Contraceptive stockouts in Western Kenya: a mixed-methods mystery client study

Abstract

Background The prevalence of modern contraception use is higher in Kenya than in most countries in Sub-Saharan Africa. The uptake has however slowed down in recent years, which, among other factors, has been attributed to challenges in the supply chain and increasing stockouts of family planning commodities. Research on the frequency of contraceptive stockouts and its consequences for women in Kenya is still limited and mainly based on facility audits. Methods This study employs a set of methods that includes mystery clients, focus group discussions, key informant interviews, and journey mapping workshops. Using this multi-method approach, we aim to quantify the frequency of method denial resulting from contraceptive stockout and describe the impact of stockouts on the lived experiences of women seeking contraception in Western Kenya. Results Contraceptives were found to be out of stock in 19% of visits made to health facilities by mystery clients, with all contraceptive methods stocked out in 9% of visits. Women experienced stockouts as a sizeable barrier to accessing their preferred method of contraception and a reason for taking up non-preferred methods, which has dire consequences for heath, autonomy, and the ability to prevent unintended pregnancy. Reasons for contraceptive stockouts are many and complex, and often linked to challenges in the supply chain – including inefficient planning, procurement, and distribution of family planning commodities. Conclusions Contraceptive stockouts are frequent and negatively impact patients, providers, and communities. Based on the findings of this study, the authors identify areas where funding and sustained action have the potential to ameliorate the frequency and severity of contraceptive stockouts, including more regular deliveries, in-person data collection, and use of data for forecasting, and point to areas where further research is needed.

Trends in and Correlates of Short-Acting Contraceptive Stock-Outs: Multicountry Analysis of Performance Monitoring for Action Agile Platform Data

“…Other reasons for stock-out include the challenges in forecasting their family planning needs and not knowing if or when the order would come. 42 Compared with public SDPs, the odds of shortacting contraceptive stock-outs were significantly lower for private SDPs in DRC (aOR¼0.31, P¼.022), India (aOR¼0.10; P<.001), and Kenya (aOR¼0.58, P¼.001). The private health sector is an important source of health services, including reproductive health, in these 3 countries.…”

“…This could result in an increased demand or a faster consumption of stock that could strain their stock levels, leading to a higher likelihood of experiencing stock-outs, especially if contraceptive supply chains and associated staffing are not adequately managed to meet the heightened demand. In Tumlinson et al, 42 the authors found that facilities experienced stock-outs because providers were not completing documentation appropriately and failing to order the commodities they needed. Other reasons for stock-out include the challenges in forecasting their family planning needs and not knowing if or when the order would come.…”

“…Other reasons for stock-out include the challenges in forecasting their family planning needs and not knowing if or when the order would come. 42 …”

Lessons learnt from daily oral PrEP delivery to inform national planning for PrEP ring introduction for women in low-income and middle-income countries: a qualitative inquiry of international stakeholders

“…[50][51][52] FP studies also highlight averting stock-outs is vital to preserving choice, as consistent inventory enables WAG to make informed decisions regarding all approved HIV prevention methods. [53][54][55][56][57] Previous literature support stakeholders' insights about LA-PrEP augmenting service and training to reduce stigma. One review showed that increasing hospitability in HIV treatment clinics was a key stigma-reducing strategy, and a trial found integrating oral PrEP into treatment clinics reached a high proportion of partners without HIV.…”

“…68 Furthermore, PEPFAR funds cannot be used to directly procure contraceptive commodities, 69 offering little help to alleviate persistent stock-outs globally. [53][54][55] The Global Fund to Fight AIDS, Tuberculosis and Malaria, another key funder of HIV programming, currently does not have a distinct focus on FP. 70 71 These narrow funding approaches have bifurcated complementary service sectors, a divide further compounded by the underfunding and politicisation of reproductive health.…”