Analysis of Contraceptive Use, Discontinuation and Switching Among Homeless Women in Kenya: a Case of Nairobi County.

Abstract

Background and Purpose: Contraceptive use, switching, and discontinuation have facilitated child spacing and choice in how many children women wish to have. Over the years, family planning has been utilized by the national government to improve maternal health and reduce x fertility. Kenya launched the Universal Health Coverage program to give everyone affordable access to reproductive health services. Homeless women are, however, a socioeconomically disadvantaged group in society. Homeless women suffer low self-esteem, low literacy levels, emotional disorders, and sexual exploitation. Violence, unwanted pregnancies, early marriages, infectious diseases, drug abuse, and prostitution are issues homeless women have to deal with daily. Homeless women encounter barriers to accessing modern contraceptives due to poverty, drug abuse, and stigmatization, among other challenges leading to underutilization of reproductive health services. Research Objectives: The study examined the extent to which homeless women in Kenya use contraceptives, the factors that lead them to stop using them, and the socioeconomic and demographic factors that influence them to switch between contraceptives. Method: The three objectives of the study were regressed using logistic regression. The study uses primary data from 384 respondents from the CBD alleys and 7 off-slum settlements in Kenya. The study design used was cross-sectional collection of data where data was collected between the month of November 2019 and January 2020. The study utilized cluster sampling to sample the offslum settlements, random sampling to sample the respondents, and multistage sampling to sample and and interview respondents using or not using contraceptives in the first stage and later interview respondents who had either switched or discontinued contraception in the second stage. The sampling design was used to reduce biases in sample selection. Findings and Recommendations: The study found that having a midwife assist with the birth or understanding lactational amenorrhea reduced the expected likelihood of using contraception. Moreover, being educated increased the likelihood of utilization. The study highlighted that an one more year abusing drugs by a homeless woman increased the possibility of contraceptive discontinuation by 13.49 % and one more child born in a healthcare facility by a street woman increased the predicted likehood of contraceptive discontinuation by 37.09%. The study discovered that a homeless woman's projected probability of switching contraceptives increased with each new incidence of premature delivery, abortion, or stillbirth and also if she had a greater understanding of intrauterine devices. The study recommends that stakeholders offer adult homeless women programs to enhance their literacy levels as well as initiate target programs to improve knowledge on contraception, especially female sterilization and IUDs