Child undernutrition in Kenya: trend analyses from 1993 to 2008-09

Background: Research on trends in child undernutrition in Kenya has been hindered by the challenges of changing criteria for classifying undernutrition, and an emphasis in the literature on international comparisons of countries’ situations. There has been little attention to within-country trend analyses. This paper presents child undernutrition trend analyses from 1993 to 2008–09, using the 2006 WHO criteria for undernutrition. The analyses are decomposed by child’s sex and age, and by maternal education level, household Wealth Index, and province, to reveal any departures from the overall national trends. Methods: The study uses the Kenya Demographic and Health Survey data collected from women aged 15–49 years and children aged 0–35 months in 1993, 1998, 2003 and 2008–09. Logistic regression was used to test trends. Results: The prevalence of wasting for boys and girls combined remained stable at the national level but declined significantly among girls aged 0–35 months (p < 0.05). While stunting prevalence remained stagnant generally, the trend for boys aged 0–35 months significantly decreased and that for girls aged 12–23 months significantly increased (p < 0.05). The pattern for underweight in most socio-demographic groups showed a decline. Conclusion: The national trends in childhood undernutrition in Kenya showed significant declines in underweight while trends in wasting and stunting were stagnant. Analyses disaggregated by demographic and socio-economic segments revealed some significant departures from these overall trends, some improving and some worsening. These findings support the importance of conducting trend analyses at detailed levels within countries, to inform the development of better-targeted childcare and feeding interventions

Is fertility declining in Benin?

This study analyzes reproductive changes in Benin, a West African country with high fertility and low prevalence of use of modern contraceptive methods, using a combination of quantitative and qualitative approaches. Findings indicate that an irreversible fertility transition has started as the result of an emerging pattern of birth limitation and continued desire for the traditional long birth intervals. The data suggest that changes in childhood mortality in combination with an increase in women's education, although modest, have created a demand for fertility control among women; that induced abortion may be one of the means through which such demand is being met, particularly in urban areas; and that the economic crisis of the 1980s was the main catalyst that precipitated the onset of transition. Changes in reproductive preferences and practice suggest a diffusion process, from urban and more educated women to rural and less-educated ones

Unintended pregnancy and subsequent use of modern contraceptive among slum and non-slum women in Nairobi, Kenya

BACKGROUND: In spite of major gains in contraceptive prevalence over the last few decades, many women in most parts of the developing world who would like to delay or avoid pregnancy do not use any method of contraception. This paper seeks to: a) examine whether experiencing an unintended pregnancy is associated with future use of contraception controlling for a number factors including poverty at the household and community levels; and b) investigate the mechanisms through which experiencing an unintended pregnancy leads to uptake of contraception. METHODS: Quantitative and qualitative data from a cross-sectional research project conducted in 2009/10 in two slum settlements and two non-slum settings of Nairobi, Kenya are used. The quantitative component of the project was based on a random sample of 1,259 women aged 15–49 years. Logistic regression models were used to assess the effect of unintended pregnancy on future contraceptive use. The qualitative component of the project successfully interviewed a total of 80 women randomly selected from survey participants who had reported having at least one unintended pregnancy. RESULTS: Women whose last pregnancy was unintended were more likely to be using a modern method of contraception, compared to their peers whose last pregnancy was intended, especially among the wealthier group as shown in the interaction model. Among poor women, unintended pregnancy was not associated with subsequent use of contraception. The qualitative investigation with women who had an unplanned pregnancy reveals that experiencing an unintended pregnancy seems to have served as a “wake-up call”, resulting in greater attention to personal risks, including increased interest in pregnancy prevention. For some women, unintended pregnancy was a consequence of strong opposition by their partners to family planning, while others reported they started using contraceptives following their unintended pregnancy, but discontinued after experiencing side effects. CONCLUSION: This study provides quantitative and qualitative evidence that women who have had an unintended pregnancy are “ready for change”. Family planning programs may use the contacts with antenatal, delivery and post-delivery care system as an opportunity to identify women whose pregnancy is unplanned, and target them with information and services

Exploring the demand‐side factors associated with the use of implants in Kenya

We explore the demand‐side factors associated with the use of implants in Kenya given the notable rapid increase in uptake of the method in the country. Data are from a longitudinal study conducted among married or cohabiting women aged 15–39 years at the time of recruitment in one rural (2,424 women) and one urban (2,812 women) site. Analysis entails descriptive statistics and estimation of multivariate logistic regression models. The results show that the key demand‐side factors associated with the use of implants were low discontinuation of the method compared with alternatives and strong motivation on the part of the women for long‐term spacing of births. However, implants had no perceived advantages over the main alternative methods in terms of beliefs about possible damage to health or unpleasant side effects or in terms of satisfaction with use. The findings suggest that addressing concerns about safety for long‐term use and for health may increase demand for implants in particular and long‐acting reversible contraceptives in general in the study settings or in similar contexts, especially among women who desire long‐term spacing of births