Analysis of Family Building Patterns in Kenya when Fertility has Stalled

The absence of any further fertility decline in Kenya in recent past has alarmed the demographic community. While such phenomenon is not new, it is also possible that the observed fertility as measured by TFR may be due to flaws in the in distortion of TFR from changes in the timing of childbearing. On the other handWhile, there may have been a real reversal in fertility decline that could arise from change in fertility preferences. However, tracing fertility trends by traditional measures (such as TFR) in early stages of demographic transition is speculative and uncertain even if data is of good quality. This study uses birth history data from the 1998 and 2003 KDHS to examine trends in family building patterns. The main conclusion is that fertility rates increased among women in their middle age (25-34) for those in parities 4 and 5 but declined for both younger and older women. From a methodological perspectives, the use of parity progression ratios uncovers patterns that may be difficult with the use of age-specific fertility rates. Parity-specific analysis is consistent with the sequential nature of childbearing and approximates the family-building behaviour of real cohorts

Gender-Role Attitudes and Reproductive Health Communication among Female Adolescents in South Nyanza, Kenya1

In this paper, we use data from three districts of Nyanza Province in Kenya to examine gender-role attitudes and reproductive health communication among adolescent females aged 12-19 years. We test for differences in gender-role attitudes between younger (12-15) and older (16-19) adolescents. We explore the possible association between educational attainment and gender-role attitudes by estimating a random effects model. We also examine the association between gender-role attitudes and reproductive health communication via an unordered multinomial logit model. The results show that adolescent females in this setting hold conservative views on decision making within the home and at the same time portray less conservative views concerning marriage and reproductive behaviour. We also find some differences by age regarding gender-role attitudes and reproductive health communication. Our findings further indicate that educational attainment is significantly associated with gender-role attitudes, which in turn are significantly associated with reproductive health communication.  

An Event History Analysis of Factors Influencing Entry into Parenthood In Nairobi

In this study, we use data from the Urban Integration Survey conducted in 2001 in Nairobi, following the standard that has been adapted in several cities in Africa (Dakar, 1989; Bamako, 1992; Yaounde, 1996 and Antananarivo, 1998), to examine the underlying factors influencing entry into parenthood for men and women during the period of economic crisis. The analysis uses event history methods, specifically the Cox Proportional Hazards Regression model, stratified by generational age and run separately by sex. The results show that the majority of the migrants to Nairobi began childbearing in Nairobi, with migration status having no effect on entry into parenthood when other factors are controlled for. What seems important in delaying entry into union is some form of economic security, while social and economic contexts appeared weak for both men and women. One intriguing result was that there is an almost monotonic increase on the likelihood of entry into motherhood with increase in the level of education

Demand satisfied by modern contraceptive among married women of reproductive age in Kenya

Background: Demand for family planning met/satisfied with modern contraceptive methods (mDFPS) has been proposed to track progress in Family Planning (FP) programs for Sustainable Development Goals. This study measured mDFPS among married women of reproductive age (MWRA) in Kenya to identify which groups were not being reached by FP programs. Materials and methods: Performance, Monitoring and Accountability 2020 (PMA2020) survey data from 2014–2018 was used. PMA2020 surveys are cross-sectional including women 15–49 years. PMA2020 used a 2-stage cluster design with urban/rural regions as strata with random selection of households. Univariate and multivariate analysis was done using stata V15. Results: Of the 34,832 respondents interviewed from 2014 to 2018, 60.2% were MWRA. There was a significant decrease in demand for FP from 2014 to 2018, p = 0.012. Lowest demand was among 15–19 and 45–49 years old women. Overall, modern contraceptive prevalence rate increased significantly from 54.6% to 60.8%, p = 0.004, being higher for women from urban areas, home visits by health care worker (HCW), educated, wealthy, visited health facilities and exposed to mass media. Unmet need for FP decreased from 23.0–13.8% over the 5-years, p\u3c0.001. Married adolescent 15–19 had the highest unmet need and those from rural areas, poor, uneducated and not exposed to mass media. mDFPS increased significantly from 69.7–79.4% over the 5-years, p\u3c0.001, with increase in long acting reversible contraception/permanent methods from 19.9–37.2% and decrease in short acting methods from 49.9–42.2%. Significant determinants of mDFPS were age, rural/urban residence, education, wealth, health facility visitation, exposure to FP messages via mass media in the last 12 months, year of study and county of residence. Conclusions: Results show a good progress in key FP indicators. However, not all MWRA are being reached and should be reached if Kenya is to achieve the desired universal health coverage as well as Sustainable Development Goals. Targeted home visits by HCW as well increase in mass media coverage could be viable interventions

Exploring contraception myths and misconceptions among young men and women in Kwale County, Kenya

BackgroundMyths and misconceptions around modern contraceptives have been associated with low contraceptive uptake in sub-Saharan Africa and Kenya in particular. Addressing persistent contraceptive knowledge gaps can make a significant contribution towards improved contraceptive uptake among young women. This qualitative study therefore sought to explore and understand young people's knowledge of modern contraception and to identify their key concerns regarding these methods.MethodsWe used focus group discussions (FGD) with vignette and writing activities to explore key myths and misconceptions around the use of contraceptives. Six FGDs (three for young men and three for young women) were conducted with a total of 28 young women and 30 young men from Kwale County, Kenya. We included 10 discussants aged 18-24 per FGD, one FGD had 8 participants. Predefined codes reflecting the discussion guides and emerging issues in the FGDs were used to develop the thematic coding framework. Our analysis followed a pattern of association on the key preset themes focusing on myths and misconceptions around contraceptive use.ResultsResults are presented under four key themes: awareness of contraception, myths and misconceptions around contraception, males' contraceptive narratives and young people's preferred sources of contraceptives. Both men and women participants reported basic awareness of contraceptives. A mixture of biological and social misconceptions were discussed and included perceptions that modern contraception: jeopardized future fertility, could result in problems conceiving or birth defects, made women promiscuous, was 'un-African', and would deny couples their sexual freedom. Compared to female respondents in the study, young men appeared to be strong believers of the perceived socio-cultural effects of contraceptives. On preferred sources of contraceptives, respondents reported on two main sources, pharmacies and public hospitals, however, they could not agree on which one was suitable for them.ConclusionsThis study revealed the presence of a mixture of biological and social myths and misconceptions around contraception, with young men also strongly adhering to these misconceptions. The low level of contraceptive knowledge, particularly on contraceptive fears as revealed by the study demonstrate critical gaps in sexual and reproductive health (SRH) knowledge among young people. Improved SRH literacy to address contraceptives' fears through appropriate and gender specific interventions to reach out to young men and women with factual SRH information may therefore contribute to increased uptake of SRH services including modern contraceptive methods

Busting contraception myths and misconceptions among youth in Kwale County, Kenya: results of a digital health randomised control trial

Objectives: The objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions. Design and setting: A three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya. Participants and interventions: A total of 740 youth aged 18–24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants received standard care. The intervention period was 7 weeks. Primary outcome: We assessed change myths believed at baseline and endline using an index of 10 contraception- related myths. We assessed change across arms using difference of difference analysis. Results: Across arms, \u3c5% of participants did not have any formal education, \u3c10% were living alone, about 50% were single and \u3e80% had never given birth. Between baseline and endline, there was a statistically significant drop in the average absolute number of myths and misconceptions believed by intervention arm (11.1%, 95% CI 17.1% to 5.2%), contact arm (14.4%, 95% CI 20.5% to 8.4%) and control arm (11.3%, 95% CI 17.4% to 5.2%) participants. However, we observed no statistically significant difference in the magnitude of change across arms. Conclusions: We are unable to conclusively state that the text message intervention was better than text message ‘contact’ or no intervention at all. Digital health likely has potential for improving SRH-related outcomes when used as part of multifaceted interventions. Additional studies with physical and geographical separation of different arms is warranted

Analysis of Family Building Patterns in Kenya when Fertility has Stalled

The absence of any further fertility decline in Kenya in recent past has alarmed the demographic community. While such phenomenon is not new, it is also possible that the observed fertility as measured by TFR may be due to flaws in the in distortion of TFR from changes in the timing of childbearing. On the other handWhile, there may have been a real reversal in fertility decline that could arise from change in fertility preferences. However, tracing fertility trends by traditional measures (such as TFR) in early stages of demographic transition is speculative and uncertain even if data is of good quality. This study uses birth history data from the 1998 and 2003 KDHS to examine trends in family building patterns. The main conclusion is that fertility rates increased among women in their middle age (25-34) for those in parities 4 and 5 but declined for both younger and older women. From a methodological perspectives, the use of parity progression ratios uncovers patterns that may be difficult with the use of age- specific fertility rates. Parity Parity-specific analysis is consistent with the sequential nature of childbearing and approximates the family-building behaviour of real cohorts.L'arrêt du déclin de la fécondité ces dernières années au Kenya alarme la communauté des démographes. Bien que ce phénomène ne soit pas nouveau, il est aussi possible que les tendances de fécondité telle que mesurée par l'indice conjoncturel de fécondité (ICF) soit affectées par des distorsions dans le calendrier des grossesses. Bien qu'il soit possible que le renversement de tendance soit dû à un changement réel des préférences en matière de fécondité, repérer les tendances de la fécondité par des indices classiques (tel que l'ICF) dans les premiers stades de la transition démographique est un exercice spéculatif et incertain, même si les données sont de bonne qualité. La présente étude utilise les histoires génésiques recueillies par les EDS du Kenya en 1998 et 2003 pour examiner les tendances de formation de la famille. La principale conclusion est que les taux de fécondité ont augmenté parmi les femmes d'âge moyen (25-34 ans) qui avaient déjà 4 ou 5 enfants mais a diminué pour les femmes plus jeunes et plus âgées. D'un point de vue méthodologique, l'utilisation des probabilités d'agrandissement de la famille dévoile des comportements qu'il est difficile d'identifier avec les taux de fécondité par âge. L'analyse des probabilités d'agrandissement est cohérente avec la nature séquentielle des grossesses et approche au mieux le processus de formation des familles dans chaque génération. génération

Investigating the association between HIV/AIDS and recent fertility patterns in Kenya

Findings from previous studies linking the HIV/AIDS epidemic and fertility of populations have remained inconclusive. In sub-Saharan Africa, demographic patterns point to the epidemic resulting in fertility reduction. However, evidence from the 2003 Kenya Demographic and Health Survey (KDHS) has revealed interesting patterns, with regions most adversely affected with HIV/AIDS showing the clearest reversal trend in fertility decline. While there is suggestive evidence that fertility behaviour in some parts of sub-Saharan Africa has changed in relation to the HIV/AIDS epidemic, more rigorous empirical analysis is necessary to better understand this relationship. In this paper, we examine individual and contextual community HIV/AIDS factors associated with fertility patterns in Kenya, paying particular attention to possible mechanisms of the association. Multilevel models are applied to the 2003 KDHS, introducing various proximate fertility determinants in successive stages, to explore possible mechanisms through which HIV/AIDS may be associated with fertility. The results corroborate findings from earlier studies of the fertility inhibiting effect of HIV among infected women. HIV-infected women have 40 percent lower odds of having had a recent birth than their uninfected counterparts of similar background characteristics. Further analysis suggests an association between HIV/AIDS and fertility that exists through proximate fertility determinants relating to sexual exposure, breastfeeding duration, and foetal loss. While HIV/AIDS may have contributed to reduced fertility, mainly through reduced sexual exposure, there is evidence that it has contributed to increased fertility, through reduced breastfeeding and increased desire for more children resulting from increased infant/child mortality (i.e. a replacement phenomenon). In communities at advanced stages of the HIV/AIDS epidemic, it is possible that infant/child mortality has reached appreciably high levels where the impact of replacement and reduced breastfeeding duration is substantial enough to result in a reversal of fertility decline. This provides a plausible explanation for the patterns observed in regions with particularly high HIV prevalence in Kenya. © 2010

Use of long-acting reversible contraception among adolescents and young women in Kenya.

The Kenya Demographic and Health Survey (KDHS 2014) revealed changing patterns in the contraceptive use of young women aged 15-24, shifting from injectable methods to implants. Long-acting reversible contraception (LARC) is user friendly, long-term, and more effective than other modern methods. It could be a game-changer in dealing with unintended pregnancies and herald a new chapter in the reproductive health and rights of young women. This study determined the factors associated with LARC use among adolescent girls and young women to expand the evidence of its potential as the most effective method of reducing unwanted pregnancies among the cohort. This study analysed secondary data from KDHS 2014 using binary logistic regression. The findings showed a rise in LARC use (18%), with identified predictors of reduced odds being aged 15-19 [OR = 0.735, 95% CI = 0.549-0.984], residence (rural) [OR = 0.674, CI = 0.525-0.865], religion (Protestant/other Christian) [OR = 0.377, CI = 0.168-0.842], married, [OR = 0.746, CI = 0.592-0.940], and region (high contraception) [OR = 0.773, CI = 0.626-0.955], while the number of living children showed increased odds for 1-2 children [OR = 17.624, CI = 9.482-32.756] and 3+ children [OR = 23.531, CI = 11.751-47.119]. This study established the rising popularity of LARC and identified factors that can be addressed to promote it. Its increased uptake could help Kenya achieve the International Conference on Population and Development 25's first and second commitments on teenage pregnancies and maternal and new-born health, thus promoting the health, wellbeing, educational goals, and rights of this critical cohort. This study can guide the accelerated efforts needed in Kenya's march towards the five zeros of unmet need for contraception, teenage pregnancies, unsafe abortions, preventable maternal deaths, and preventable neonatal/infant deaths

Increased Use of Injectable Contraception in Sub-Saharan Africa

National surveys show a remarkable upsurge in the use of injectable contraceptives in east and South Africa, in contrast to central and West Africa and certain other regions. Data are analyzed here from 95 surveys conducted since 1980 in 38 sub-Saharan African countries, to determine past injectable trends in the context of alternative methods and to explore related issues. In eastern and southern countries injectable use has risen to about 15%-20% of married women, equaling about 40% of all contraceptive use, with some countries above that. Increases in total use have followed increases in injectable use; that and other evidence is clear that the injectable has not merely substituted for the use of pre-existing methods but has given a net increase to total use. Rural use patterns are not much different from urban ones; however the middle and higher wealth quintiles have especially moved toward injectable use. In west and central countries traditional methods are still paramount, with modern methods increasing slightly, but total use remains quite low there. So far no plateau has appeared in total injectable use, though one may be emerging in its share of all use as other methods also increase. Most use is supplied through the public sector, which raises long term cost issues for health ministries and donors. Many sexually active, unmarried women use the method Discontinuation rates are quite high, and alternative methods need to be kept readily availableLes enquêtes nationales montrent un essor remarquable dans l'utilisation des contraceptifs injectables en Afrique de l’est et en Afrique du Sud, contrairement à l'Afrique Centrale et de l'Ouest et dans certaines autres régions. Les données sont analysées ici à partir de 95 enquêtes menées depuis 1980 dans 38 pays d'Afrique subsaharienne, afin de déterminer les tendances d’injectables dans le contexte des méthodes alternatives et d'explorer les questions qui s’y liées. Dans les pays de l'Est et du Sud de l'utilisation des injectables a augmenté d'environ 15% à 20% chez les femmes mariées, ce qui représente environ 40% de toutes les utilisations des contraceptifs, certains pays ayant des chiffres supérieurs à cela. Les augmentations de la consommation totale ont suivi l’augmentation à l’égard de l'utilisation des injectables ; cela et d’autres preuves; montrent clairement que l’injectable n'a pas seulement remplacé l'utilisation de méthodes existantes, mais a causé une augmentation nette de la consommation totale. Les tendances dans l'utilisation rurale ne sont pas très différentes de celles en milieu urbain; néanmoins, les quintiles de richesse moyennes et supérieures se sont surtout orientés vers une utilisation des injectables. Dans les pays de l'Ouest et du Centre les méthodes traditionnelles sont toujours primordiales, les méthodes modernes étant en légère augmentation, mais l'utilisation totale reste assez faible là-bas. Jusqu'à présent, aucun plateau n’est apparu dans l'utilisation totale à injectable, quoiqu’il puisse figurer de sa part dans toute l'utilisation au fur et à mesure que d'autres méthodes aussi augmentent. La plupart des injectables proviennent du secteur public, ce qui soulève des questions à long terme concernant le coût pour les ministères de la santé et les donateurs. Beaucoup de femmes non mariées qui sont sexuellement actives, les femmes non mariées utilisent cette méthode. Les taux d'abandon de cette méthode sont très élevés, et les méthodes alternatives doivent être facilement disponibles