Factors Influencing Family Planning Uptake Among Adolescents and Postpartum Women in Kenya

Family planning (FP) is a cost-effective public health strategy, but the uptake is low with marked disparity among adolescents and postpartum women. However, data on these marginalized groups are limited. This quantitative, cross-sectional study sought to provide information on the factors that contribute to the uptake of FP among adolescents and postpartum women in Kenya. The 2014 Kenya Demographic Health Survey FP data were analyzed regarding the factors associated with FP uptake among adolescents and postpartum women as well as the differences by region. The factors were organized according to the socioecological model (SEM) and included intrapersonal, interpersonal, community, and organizational levels of influence. The logistic regression model was used to determine the contribution of different factors to the uptake of FP. The results indicated that compared to adolescents, older women have better socioeconomic status, and a higher proportion are using modern FP methods. On bivariate analysis, factors at all levels of the SEM were associated with uptake of FP in both groups. On regression analysis, factors that contributed most significantly to the uptake of FP were at the intrapersonal and organizational levels among adolescents and at the intrapersonal and interpersonal levels among postpartum women. Recommendations include further research on empowering adolescents to make informed choices in FP, FP interventions focusing on more than one level of SEM, and regional disparities being addressed. The information provided by this study can contribute to improved FP uptake and positive social change for adolescents and postpartum women, which means better health, economic benefits, and improved quality of life

Opportunities and challenges in implementing community based skilled birth attendance strategy in Kenya

Background Availability of skilled care at birth remains a major problem in most developing countries. In an effort to increase access to skilled birth attendance, the Kenyan government implemented the community midwifery programme in 2005. The aim of this programme was to increase women’s access to skilled care during pregnancy, childbirth and post-partum within their communities. Methods Qualitative research involving in-depth interviews with 20 community midwives and six key informants. The key informants were funder, managers, coordinators and supervisors of the programme. Interviews were conducted between June to July, 2011 in two districts in Western and Central provinces of Kenya. Results Findings showed major challenges and opportunities in implementing the community midwifery programme. Challenges of the programme were: socio-economic issues, unavailability of logistics, problems of transportation for referrals and insecurity. Participants also identified the advantages of having midwives in the community which were provision of individualised care; living in the same community with clients which made community midwives easily accessible; and flexible payment options. Conclusions Although the community midwifery model is a culturally acceptable method to increase skilled birth attendance in Kenya, the use of skilled birth attendance however remains disproportionately lower among poor mothers. Despite several governmental efforts to increase access and coverage of delivery services to the poor, it is clear that the poor may still not access skilled care even with skilled birth attendants residing in the community due to several socio-economic barriers

Integrating tuberculosis case finding and treatment into postnatal care

Under the USAID funded FRONTIERS program, the Population Council conducted a study in six health facilities in Western Kenya that demonstrated that screening for TB within an antenatal care (ANC) setting is feasible and acceptable among the service providers. However, a major challenge remains: although TB detection is encouraged among ANC clients within the maternal and child health clinics in the country, providers in these settings fail to appreciate the need for a continuum of care from pregnancy through to the postnatal period. In order to address this gap, the APHIA II Operations Research Project developed and tested an intervention to improve TB screening, case detection, treatment, and care among postnatal women. The findings demonstrate that while it is feasible to use postnatal care services as a platform for TB screening and case detection, the actual number of cases detected was extremely low, even though the facilities were located in areas expected to have high prevalence. It might be important for program managers and policymakers to decide whether routine TB screening in RH services is justifiable, given the very low cases of TB detected

Progesterone vaginal ring: Results of an acceptability study in Kenya

The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. Previous studies have shown that contraceptive vaginal rings are safe, effective, and well accepted in varied cultural settings. However, the extent to which the ring is acceptable in the sub-Saharan African context is unknown. This study examined the acceptability of the PVR in Kenya as part of a larger project that was also conducted in Nigeria and Senegal. The specific objectives of the study were to assess the factors influencing the acceptability of the method among clients, their spouses, providers, community members, and those who were counseled but did not choose the method, to inform future introduction efforts. Findings indicate that the ring was acceptable to most clients and key stakeholders. In addition, several positive attributes of the ring that were mentioned by participants are likely to increase uptake of the method

Strengthening the delivery of comprehensive reproductive health services through the community midwifery model in Kenya

The overall objective of this project was to strengthen the delivery of family planning/reproductive health and HIV (FP/RH/HIV) services at the community level. The interventions included revision of existing guidelines and protocols for the community midwifery approach, training of providers, provision of equipment and supplies, and creating awareness on the use of community referral cards. In addition, cost analysis of community midwives’ services and willingness-to-pay assessments for various reproductive health services among current and potential users of community midwifery services were undertaken. The results showed that the community midwifery model improved clients’ access to a comprehensive package of RH/HIV including long-term family planning methods. The report provides specific recommendations for additional improvements to strengthen the delivery system

Effectiveness, safety and acceptability of Sino-implant (II) during the first year of use: Results from Kenya and Pakistan

Background: Sino-implant (II) is a two-rod subcutaneous contraceptive implant used up to 4 years, containing 150 mg of levonorgestrel. We conducted two observational studies of Sino-implant (II) to evaluate its performance in routine service delivery settings.Methods: We enrolled 1326 women age 18-44 who had Sino-implant (II) inserted at clinics in Pakistan and Kenya. Women were followed-up using either an active or passive follow-up scheme in each study. Study outcomes were: one-year cumulative pregnancy and discontinuation rates; rates of insertion and removal complications; adverse event and side effect rates; reasons for discontinuation; and implant acceptability and satisfaction with clinic services.Results: A total of 754 women returned for at least one follow-up visit. The overall Pearl pregnancy rate was 0.4 per 100 woman-years [95% confidence interval (CI) 0.1, 0.9] resulting from 1 confirmed post-insertion pregnancy in Kenya and 4 in Pakistan. Country-specific Pearl rates were 0.2 (95% CI 0.0, 0.9) in Kenya and 0.6 (95% CI 0.2, 1.6) in Pakistan. The total cumulative 12-month probability of removal was 7.6% (95% CI 6.1, 9.1), with country-specific removal probabilities of 3.7% in Kenya (95% CI 2.1, 5.3) and 10.8% in Pakistan (95% CI 8.5, 13.2). Four serious adverse events occurred in Kenya and none occurred in Pakistan; one SAE (an ectopic pregnancy) was possibly related to Sino-implant (II). Most women in both countries said they would recommend the implant to others.Conclusion: The results from these studies reveal high effectiveness and favorable safety and acceptability during the first year of use of Sino-implant.Implication: The favorable Sino-implant (II) findings from Kenya and Pakistan provide further evidence from disparate regions that Sino-implant (II) is safe, effective and acceptable during routine service delivery

The community midwifery model in Kenya: Expanding access to comprehensive reproductive health services at the community level

The ‘community midwifery approach’ is an innovation involving the engagement of skilled midwives residing in communities to take critical maternal health services to women’s homes, thus improving maternal, newborn and infant health. This paper is based on a study that aimed to assess the effect of expanding community midwives’ mandate to go beyond the provision of delivery services alone, to incorporate a more comprehensive package of reproductive health and HIV services. This operations research project involved pre- and post-intervention data collection without a comparison group to assess intervention effects. The project was implemented in the Bungoma and Lugari Districts of Western Province, Kenya. Findings from the project indicate that the expanded community midwifery model improved clients’ access to a comprehensive package of family planning, reproductive health and HIV services at the community level. However, the intervention was less successful in improving the provision of a continuum of care by community midwives

Eligibility criteria for selecting the study areas and facilities.

Eligibility criteria for selecting the study areas and facilities.</p

Barriers in accessing and utilising healthcare services during the COVID-19 pandemic by socio-ecological levels.

Barriers in accessing and utilising healthcare services during the COVID-19 pandemic by socio-ecological levels.</p