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Factors influencing women’s decisions regarding birth planning in a rural setting in Kenya and their implications for family planning programmes

Published online by Cambridge University Press:  23 October 2020

Francis Obare Open the ORCID record for Francis Obare [Opens in a new window] ,
George Odwe Open the ORCID record for George Odwe [Opens in a new window]  and
John Cleland
Francis Obare*
Affiliation:
Population Council, Nairobi, Kenya
George Odwe
Affiliation:
Population Council, Nairobi, Kenya
John Cleland
Affiliation:
Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, UK
*
*Corresponding author. Email: [email protected]
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Abstract

Evidence suggests that socio-cultural barriers that limit the ability of women in sub-Saharan Africa to make decisions regarding contraceptive use and childbearing contribute to the slow uptake of contraception in this region. This paper explores factors influencing women’s decisions regarding contraceptive uptake, switching and discontinuation, and the implications of those decisions for family planning programmes. Data were from in-depth interviews that were conducted in 2018 with 42 women who participated in a longitudinal research project implemented in Homa Bay County of Kenya. Participants comprised women who were aged 15–39 years at the time of recruitment into the study and who discontinued using injectables or implants between the first and second rounds of data collection. Data were analysed using an exploratory inductive content analytic approach. The findings show that uptake of contraception was largely driven by concerns about the negative consequences of frequent childbirth on individual health and household socioeconomic well-being. Most women discontinued methods because of dissatisfaction but, instead of abandoning contraception altogether, switched to alternative methods, albeit sometimes less-effective ones. However, some women had difficulties in identifying an appropriate new method after experiencing side-effects, contraceptive failure or stock-out of their current method. Securing the cooperation of sexual partners was an additional problem especially for women whose partners did not support contraception. The findings suggest that concerns about the negative consequences of frequent childbirth outweigh challenges associated with contraceptive use. This presents an opportunity for family planning programmes to improve contraceptive uptake and continuation by addressing the health system challenges related to commodity stock-out and poor quality of care, as well as the concerns of men.

Keywords

ContraceptivesDecision-makingRural Kenya
Type
Research Article
Information
Journal of Biosocial Science , Volume 53 , Issue 6 , November 2021 , pp. 935 - 947
Copyright
© The Author(s) 2020. Published by Cambridge University Press

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References

Ali, MM, Cleland, J and Shah, IH (2012) Causes and Consequences of Contraceptive Discontinuation: Evidence from 60 Demographic and Health Surveys. World Health Organization, Geneva.Google Scholar
Anunobi, FO (2002) Women and development in Africa: from marginalization to gender inequality. African Social Science Review 2(1), 41–63.Google Scholar
Bahamondes, L and Peloggia, A (2019) Modern contraceptives in sub-Saharan African countries. Lancet Global Health 7(7), PE819–PE820.CrossRefGoogle ScholarPubMed
Blackstone, SR, Nwaozuru, U and Iwelunmor, J (2017) Factors influencing contraceptive use in sub-Saharan Africa: a systematic review. International Quarterly of Community Health Education 37(2), 79–91.CrossRefGoogle ScholarPubMed
Castle, S and Askew, I (2015) Contraceptive Discontinuation: Reasons, Challenges, and Solutions. Population Council and FP2020. URL: https://www.familyplanning2020.org/resources/contraceptive-discontinuation-reasons-challenges-and-solutions (accessed February 2020).Google Scholar
CESCR (2016) General Comment No. 22 on the Right to Sexual and Reproductive Health. International Network for Economic, Social & Cultural Rights. Committee on Economic, Social and Cultural Rights. URL: https://www.escr-net.org/resources/general-comment-no-22-2016-right-sexual-and-reproductive-health (accessed July 2019).Google Scholar
Darteh, EK, Dickson, KS and Doku, DT (2019) Women’s reproductive health decision-making: a multi-country analysis of demographic and health surveys in sub-Saharan Africa. PLoS One 14(1), e0209985, 1–12.CrossRefGoogle ScholarPubMed
DeRose, LF and Ezeh, AC (2010) Decision-making patterns and contraceptive use: evidence from Uganda. Population Research and Policy Review 29(3), 423–439.CrossRefGoogle Scholar
Diamond-Smith, N, Warnock, R and Sudhinaraset, M (2018) Interventions to improve the person-centered quality of family planning services: a narrative review. Reproductive Health 15(144), 1–17.CrossRefGoogle ScholarPubMed
Fabic, MS, Choi, Y, Bongaarts, J, Darroch, JE, Ross, JA, Stover, J et al. (2015) Meeting demand for family planning within a generation: the post-2015 agenda. The Lancet 385(9981), 1928–1931.CrossRefGoogle ScholarPubMed
FP2020 (2017) 2017 Family Planning Summit: Summary of Commitments. Family Planning 2020, Washington, DC. URL: http://www.familyplanning2020.org/sites/default/files/FP_Summit_2017_Commitment_Summary_Update-V18-Clean_7.pdf (accessed July 2019).Google Scholar
FP2020 Rights and Empowerment Working Group (n.d.) Family Planning 2020: Rights and Empowerment Principles for Family Planning. Family Planning 2020, Washington, DC. URL: https://www.familyplanning2020.org/sites/default/files/FP2020_Statement_of_Principles_11x17_EN_092215.pdf (accessed July 2019).Google Scholar
Gruskin, S, Bogecho, D and Ferguson, L (2010) ‘Rights-based approaches’ to health policies and programs: articulations, ambiguities, and assessment. Journal of Public Health Policy 31(2), 129–145.CrossRefGoogle ScholarPubMed
Hardee, K, Harris, S, Rodriguez, M, Kumar, J, Bakamjian, L, Newman, K and Brown, W (2014) Achieving the goal of the London Summit on Family Planning by adhering to voluntary, rights-based family planning: what can we learn from past experiences with coercion? International Perspectives on Sexual and Reproductive Health 40(4), 206–214.CrossRefGoogle ScholarPubMed
Jain, AK, Obare, F, RamaRao, S and Askew, I (2013) Reducing unmet need by supporting women with met need. International Perspectives on Sexual and Reproductive Health 39(3), 133–141.Google ScholarPubMed
Juma, M, Askew, I, Alaii, J, Bartholomew, LK and van den Borne, B (2014) Cultural practices and sexual risk behavior among adolescent orphans and non-orphans: a qualitative study on perceptions from a community in western Kenya. BMC Public Health 14(84), 1–9.CrossRefGoogle ScholarPubMed
KNBS (2019) 2019 Kenya Population and Housing Census: Population by County and Sub-County. Kenya National Bureau of Statistics, Nairobi.Google Scholar
KNBS, MOH, NACC, KEMRI and NCPD (2015) Kenya Demographic and Health Survey 2014. KNBS, MOH, NACC, KEMRI and NCPD, Nairobi.Google Scholar
Kumar, J and Hardee, K (2017) Rights-Based Family Planning: 12 Resources to Guide Programming. Population Council, New York.Google Scholar
Machiyama, K, Casterline, JB, Mumah, JN, Huda, FA, Obare, F, Odwe, G et al. (2017) Reasons for unmet need for family planning, with attention to the measurement of fertility preferences: protocol for a multi-site cohort study. Reproductive Health 14(23), 1–11.CrossRefGoogle ScholarPubMed
Machiyama, K, Huda, FA, Ahmmed, F, Odwe, G, Obare, F, Mumah, JN et al. (2018) Women’s attitudes and beliefs towards specific contraceptive methods in Bangladesh and Kenya. Reproductive Health 15(75), 1–15.CrossRefGoogle ScholarPubMed
Madiba, S and Ngwenya, N (2017) Cultural practices, gender inequality and inconsistent condom use increase vulnerability to HIV infection: narratives from married and cohabiting women in rural communities in Mpumalanga province, South Africa. Global Health Action 10 (Supplement 2), 1–8.CrossRefGoogle ScholarPubMed
Mutumba, M, Wekesa, E and Stephenson, R (2018) Community influences on modern contraceptive use among young women in low and middle-income countries: a cross-sectional multi-country analysis. BMC Public Health 18(430), 1–9.CrossRefGoogle ScholarPubMed
NASCOP (2020) Preliminary Kenya Population-Based HIV Impact Assessment (KENPHIA) 2018 Report. National AIDS and STI Control Programme, Nairobi.Google Scholar
Odwe, G, Mumah, J, Obare, F, Wamukoya, M, Machiyama, K, Cleland, J and Casterline, J (2019) Factors influencing satisfaction with oral contraceptive pills and injectables among past users in Kenya. Journal of Biosocial Science 51(4), 491–504.CrossRefGoogle ScholarPubMed
Olakunde, BO, Sam-Agudu, NA, Patel, TY, Hunt, AT, Buffington, AM, Phebus, TD et al. (2019) Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators. Contraception 99(4), 205–211.CrossRefGoogle ScholarPubMed
Otieno, EJ and Okuku, MT (2017) Socio-cultural factors contributing to the spread of HIV and AIDS in Homabay County, Kenya. In Maurice, AN (ed.) Beyond Agency, Voice and Space in Africa’s Development. Centre for Democracy, Research and Development, Nairobi, pp. 135–146.Google Scholar
Owino, B, Ochako, R, Mgamb, E, Sidha, H and Adeke, V (2017) Setting New Family Planning Goals in Kenya: Building on Decades of Progress in Contraceptive Use. Measure Evaluation, Chapel Hill.Google Scholar
PRB (2019) Family Planning Datasheet 2019. Population Reference Bureau, Washington, DC.Google Scholar
Republic of Kenya/Homa Bay County Government (2018) Second County Integrated Development Plan 2018–2022. Republic of Kenya/Homa Bay County Government, Homa Bay.Google Scholar
Towriss, CA, Beguy, D, Wringe, A, Hussein, BH and Timaeus, IM (2020) Planning a family in Nairobi’s informal settlements: results of a qualitative study. Journal of Biosocial Science 52(2), 286–299.CrossRefGoogle ScholarPubMed
UNDESA (2015) Trends in Contraceptive Use Worldwide 2015. United Nations, New York.Google Scholar
UNDESA (2017) World Family Planning 2017 Highlights. United Nations, New York.Google Scholar
UN/DPI (1995) ICPD ‘94: Summary of the Programme of Action: Proceedings of the 1994 International Conference on Population and Development, Cairo. United Nations Department of Public Information, New York.Google Scholar
UNFPA (2010) A Human Rights-Based Approach to Programming: Practical Information and Training Materials. United Nations Population Fund, New York.Google Scholar
UNFPA (2004) Programme of Action Adopted at the International Conference on Population and Development, Cairo, 5–13th September 1994. United Nations Population Fund, New York.Google Scholar
United Nations (1995) Beijing Declaration and Platform for Action. Fourth World Conference on Women, Beijing, 4–15th September 1995. URL: https://www.un.org/womenwatch/daw/beijing/pdf/BDPfA%20E.pdf (accessed July 2019).Google Scholar
Walle, A and Woldie, M (2017) Client-centeredness of family planning services in a resource-limited setting. Ethiopian Journal of Health Science 27(4), 373–382.CrossRefGoogle Scholar