Contraceptive Use Dynamics In Kenya, 2003-2014

Abstract

This study presents the findings of an investigation of the dynamics of contraceptive use in Kenya from 2003 to 2014 using Kenya Demographic and Health Survey (KDHS) data from three surveys conducted during that period. The study sought to highlight the impact of contraceptive discontinuation on retention of contraceptive users in the study period and the critical role played by the method chosen. It examined on a national scope, the trends in contraceptive use and the determinants of method choice and discontinuation using cross-classification and life tables for descriptive analyses, while multinomial logistic and Cox proportional-hazards methods were used in regression analyses. Over the course of their reproductive life course, women and/or their spouses change their family planning choices in an intricate process governed by various factors. The understanding of these shifts is important for both policy and service delivery in order to meet the reproductive needs of women and/or spouses, minimise unmet need and contraceptive discontinuation and hence unwanted fertility. Although there have been comprehensive studies on the issues of choice of methods and subsequent discontinuation, there is a lack of comprehensive analysis since the publication of the KDHS 2008/2009. This study sought to answer three critical questions for assessment and policy concerns. 1) What are the trends in contraceptive method choice? 2) What factors influence method choice? 3) What factors influence contraceptive discontinuation? The study revealed a phenomenal change of high prevalence of modern contraception occurred between 2008 and 2014. The overall picture presented was that of consistently rising prevalence of modern contraceptive methods among women of all ages, especially among younger women aged 15-24 and those from the rural areas and lower wealth status. There was a general shift in the use of contraceptive methods from short-term to long-acting reversible contraception (LARC), more so implants. The factors of age, residence, education, type of contraceptive, region and wealth emerged as determinants of contraceptive method choice, while the predictors of discontinuation emerged as the method of contraception and age. The overall rates of discontinuation at 12 months were 30%, for 24 months 37% and for 36 months 74%. The conclusions suggest the reaping of benefits from the repositioning and scaling up of family planning campaigns after the stagnation revealed in KDHS 2003. This was shown in the uptake of modern methods of contraception, especially the more effective ones. The study recommends more research on issues of side effects among contraceptive users of secondary education and among method switchers. On policy, the high demand for LARC calls for sustainable investments in their supply and regular training of service providers, as the methods are provider dependent. Further, comprehensive counselling and follow-up should be implemented to deal with issues of side effects, hence reduction of discontinuation.