study on the uptake, barriers and drivers of modern fp methods wra aged 15-49 years in rural kenya...

Study on the Uptake, Barriers and Drivers of Modern FP Methods•WRA aged 15-49 years in Rural Kenya•WRA aged 15-24 years in Urban and Rural Kenya

Presented by: Anne Njeru, DRH Susan Karimi, PSI Kenya

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Background – why the study?

• Need to complement the Tupange study among Urban WRA, for a holistic picture

• Most studies have focused on older women; only 2 qualitative studies conducted among young women (in Uganda).

• Knowledge of types of modern FP methods is not a major barrier; other factors may affect a woman’s choice to take up a method

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Background – why the study?

• In Kenya, there have been 2 specific qualitative studies exploring barriers / motivations. The most recent was implemented by Future’s group

• The key barriers identified from this study, conducted via 33 focus group discussions with men & women in Nyanza and Coast, were:– Misinformation & misconceptions– Social – cultural and Religions barriers– Male involvement– Provider behavior– Costs and frequent stock outs of contraceptive

commoditiespage 3

Objectives of the Study:

1. To monitor uptake of Modern FP Methods (MFPM)

1. To determine barriers and drivers associated with uptake of MFPM

2. To evaluate exposure to FP communication and its possible association to uptake of MFPM

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Study Methodology• Sample size: 5,624 WRA purposely selected

from randomly sampled households, based on clusters from the KNBS National Sampling Frame.

• Study population: Sexually active women between 15 – 49 years in Rural areas, and 15-24 years in Urban areas

• Geographical coverage: Nairobi, Coast, R. Valley, Western, Nyanza, Eastern and Central.

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Study Methodology

Determination of SES: •Looked at ownership of various household assets, sources of drinking water, dwelling characteristics and toilet facilities.

•Each characteristic was assigned a score with weighting, and the total score used as the household’s score

•Urban and rural areas were treated differently

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Study Methodology

• Data collection: All respondents were interviewed by a same sex interviewer using a scan-able questionnaire.

• Data analysis: The scanned data was captured in a database, exported into a statistical package (SPSS) to check on consistency & completeness, and weighted by KNBS.

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FINDINGSFINDINGSAmong WRA aged 15-24 years in Rural and Urban Kenya

Background Characteristics

• Most young women (53%) had some primary education (complete and incomplete)

• Urban women reported higher education levels compared to rural counterparts

• 59% of Rural youth were married compared to 48% of Urban youth

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• Both have high unmet need for family planning at 53.4% and 53.5% respectively

• Both have similar uptake of FP at 40.6% and 42.2% for all methods

• Uptake among the poorest SES is significantly lower in both Urban and Rural areas

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No difference between Urban and Rural youth in terms of uptake &

need for FP

On average, 50% of youth have unmet need for FP

Unmarried youth have twice as much unmet need for FP as married youth

Young women in Coast province have the lowest uptake of modern FP methods

Married youth are twice likely to be using a modern FP method than unmarried youth

Method Mix Among Users of MFPM

Urban Rural Total% % %

Daily Pill 14.7 16.9 16.1Injection 45.5 57.6 53.3Condom 21.6 13.1 16.1IUD 2.4 2.1 2.2Implants 12.1 9.3 10.3OthersTOTAL 100.0 100.0 100.0

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More than 50% of young women using a modern FP method are using injection

Majority of young women using pills are using Femiplan or Chaguo Lako

Pharmacies are the main source of FP pills for young women

89% of young women were exposed to the ‘C Word’ campaign

Exposure by media type was different among Urban and Rural youth

Exposure by Province differed with Coast having lowest Exposure

PROVINCE

EASTERN R/VALLEY NYANZAWESTER

N NAIROBICENTRA

L COAST(%) (%) (%) (%) (%) (%) (%)

Radio commercials 82.4a 78.7a 92.1b 90.5b 91.4b 93.2b65.6c

TV Commercials 52.3a,d 43.8b 45.2a,b 42.3b87.5c 61.3d 37.6b

Posters/fliers/

brochures

74.3a,d,f 59.3b 71.7a,c 82.2d,e 84.3e 73.5c,f47.6g

Newspaper/

magazine

23.2a,d 26.4a,c 23.0a,d 31.4a,b 36.7b 33.6b,c 15.2d

Free IPC 15.0a,b 12.0a,b,c 15.9a 8.8b,c 11.6a,b,c 9.8a,b,c 6.9c

Radio activations 54.3a,d 54.1a 77.0b 81.5b 59.8a,c 67.5c43.9d

Billboard 22.5a,c 22.4a,c 29.0a 26.7a 42.6b 28.8a 16.8c

Exposure by Channel Type

Use of MFPM

Completely Not

ExposedRadio Only

Radio + TV

IPC+ Radio/+ TV

Non User 81.9a 62.5b 61.1b 51.5c

User 18.1a 37.5b 38.9b 48.5c

Uptake of a modern FP method was positively correlated with

exposure

Barriers & drivers to uptake of modern FP methods

PSI Behavior Change Model

HEALTH STATUS

AT RISK/NEED

Goal

BEHAVIOR

OPPORTUNITY ABILITY MOTIVATION

Outputs

PRODUCT PLACE PROMOTIONPRICE

Activities

Availability

Brand Appeal Social Support

Self EfficacySocial Norms

Knowledge Beliefs

Intentions

Attitudes

Threat (Risk assessment)Subjective

Norms

Outcome Expectations

Our sphere of influence

What we are trying to influence

To change behavior

Purpose

That improves health

Behavior Change Framework for Social Marketing

Barriers / drivers that determine use of a modern FP

method

Use of MFPM

User Non User

OR

Opportunity provided at FP Clinics 4.08a 3.86b 1.9

Ability to Negotiate Use of FP with partner

3.80a 3.56b 1.92

Ability to dispel Myths and Misconceptions

3.22a 2.99b 1.7

Locus of Control 3.98a 3.87b 1.42

Threat of Unwanted Pregnancy 4.07a 3.84b 1.58

Expecting positive outcome 4.14a 3.86b 1.98

1. Expecting positive outcome 2. Ability to Negotiate use with partner3. Threat of Unwanted Pregnancy4. Locus of Control5. Ability to dispelling Myths and

Misconceptions

Barriers / drivers that determine use among UNMARRIED youth

Conventional Mid Point for Leikert ScaleHard to Shift Area

given the high score in the population

Possible Intervention areas due to ability to

Shift in Population and Effect on Behavior

Additional insights from qualitative youth study

• Conducted through 36 in-depth interviews with women aged 15-24 years, in urban and peri-urban areas of Kenya

• Data collected in 3 regions: Nyanza, Central, Coast from users and non-users of modern FP methods

• Data (quotes) coding conducted by a team including DRH and members of the AYSRH TWG, based on 9 categories

• Emerging themes identifiedpage 27

Key findings from qualitative study

• Both users and non-users receive FP information from trusted references like friends, mothers, mothers-in-law and sisters

• Both users and non-users are open to receive FP information through media channels including TV, Radio and internet

• Both users and non-users portrayed lack of factual information on the different contraceptive methods, and believe in myths and misconceptions

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• Some users and non-users felt their partners were a barrier because they feel their girlfriends are being unfaithful especially condoms.

• Some women reported complaints from their

partners of their low sex drive due to use of MFPM

• Majority of users and non users had correct knowledge on injections and condoms, and sited dual protection as a key benefit.

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• Respondents exhibited likeness towards particular MFPM (condoms and pills) either due to convenience or no / fewer side effects

• Respondents reported using different strategies to overcome barriers to using MFPMs; e.g. planning in advance, requesting for cash from their spouses, looking for the method in other health facilities / pharmacies.

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FINDINGSFINDINGSAmong WRA aged 15-49 years in Rural Kenya

Unmet-Need among Rural women is highest among lowest SES

Unmet need among married women is highest between 25-29 & 30-34

Unmet need among Unmarried women is highest between 15-19 & 45-49

3 in every 5 women in Rural Kenya is NOT using ANY family planning method

Less than half of Rural unmarried women are using a modern FP method

Central has twice the uptake of Coast

Uptake is positively correlated to SES

Injection is the most common method used by Rural women

Half of women in Rural areas are using Femiplan pills, more so the unmarried

Pharmacies and Clinics are the most common sources of pills

80% of women in Rural areas were exposed to the Healthy Timing & Spacing communication

Exposure by Channel TypeCompletel

y Not Exposed

Radio

OnlyRadio + TV

IPC+Radio/+TV

Use of MFPM

Non User

76.1a 55.0b 60.7b 46.3c

User 23.9a 45.0b 39.3b 53.7c

Uptake of a modern FP method was positively correlated with

exposure

Use of MFPM

User Non User

OR

Opportunity provided at Family Planning Clinics

4.10a 3.88b 1.9

Ability to Negotiate Use of FP 3.81a 3.59b 1.83

Dispelling Myths and Misconceptions 3.29a 3.01b 1.83

Locus of Control 4.01a 3.83b 1.67

Threat of Unwanted Pregnancy 4.04a 3.73b 1.68

Positive Expectations on the Outcome of Using Contraceptives

4.16a 3.83b 2.41

Barriers / drivers that determine use of a modern FP

method

• FP communication should focus on dispelling myths & misconceptions, and support on involving male partners

• Primary target audience for youth should be Unmarried women as they have significantly lower uptake and higher unmet need for FP

• Married youth should be considered along side older married women as they have similar characteristics

Recommendations

•Continue implementing through multiple communication channels with emphasis on IPC

•Continue to increase access to correct information about modern FP methods, for informed choice

•Ensure consistent availability of modern FP methods and IEC materials in pharmacies and health facilities, and build capacity of Pharmacy attendants

Recommendations

ASANTE!

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study on the uptake, barriers and drivers of modern fp methods wra aged 15-49 years in rural kenya...

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