Trends and factors associated with long-acting reversible contraception in Kenya

Contraceptive use and discontinuation among women aged 15-24 years in Kenya

Introduction

The 15-24-year-old age group of young women make up about 15% of the population of 47 million Kenyans which comes to 7 million. Addressing the reproductive health goals of this cohort is thus a policy priority because of the high potential they pose for unintended pregnancy through incorrect and intermittent use of contraception.

Objective

The study sought to present evidence on contraceptive use among women aged 15-24 in Kenya between 2012 and 2014 using Kenya Demographic and Health Survey (KDHS) 2014 Contraceptive calendar data and make recommendations on enhancing the correct and consistent use of contraception.

Methodology

The data used was obtained from the Choices and Challenges tool developed by Population Reference Bureau (PRB) and visualized innovatively using Sankey Diagrams that show contraceptive use/non-use, continuation, switching/discontinuation, and pregnancy.

Results

The use of contraceptives went up by about 30% during the study period while the use of modern methods went up by 83%. The uptake of Long-Acting Reversible Contraception (LARC) went up by 87% while that of Short Acting Methods (SAM) went up by 70% but the progress was clouded by discontinuation rates of 35% with side effects being the leading reason for the abandonment of contraception.

Conclusion

For Kenya to achieve transformative results in ending the unmet need for contraception and preventable maternal deaths, it is critical to sustaining the current gains in contraceptive prevalence rate (CPR) by promoting the retention of youth users and encouraging new users.

Factors associated with use of long-acting reversible and permanent contraceptives among married women in rural Kenya: A community-based cross-sectional study in Kisii and Kilifi counties

Long-acting and permanent contraceptive methods (LAPM) are effective and economical methods for delaying or limiting pregnancies, however they are not widely used. The Kenya government is promoting the use of modern methods of family planning through various mechanisms. This study aimed to determine the prevalence and factors associated with the use of LAPM among married women of reproductive age in targeted rural sub-counties of Kilifi and Kisii counties, Kenya. Baseline and end line Data from a program implemented on improving Access to Quality Care and Extending and Strengthening Health Systems (AQCESS) in Kilifi and Kisii counties of Kenya were used. Multi-stage sampling was used to sample 1117 and 1873 women for the end line and baseline surveys, respectively. Descriptive analysis was used to explore the respondents' characteristics and use of LAPM on a self-weighted samples. Univariable and multivariable binary logistic regression models using svy command were used to assess factors associated with the use of LAPM. A total of 762 and 531 women for the baseline and end line survey, respectively were included in this study. The prevalence of use of LAPM for baseline and end line survey were 21.5% (95% CI: 18.7-24.6%) and 23.2% (95% CI: 19.6%-27.0%), p-value = 0.485. The use of LAPM in Kisii and Kilifi counties was higher than the national average in both surveys. The multivariable analysis for the end line survey showed having 3-5 number of children ever born (aOR = 2.04; 95% CI: 1.24-3.36) and future fertility preference to have another child (aOR = 0.50; 95% CI: 0.26-0.96) were significantly associated with odds of LAPM use. The baseline showed that having at least secondary education (aOR = 1.93; 95%CI: 1.04-3.60), joint decision making about woman's own health (aOR = 2.08; 95%CI: 1.36-3.17), and intention to have another child in future (aOR = 0.59; 95%CI: 0.40-0.89) were significantly associated with the use of LAPM. Future fertility preference to have another child was significantly associated with the use of LAPM in the two surveys. Continued health promotion and targeted media campaigns on the use of LAPM in rural areas with low socioeconomic status is needed in order to improve utilization of these methods. Programs involving men in decision making on partner's health including family planning in the rural areas should be encouraged.

Prevalence of and factors associated with contraceptive discontinuation in Kenya

BACKGROUND

 The overwhelming uptake of contraception in Kenya at 58% suggests huge potential for a continued increase, but discontinuation threatens efforts to achieve new targets. Further increases in contraceptive prevalence will depend more on continuation and re-adoption amongst past users because unintended pregnancies would increasingly result from discontinuation. Eliminating discontinuations from side effects and method failure could increase continuation rates by 10%.

AIM

 To establish the prevalence and factors associated with contraceptive discontinuation.

SETTING

 Kenya, with a successful family planning programme, but also the challenge of discontinuation rates of 31%.

METHODS

 Contraceptive calendar data from the 2014 Kenya Demographic and Health Survey were used in the survival analysis approach.

RESULTS

 Overall discontinuation rates were 37% (24 months) and 74% at (36 months), whilst discontinuation in need was 36%. Side effects accounted for 40% of discontinuations, whilst injection and pill recorded the highest rates. Current method emerged as a predictor of discontinuation at 24 months with the following hazard ratio (HR) at 95% confidence interval [CI]; intrauterine device (IUD) (HR = 0.466, CI = 0.254-0.857), injection (HR = 0.801, 95% CI = 0.690-0.930), implants (HR = 0.580, 95% CI = 0.429-0.784) and at 36 months, injection (HR = 0.808, 95% CI = 0.722-0.904) and implants (HR = 0.585, 95% CI = 0.468-0.730). Age (15-24 years) displayed influence only at 36 months (HR = 1.219, 95% CI = 1.044-1.424).

CONCLUSION

 The study showed a close link between contraceptive method used and discontinuation and thus the need to address method-related issues in an attempt to minimise discontinuation in Kenya. Expanding contraceptive options and improving the quality of service can scale up switching and thus help reduce discontinuation and unintended births.

"I Found Out I was Pregnant, and I Started Feeling Stressed": A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28-38 weeks pregnant, 6-weeks postpartum and 5-7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.