Why contraceptive use in Nairobi calls for policy directions
In 2019, “37.2 per cent of young women and 52.7 per cent of young men aged 15–24 living in Nairobi were using a modern contraceptive method.”
What you need to know:
- The male condom is the most common method, as reported by 91.4 per cent of males and 36.1 per cent of females. This raises the question as to the availability and popularity of the female condom to this cohort.
- The next most common methods are implants and injectables, reported by 18.4 per cent and 15.2 per cent of female users, respectively.
While national statistics show that about 20 per cent of girls aged 15–19 are pregnant or already mothers, teenage is a ballooning demographic category on which there is limited data with regard to sexual and reproductive health.
These are two justifications for the “Gender and Covid-19 Study: Contraceptive Use Dynamics” jointly conducted by the Performance Monitoring for Action and the International Centre for Reproductive Health Kenya in Nairobi in 2019, with follow-ups in 2020 and 2021.
The study covered 1,357 youth aged 15–24 (690 males and 664 females).
The baseline in 2019 revealed that “37.2 per cent of young women and 52.7 per cent of young men aged 15–24 living in Nairobi were using a modern contraceptive method.”
The male condom was the most common method, as reported by 91.4 per cent of males and 36.1 per cent of females. This raises the question as to the availability and popularity of the female condom to this cohort.
The next most common methods were implants and injectables, reported by 18.4 per cent and 15.2 per cent of female users, respectively. The finding that 85.2 per cent non-users "who had been sexually active in the three months prior to the survey…reported that they intended to use a contraceptive method in the future” indicates a high level of awareness about the products and readiness to use them.
The study established that the main reasons for non-use were infrequent or no sex at 52.2 per cent and being unmarried at 41 per cent among the non-users.
The 2020 remote follow-up study revealed that the male condom remained the most popular method. In addition, 17.7 per cent of female respondents had switched methods, while 12.7 per cent had stopped using any. Some 29.9 per cent of female respondents had started using a method, while 19.8 per cent remained non-users.
Among males, 10 per cent had switched methods, 18.5 per cent had stopped use, 25.3 per cent began using one and 8.7 per cent remained non-users. That “method switching and discontinuation was less than 30 per cent among all respondents” indicates that there was relative consistency in use of contraceptives.
Reasons for discontinuing use or switching methods remained infrequent sex and marital status. Additional reasons for females were medical factors, such as fear of side effects. This fear was not necessarily based on personal experience; it was also informed by anecdotal claims from acquaintances. This means that hearsay and rumours play a big role in influencing female’s decisions on use of contraceptives widely believed to have adverse side effects.
The 2021 survey showed that about 50 per cent of all women in Nairobi were using a modern contraceptive method, and the proportion of those on implants increased from 14 per cent in 2014 to 27 per cent in 2021. However, there was a decrease from 46 per cent to 32 per cent among those using injectables.
The study records that stock-outs on the day of the interviews were high on the methods tracked, suggesting gaps in the supply chain. A notable finding was that among women who were not currently using contraceptives, about 80 per cent had no intention of doing so in the next 12 months.
This contradicts the baseline finding that 85.2 per cent intended to use a contraceptive method in future. Such confounded findings imply the need for confirmatory studies on this variable.
The study further noted that “just over half of women reported receiving comprehensive contraceptive counseling from a provider” and about 67 per cent received information about side effects. This indicates that a sizeable number of users of contraceptives are not adequately informed.
Notably also, the number of girls aged 15–19 years receiving information from a provider or community health worker in the past year was four times lower than that of counterparts in the 20–49 cohort. This suggests neglect of the younger generation by service providers, an assumption that this group does not require such services, poor service seeking behaviour and/or practical barriers to the products and services.
It was noted that 95 per cent of women using a female-controlled modern contraceptive method reported that their partners were aware of this. This depicts a high level of partner consultation, which indicates healthy relationships.
The other finding that “among women who were not currently using family planning, 84 per cent reported that this decision was made by herself alone” indicates a high level of autonomy among this group.
The 2021 study confirmed that stock-outs persisted, evident in the fact that 53 per cent of public facilities offering injectables lacked the items on the day of the interview and 22 per cent in the previous three months, the reason being delay in shipment of ordered items.
The findings point to a number of policy directions. One is to ensure uninterrupted supply of the contraceptive products. Two is to expand outreach to the sexually active younger female population.
Three is to popularise female-controlled contraceptive methods. Four is to strengthen counselling and provision of information on the side effects of the methods, so as to forestall and counter misinformation.
The writer is an international gender and development consultant and scholar ([email protected]).
