Navigating family planning access during Covid-19: A qualitative study of young women’s access to information, support and health services in peri-urban Nairobi

Abstract

The COVID-19 response has profoundly affected women’s access to family planning services in Kenya. While prior studies have shown how the COVID-19 response created barriers to accessing family planning (FP) services, less is known about how the pandemic affected the normative influence that partners, peers, and health providers exert on women’s FP choices. In this qualitative study, we interviewed 16 women (aged 18–25 years), 10 men in partnerships with women, and 14 people in women’s social networks across 7 low-income wards in Nairobi, Kenya. Our findings suggest that COVID-19 response measures changed the contexts of normative influence on FP: financial insecurity, increased time at home with husbands or parents, and limited access to seek the support of health workers, friends, and other people in their social network affected how women negotiated FP access and use within their homes. Our study underscores the importance of ensuring FP is an essential service in a pandemic, and of developing health programs that change norms about FP to address the gendered burden of negotiating FP during COVID-19 and beyond.

Use of digital media for family planning information by women and their social networks in Kenya: A qualitative study in peri-urban Nairobi

“…In Kenya, there are inequities in accessing and navigating digital spaces resulting in a digital divide between those who have access to technology and data (such as phones or laptops) and those who are not able to access digital spaces due to other factors such as wealth or digital literacy (World Bank, 2019 ; Yousef et al, 2021 ). The digital divide has been exacerbated during COVID-19 (Beaunoyer et al, 2020 ), where studies have found that those living in peri-urban or low-income settings face difficult choices between accessing technology to stay connected to social networks remotely and meeting other daily needs, such as purchasing food (Hassan et al, 2021a ). However, we found those able to access and navigate digital media spaces faced other barriers such as social stigma in accessing and sharing information on FP.…”

“…Previous interventions to improve access to FP information found that targeting the channels in which social networks communicate has been key to address misinformation about FP (Nazzar et al, 1995 ; Colleran and Mace, 2015 ; Boydell et al, 2020 ). Studies in Kenya point to the role of health care providers (Alege et al, 2016 ) and key influencers, such as close family and friends, as trusted sources of FP information (Hassan et al, 2021a ) 1 . As more young people have access to the internet, digital media and technology in Kenya, healthcare providers have turned to digital media to develop new ways of sharing credible FP information with multiple groups, with an emphasis on young people (Zhou et al, 2018 ).…”

“…Research conducted by the United Nations Population Fund (UNFPA) predicts that more than 47 million women could lose access to contraception leading to 7 million unintended pregnancies as a result of the COVID-19 crisis (United Nations Population Fund, 2020 ). This gap in access to FP services disproportionally affects young people, who experience unique barriers to accessing FP methods and information (Prata et al, 2013 ; Engelbert Bain et al, 2021 ; Hassan et al, 2021a ). In another study, we found that women in peri-urban Nairobi faced additional challenges accessing FP information and services during the pandemic and relied on digital media to reach their social networks to discuss FP and to seek information online (Hassan et al, 2021a ).…”

“…This gap in access to FP services disproportionally affects young people, who experience unique barriers to accessing FP methods and information (Prata et al, 2013 ; Engelbert Bain et al, 2021 ; Hassan et al, 2021a ). In another study, we found that women in peri-urban Nairobi faced additional challenges accessing FP information and services during the pandemic and relied on digital media to reach their social networks to discuss FP and to seek information online (Hassan et al, 2021a ).…”

“…There is limited research on preferred avenues of accessing FP information online among young women and their key influencers in low-resource settings, which is critical to address the challenges of unmet need of FP as well as removing barriers to FP information. Data for this study come from a larger study on the potential of online networks to initiate social norms change on offline networks, where the initial analyses of these data suggest that COVID-19 changed the normative influence of FP and limited access to women's social network and affected how they negotiated FP use within homes (Hassan et al, 2021a ). Further, we found that women consult various key influencers in their social networks based on the information they need or the choices they are making in relation to FP (See footnote 1).…”