TABLE OF CONTENTS DECLARATION…………… ii
DEDICATION………………………………………………………………………………………………….. iii
ACKNOWLEDGEMENTS……………………………………………………………………………….. iv
TABLE OF CONTENTS……………………………………………………………………………………. v
LIST OF TABLES…………………………………………………………………………………………….. ix
LIST OF FIGURES……………………………………………………………………………………………. x
LIST OF ABBREVIATIONS AND ACRONYMS……………………………………………… xi
DEFINITION OF TERMS……………………………………………………………………………….. xii
LIST OF ABBREVIATIONS AND ACRONYMS……………………………………………. xiii
ABSTRACT……………………………………………………………………………………………………. xiv
CHAPTER ONE: INTRODUCTION………………………………………………………………….. 1
- Background to the study………………………………………………………………………………….. 1
CHAPTER TWO: LITERATURE REVIEW……………………………………………………… 7
2.2.3 FP services provision in Kenya…………………………………………………………………. 8
CHAPTER THREE: MATERIALS AND METHODS……………………………………… 16
- Introduction………………………………………………………………………………………………….. 16
CHAPTER FOUR: RESULTS………………………………………………………………………….. 24
- Introduction………………………………………………………………………………………………….. 24
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS44
- Introduction………………………………………………………………………………………………….. 44
REFERENCES………………………………………………………………………………………………… 50
APPENDICES………………………………………………………………………………………………….. 56
Appendix I: Informed Consent Form for respondents…………………………………………….. 56
Appendix II: Interview schedule………………………………………………………………………….. 61
Appendix III: FGD guide……………………………………………………………………………………. 67
Appendix IV: Key informant interview guide………………………………………………………… 69
Appendix V: Map showing location of Moyale Sub-county in Kenya……………………….. 70
Appendix VI: Graduate school research authorization letter…………………………………….. 71
Appendix VII: Kenyatta university ethics review committee approval letter………………. 72
Appendix VIII: NACOSTI research authorization letter…………………………………………. 74
Appendix X: Ministry of Interior and coordination research authorization letter………… 75
LIST OF TABLES
Table 3.1: Distribution of respondents per health facility…………………………………………. 20
Table 4.1: Socio – demographic characteristics of the respondents…………………………… 25
Table 4.2: Socio – demographic determinants of FP uptake………………………………………. 32
Table 4.3: Socio-economic determinants of FP uptake…………………………………………….. 36
Table 4.4: Socio – cultural determinants of FP uptake………………………………………………. 39
Table 4.5a: Independent predictors of FP uptake……………………………………………………. 43
Table 4.5b: Independent predictors of FP uptake……………………………………………………. 44
LIST OF FIGURES
Figure 1.1: Conceptual framework for predictors of FP services uptake………………………. 6
Figure 4.1: Contraceptive methods used by the respondents…………………………………….. 26
Figure 4.2: Prevalence of FP uptake………………………………………………………………………. 27
Figure 4.3: Algorithm for unmet need for FP…………………………………………………………. 29
LIST OF ABBREVIATIONS AND ACRONYMS
| AIDS | Acquired Immune Deficiency Syndrome |
| ANC | Ante Natal Care |
| DHMT | District Health Management Team |
| HF | Health Facility |
| HIV | Human Immunodeficiency Virus |
| HTC | HIV Testing and Counselling |
| KDHS | Kenya Demographic and Health Survey |
| KNBS | Kenya National Bureau of Statistics |
| KSPA | Kenya Service Provision Assessment |
| MCH/FP | Maternal and Child Health/Family planning |
| MDGs | Millennium Development Goals |
| MNCH | Maternal, Newborn and Child Health |
| MOH | Ministry of Health |
| MOMS | Ministry of Medical Services |
| MOPHS | Ministry of Public Health and Sanitation |
| MTCT | Mother to Child Transmission of HIV |
| NACOSTI | National Commission for Science Technology & Innovation |
| NAL | Northern Arid Lands |
| NCPD | National Council for Population and Development |
| NHSSP | National Health Sector Strategic Plan |
| RH/FP | Reproductive Health/ Family Planning |
| WHO | World Health Organization |
DEFINITION OF TERMS
Family planning – Refers to the voluntary practice of regulating the number and spacing of children through contraception or other methods of birth control
Infecund women -Women who were first married five or more years ago, never used contraception, and have not had a birth in the past five years
FP uptake – Current use of any contraceptive method
Migration status – Refers to whether the respondent moved from one area of residence to another in the last six months
Preferred number of children – The number of children one would wish to have during his/her life time
Unmet need for FP– Percentage of women of reproductive age, either married or in a union, who are fecund and sexually active but are not using any method of contraception, and report not wanting any more children or wanting to delay the next child.
Total demand – Refers to the sum of unmet need (demand) for FP and the met demand for FP
LIST OF ABBREVIATIONS AND ACRONYMS
| AIDS | Acquired Immune Deficiency Syndrome |
| ANC | Ante Natal Care |
| DHMT | District Health Management Team |
| HF | Health Facility |
| HIV | Human Immunodeficiency Virus |
| HTC | HIV Testing and Counselling |
| KDHS | Kenya Demographic and Health Survey |
| KNBS | Kenya National Bureau of Statistics |
| KSPA | Kenya Service Provision Assessment |
| MCH/FP | Maternal and Child Health/Family planning |
| MDGs | Millennium Development Goals |
| MNCH | Maternal, Newborn and Child Health |
| MOH | Ministry of Health |
| MOMS | Ministry of Medical Services |
| MOPHS | Ministry of Public Health and Sanitation |
| MTCT | Mother to Child Transmission of HIV |
| NACOSTI | National Commission for Science Technology & Innovation |
| NAL | Northern Arid Lands |
| NCPD | National Council for Population and Development |
| NHSSP | National Health Sector Strategic Plan |
| RH/FP | Reproductive Health/ Family Planning |
| WHO | World Health Organization |
ABSTRACT
Family planning (FP) is one of the fundamental pillars of safe motherhood and a reproductive health right. However, the Northern arid lands of Kenya, where Moyale Sub- County lies, have continued to record low levels of family planning services uptake. This situation has led to poor health outcomes among women, children and the general population thus poor progress towards achievement of Millennium Development Goals (MDGs). Consequently, this study set out to determine the modern contraceptive methods used by the women,the level of unmet need for FP services, the total demand for FP services and the influence of socio – demographic, economic and cultural factors on FP uptake among the women. The study employed a cross-sectional descriptive design. Stratified two stage random sampling method was used to obtain a sample of 170 respondents who were drawn from women visiting health facilities in the sub-county. Data was collected through interviews with randomly selected respondents, key informants, and focused group discussions. Informed consent was sought from all participants with confidentiality and privacy being maintained throughout the study. Data analysis for the quantitative and qualitative data was carried out using computer Statistical Package for Social Sciences (SPSS Version 20) and content analysis respectively. Chi-square was used to measure significant associations between independent and dependent variables with P < 0.05. Binary logistic regression analysis was used to determine the independent predictors and their contribution to FP uptake. The findings from this study showed that the prevalence of contraceptive uptake is 54.7%. Close to half of the respondents 45.3% were not using any contraceptive method. The total unmet demand for FP was found to be 24.8 % while the total demand for FP was 79.8%. The significant predictors of FP uptake were experience of child loss (O.R= 0.183; p = 0.001), affiliation to Islamic religion (O.R = 4.036; P = 0.026), preferred number of children (O.R = 0.380; P = 0.039), inter-spousal communication (O.R = 5.500; P = 0.045), husbands education level (O.R = 7.598; P = 0.022), joint FP decision making (O.R = 4.992; P = 0.020) and social group approval (O.R = 4.495; P = 0.001).This study recommends creation of awareness and advocacy on benefits of smaller family sizes in the Sub-county, improved access to at least secondary education in the general population, FP campaigns and outreaches at the rural communities and women who have experience of child loss, formation of FP advocacy social groups and utilization of existing social groups for channeling FP messages to the community. The study further recommends strengthening and mainstreaming of male involvement and religious leaders participation in FP interventions and initiation of a communication program that explicitly promotes inter-spousal communication.
CHAPTER ONE: INTRODUCTION
1.1 Background to the study
Globally, 146 million married women of reproductive age had an unmet need for family planning in 2010 and it is estimated that by end of 2015 this number will increase to 153 million. The vast majority of these women are in the developing nations especially in African continent (Alkema, 2013).
Currently, in Sub – Saharan Africa (SSA), at least 25% of women aged 15-49 have unmet need for FP and about 14 million unintended pregnancies occur each year. Over the next 40 years, Africa’s population is expected to double from 1 to 2 billion thus accounting for 22% of world population, up from 15% in 2010. In Kenya, the unmet need for family planning is at 25% while 17% of births are reported as unwanted or unplanned. Use of contraceptives is also generally lower in rural areas in comparison to urban areas with family planning use reported at 43% and 53% respectively. According to KDHS (2009), 88 % of women aged 15-49 years were not using any contraception method in Moyale sub -county while only 7 % of the married women or in a union reported current use of contraception.
Expansion of FP services in SSA can reduce maternal mortality and new born deaths by 69% and 45% respectively, unintended pregnancies by 77% and unsafe abortions from
5.2 million to 1.2 million per year (Singh,2009 & UNDP,2009). In this light, FP2020 has set a goal of expanding family planning services to reach an additional 120 million women who have desire to either limit or space their children globally.
Family planning (FP) is not only a key intervention for improving health but also, a key strategy for the achievement of national and international development goals including Kenya vision 2030 and Millennium Development Goals (MDGs) (MoH, 2010). FP is a human right and it is identified as a priority component in the National Reproductive Health Policy (MoH, 2007). All individuals have the right to access FP, including all FP- pertinent data regarding benefits and scientific progress made in the area of contraception.
In Kenya and other African countries, one of the main factors contributing to the challenge of achieving MDGs is the continued rapid growth of the population. The number of people in need of health, education, economic, and other services is large and increasing, which, in turn, means that the amount of resources, personnel, and infrastructure required to meet the MDGs is also increasing. In light of this fact, development efforts in support of the MDGs recognize the importance and benefits of slowing population growth. Enhancing FP use has the potential to helping Kenya significantly reduce the costs of meeting the five selected MDGs, including: achieving universal primary education, reducing child mortality, improving maternal health, ensuring environmental sustainability and combating HIV/AIDS, malaria, and other diseases (Republic of Kenya, 2007).
Statement of the problem
Low FP services uptake impacts negatively on health outcomes for women and their children. As such, the Kenyan government has set a target for increasing FP services uptake to over 70 per cent so as to achieve vision 2030 (Republic of Kenya,2010). In Moyale Sub-county FP services uptake remains unacceptably low and far below the
national target. This is mirrored in the low CPR (Contraceptive Prevalence Rate) of 12% and high fertility rate of 4.9 (DHIS, 2012 & KDHS, 2009).This worrying situation is attributed to various socio-demographic, economic and cultural factors as demonstrated by KDHS 2009. As such, this study examined the significance of these factors as predictors of FP services uptake in the Sub-county. To attain this, a cross-sectional descriptive study was conducted among women of reproductive age visiting health facilities in the Sub-county.
Justification of the Study
The findings from this study will be valuable in informing the government, non- governmental and private organizations, faith based organizations, individual women, programmers and policy makers on strategies to promote FP services uptake, interventions and FP delivery protocols that are responsive to the unique context and needs for Moyale Sub-county residents.
Research objectives
Broad Objective
To examine predictors of FP services uptake among women of reproductive age visiting health facilities in Moyale Sub-county
Specific Objectives
The specific objectives of this study were:
- To determine the contraceptive methods used by the women of reproductive age visiting health facilities in Moyale Sub-county
- To determine the level of unmet need for FP services among the women of reproductive age visiting health facilities in Moyale Sub-county
- To determine the total demand for FP services among the women of reproductive age visiting health facilities in Moyale Sub-county
- To find out the contributions of socio-demographic, economic and cultural factors on FP services uptake among the women of reproductive age visiting health facilities in Moyale Sub-county.
Research questions
- What are the contraceptive methods used by women of reproductive age visiting health facilities in Moyale Sub-county?
- What is the level of unmet need for FP services among women of reproductive age visiting health facilities in Moyale Sub-county?
- What is the total demand for FP services among women of reproductive age visiting health facilities in Moyale Sub-county?
- What are the contributions of socio demographic, economic and cultural factors on FP services uptake among women of reproductive age visiting health facilities in Moyale Sub-county?
Hypothesis
H0: There is no relationship between socio demographic, cultural and economic factors and FP services uptake among women of reproductive age visiting health facilities in Moyale Sub-county.
Significance of the study
Currently there is limited information on the prevalence and determinants of FP services uptake in resource limited and Islam dominated regions of northern Kenya. This study will help fill in this gaps in knowledge by gauging the current level of FP services uptake and its predictors.
Limitations and delimitations
The study used a sample drawn from women of reproductive age visiting HFs in the Sub- county and who were seeking services such as immunization, FP and growth monitoring for their children. The study was limited to determination of contraceptive methods used by the women, total demand for FP services, level of unmet need for FP and contribution of factors influencing FP services uptake only. It did not extend to study of health system factors.
Conceptual framework
Figure 1.1 lays the conceptual framework for this study. Two groups of variables are used to examine factors influencing uptake of FP services. The independent variables, which influence the uptake of FP services of the study population, are subdivided into three sets. The first two are the underlying factors which include important demographic and socioeconomic variables. The third group of independent variables is the proximate determinants which are women’s knowledge, attitudes, couple communication and perceptions about FP.
For this particular study, two dependent variables are considered (uptake and non-uptake of FP services). Demographic, socioeconomic and social cultural factors are assumed to
be the underlying determinants of FP services uptake. That is, the effect of the underlying factors is expected to reach the ultimate dependent variable through the assumed proximate variables.
