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

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.

Method-specific beliefs and subsequent contraceptive method choice: Results from a longitudinal study in urban and rural Kenya

“…Although ‘don’t know’ responses were reclassified as disapproval, this is unlikely to account for the contrast—most past users who gave ‘don’t know’ responses were also dissatisfied with the method. Qualitative research suggested that clandestine use of contraception is common in Homa Bay because of hostility or indifference of the partner but no similar evidence is available for Nairobi [ 23 ]. It is also the case that polygyny is much more common in Homa Bay (25%) than in Nairobi (5%) and the existence of co-wives may create social distance between partners and reduce discussion of matters such as contraception [ 33 ].…”

“…The population of Homa Bay is predominantly composed of the Luo ethnic group and the main occupation is subsistence agriculture and fishing. The county has a high fertility rate of 5.2 and a high unmet need for family planning (26%), with less than half (47%) of married women using contraception [ 23 ]. It also has a much higher level of HIV infection than Nairobi (20% and 4%, respectively) [ 24 ].…”