Use of contraceptives on the rise among Kenya’s urban poor

“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.

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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).

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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.

In Kakamega, however, the percentage needing permission to use a contraceptive method increased by 10 percentage points between the baseline and end line surveys, and about one-third of the women (32 per cent) in Nairobi reported they needed permission from someone else to use a contraceptive method at both surveys.

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According to a recent survey, injectables are the most popular form of birth control among women in the urban areas of Nairobi, Machakos, Kakamega, Mombasa and Kisumu

Contraceptive use in 5 urban centres

Nairobi: The most prevalent method at baseline in Nairobi was injectables for women overall, as well as those married or in a relationship. Injectables remained the most prevalent method at end line though

implant use increased most between surveys—from 2 to 9 per cent for women overall and from 3 to 13 per cent for women married or in union.

Mombasa: The contraceptive prevalence increased from 34 to 47 per cent for women overall, and from 48 to 53 per cent for those married or in a relationship. Use of most contraceptive methods increased between surveys except for daily pills, emergency

contraception, female condoms, and traditional methods, which decreased between surveys. Injectables were also the most prevalent method in Mombasa; however, implant use increased most between

surveys, from 2 to 11 per cent for women overall and from 3 to 14 per cent for women married or in union.

Kisumu: Though injectables were the most prevalent method among women overall and those married or in union in Kisumu at baseline, the percentage using injectables at end line declined, while those using

implants increased, making implants the most prevalent method at end line for women overall and those married or in union.

Specifically, about one in five women (one in four for those married or in union) reported using implants at end line. Overall in Kisumu, the contraceptive prevalence rate (CPR) among the percentage of currently married women who are using a method of contraception, increased from 48 to 63 per cent for women overall and from 57 to 73 per cent for those married or in union.

Machakos: Contraceptive prevalence rate increased from 53 per cent at baseline to 65 per cent at end line for women overall and from 73 per cent at baseline to 81 per cent at end line for women married or in union.

The majority of this increase was observed in the use of implants, which increased from 4 to 12 per cent for women overall and from 6 to 15 per cent for women married or in union.

The use of sterilisation, male condoms, and traditional methods decreased between surveys, while the use of implants, IUDs, injectables, emergency contraceptives, and female condoms/LAM increased

between surveys for women overall as well as for those married or in union.

Kakamega: CPR increased from 49 to 56 per cent among women overall and from 61 to 65 per cent among women married or in union. Similar to Machakos, the majority of the increase in CPR was in use

of implants (3 to 15 per cent for women overall and 4 to 18 per cent for women married or in union). However, injectables were the most prevalent contraceptive method for all women at the time of both surveys.