Study on the Uptake, Barriers and Drivers of Modern FP Methods WRA aged years in Rural Kenya WRA aged years in Urban and Rural Kenya Presented by: Anne Njeru, DRH Susan Karimi, PSI Kenya page 1

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 page 2

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 commodities page 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 page 4

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 years in Urban areas Geographical coverage: Nairobi, Coast, R. Valley, Western, Nyanza, Eastern and Central. page 5

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 page 6

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. page 7

FINDINGS FINDINGS Among WRA aged 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 page 9

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 page 10 No difference between Urban and Rural youth in terms of uptake & need for FP

page 11 On average, 50% of youth have unmet need for FP

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

page 13 Young women in Coast province have the lowest uptake of modern FP methods

page 14 Married youth are twice likely to be using a modern FP method than unmarried youth

Method Mix Among Users of MFPM UrbanRuralTotal %% Daily Pill Injection Condom IUD Implants Others TOTAL100.0 page 15 More than 50% of young women using a modern FP method are using injection

page 16 Majority of young women using pills are using Femiplan or Chaguo Lako

page 17 Pharmacies are the main source of FP pills for young women

page 18 89% of young women were exposed to the ‘C Word’ campaign

page 19 Exposure by media type was different among Urban and Rural youth

page 20 Exposure by Province differed with Coast having lowest Exposure PROVINCE EASTERNR/VALLEYNYANZAWESTERNNAIROBICENTRALCOAST (%) Radio commercials 82.4 a 78.7 a 92.1 b 90.5 b 91.4 b 93.2 b 65.6c TV Commercials 52.3 a,d 43.8 b 45.2 a,b 42.3 b 87.5c61.3d37.6b Posters/fliers/brochures 74.3 a,d,f 59.3 b 71.7 a,c 82.2 d,e 84.3 e 73.5 c,f 47.6g Newspaper/magazine 23.2 a,d 26.4 a,c 23.0 a,d 31.4 a,b 36.7 b 33.6 b,c 15.2 d Free IPC 15.0 a,b 12.0 a,b,c 15.9 a 8.8 b,c 11.6 a,b,c 9.8 a,b,c 6.9 c Radio activations 54.3 a,d 54.1 a 77.0 b 81.5 b 59.8 a,c 67.5 c 43.9d Billboard 22.5 a,c 22.4 a,c 29.0 a 26.7 a 42.6 b 28.8 a 16.8 c

page 21 Exposure by Channel Type Use of MFPM Completely Not Exposed Radio Only Radio + TV IPC+ Radio/+ TV Non User81.9 a 62.5 b 61.1 b 51.5 c User18.1 a 37.5 b 38.9 b 48.5 c Uptake of a modern FP method was positively correlated with exposure

Barriers & drivers to uptake of modern FP methods

page 23 Behavior Change Framework for Social Marketing

page 24 Barriers / drivers that determine use of a modern FP method Use of MFPM User Non UserOR Opportunity provided at FP Clinics4.08 a 3.86 b 1.9 Ability to Negotiate Use of FP with partner3.80 a 3.56 b 1.92 Ability to dispel Myths and Misconceptions3.22 a 2.99 b 1.7 Locus of Control3.98 a 3.87 b 1.42 Threat of Unwanted Pregnancy4.07 a 3.84 b 1.58 Expecting positive outcome4.14 a 3.86 b 1.98

1.Expecting positive outcome 2.Ability to Negotiate use with partner 3.Threat of Unwanted Pregnancy 4.Locus of Control 5.Ability to dispelling Myths and Misconceptions Barriers / drivers that determine use among UNMARRIED youth

Conventional Mid Point for Leikert Scale Hard 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 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 identified page 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 page 28

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. page 29 Key findings from qualitative study

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. page 30 Key findings from qualitative study

FINDINGS FINDINGS Among WRA aged years in Rural Kenya

Unmet-Need among Rural women is highest among lowest SES

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

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

page 35 3 in every 5 women in Rural Kenya is NOT using ANY family planning method

page 36 Less than half of Rural unmarried women are using a modern FP method

page 37 Central has twice the uptake of Coast

page 38 Uptake is positively correlated to SES

page 39 Injection is the most common method used by Rural women

page 40 Half of women in Rural areas are using Femiplan pills, more so the unmarried

page 41 Pharmacies and Clinics are the most common sources of pills

page 42 80% of women in Rural areas were exposed to the Healthy Timing & Spacing communication

page 43 Exposure by Channel Type Completely Not Exposed Radio Only Radio + TV IPC+Radio /+TV Use of MFPM Non User 76.1 a 55.0 b 60.7 b 46.3 c User23.9 a 45.0 b 39.3 b 53.7 c Uptake of a modern FP method was positively correlated with exposure

page 44 Use of MFPM User Non UserOR Opportunity provided at Family Planning Clinics4.10 a 3.88 b 1.9 Ability to Negotiate Use of FP3.81 a 3.59 b 1.83 Dispelling Myths and Misconceptions3.29 a 3.01 b 1.83 Locus of Control4.01 a 3.83 b 1.67 Threat of Unwanted Pregnancy4.04 a 3.73 b 1.68 Positive Expectations on the Outcome of Using Contraceptives 4.16 a 3.83 b 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! page 47