceived size of newborn and Caesarean section deliveries among teenagers in the region. A comparison between teenagers and older women, based on logistic regression analyses for individual countries, as well as multilevel logistic analyses applied to pooled data across countries, and controlling for the effects of important socioeconomic and demographic factors, shows that in general, births to teenagers are more likely to be small in size but are less likely to be delivered by Caesarean section compared with births among older women. An examination of the country-level variations shows significant differences in perceived size of newborn and Caesarean section deliveries between countries. However, the observed pattern by maternal age does not vary significantly between countries, suggesting that these patterns are generalizable for the region. For teenagers with characteristics associated with higher odds of Caesarean section, being in a country with an overall higher rate particularly amplifies their individual probability.

A comparative analysis of the use of maternal health services between teenagers and older mothers in sub-Saharan Africa: evidence from Demographic and Health Surveys (DHS).

This paper uses Demographic and Health Surveys data from 21 countries in sub-Saharan Africa to examine the use of maternal health services by teenagers. A comparison of maternal health care between teenagers and older women, based on bivariate analysis shows little variation in maternal health care by age. However, after controlling for the effect of background factors such as parity, premarital births, educational attainment and urban/rural residence in a multivariate analysis, there is evidence that teenagers have poorer maternal health care than older women with similar background characteristics. The results from multilevel logistic models applied to pooled data across countries show that teenagers are generally more likely to receive inadequate antenatal care and have non-professional deliveries. An examination of country-level variations shows significant differences in the levels of maternal health care across countries. However, there is no evidence of significant variations across countries in the observed patterns of maternal health care by maternal age. This suggests that the observed patterns by maternal age are generalizable across the sub-Saharan Africa region.