Family Planning: 2005 - 2008
Changing fortunes: Analysis of fluctuating policy space for family
planning in Kenya.
Author:
Crichton J
Source:
Health Policy and Planning. 2008;23:339-350.
Abstract:
Policies relating to contraceptive services (population, family planning
and reproductive health policies) often receive weak or fluctuating levels
of commitment from national policy elites in Southern countries, leading
to slow policy evolution and undermining implementation. This is true of
Kenya, despite the government's early progress in committing to
population and reproductive health policies, and its success in
implementing them during the 1980s. This key informant study on family
planning policy in Kenya found that policy space contracted, and then
began to expand, because of shifts in contextual factors, and because of
the actions of different actors. Policy space contracted during the mid1990s in the context of weakening prioritization of reproductive health in
national and international policy agendas, undermining access to
contraceptive services and contributing to the stalling of the country's
fertility rates. However, during the mid-2000s, champions of family
planning within the Kenyan Government bureaucracy played an
important role in expanding the policy space through both public and
hidden advocacy activities. The case study demonstrates that policy space
analysis can provide useful insights into the dynamics of routine policy
and programme evolution and the challenge of sustaining support for
issues even after they have reached the policy agenda. (author's)
Language:
English
Keywords:
KENYA | RESEARCH REPORT | CASE STUDIES | FAMILY
PLANNING | CONTRACEPTION | FAMILY PLANNING POLICY |
HEALTH POLICY | GOVERNMENT | POLICY DEVELOPMENT |
POLITICAL FACTORS | AFRICA, EASTERN | AFRICA, SUB
SAHARAN | AFRICA | DEVELOPING COUNTRIES | STUDIES |
RESEARCH METHODOLOGY | POPULATION POLICY | SOCIAL
POLICY | POLICY | SOCIOCULTURAL FACTORS | PLANNING |
ORGANIZATION AND ADMINISTRATION
Document Number: 327983
1
Family Planning: 2005 - 2008
Hormonal contraception and HIV prevalence in four African
countries.
Author:
Leclerc PM; Dubois-Colas N; Garenne M
Source:
Contraception. 2008 May;77(5):371-376.
Abstract:
The HIV seroprevalence among women aged 15-24 years was compared
according to their pattern of contraceptive use in four African countries:
Kenya, Lesotho, Malawi and Zimbabwe. Data were derived from
Demographic and Health Surveys (DHS) conducted between 2003 and
2006 on representative samples, totaling 4549 women. It is indicated that
users of depo-medroxyprogesterone acetate (DMPA) have a significantly
higher seroprevalence than nonusers [odds ratio (OR)=1.82, 95% CI=1.632.03] and higher than users of oral contraceptives and users of traditional
methods. The results were confirmed in a multivariate analysis including
as controls, age, duration since first intercourse, urban residence,
education, number of sexual partners in the last 12 months and marital
status. A somewhat smaller net effect (OR=1.34, 95% CI=1.10-1.63) was
found. In contrast, oral contraceptives and traditional methods did not
show any risk for HIV (OR=0.96 and 0.92, respectively). The increased
risk of DMPA was present in three of the four countries investigated, and
significant in Zimbabwe and Lesotho, the countries with the highest HIV
seroprevalence. The HIV risk attributable to DMPA remained small
altogether and was estimated as 6% in the four countries combined.
(author's)
Language:
English
Keywords:
KENYA | LESOTHO | MALAWI | ZIMBABWE | RESEARCH
REPORT | WOMEN | ADOLESCENTS, FEMALE | DEPO-PROVERA
| HIV | PREVALENCE | CONTRACEPTIVE AGENTS, ESTROGEN |
CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE
USAGE | DEVELOPING COUNTRIES | AFRICA, EASTERN |
AFRICA, SUB SAHARAN | AFRICA | AFRICA, SOUTHERN |
DEMOGRAPHIC FACTORS | POPULATION | ADOLESCENTS |
YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE
AGENTS, FEMALE | CONTRACEPTIVE AGENTS |
CONTRACEPTION | FAMILY PLANNING | HIV INFECTIONS |
VIRAL DISEASES | DISEASES | MEASUREMENT | RESEARCH
METHODOLOGY
Document Number: 325790
2
Family Planning: 2005 - 2008
Secrecy, disclosure and accidental discovery: Perspectives of
diaphragm users in Mombasa, Kenya.
Author:
Okal J; Stadler J; Ombidi W; Jao I; Luchters S
Source:
Culture, Health and Sexuality. 2008 Jan;10(1):13-28.
Abstract:
The diaphragm is receiving renewed attention as a promising femalecontrolled method of preventing HIV and other sexually-transmitted
infections. It is anticipated that female-controlled technologies will reduce
women's biological susceptibility and assist in counteracting their
sociocultural vulnerability to HIV. Understanding the subjective
experiences of diaphragm users in different settings has the potential to
inform the development and promotion of such methods. This paper
explores the perspectives of female sex workers and women attending
sexual and reproductive health services in Mombasa, Kenya. Data are
reported from focus group discussions and in-depth interviews with
women and men, following a prospective study investigating diaphragm
continuation rates over six months. Discussions highlighted covert use of
the diaphragm, during sex work or with casual partners, and coital
independence as favourable attributes. These features were especially
pronounced compared with male condoms. Few difficulties with
diaphragm use were reported, although its insertion and removal
occasionally presented problems. Many women-especially those in long
term partnerships-wished to disclose its use but found the disclosure
process highly problematic. Accidental discovery often resulted in
partner conflict. Although future uptake of the diaphragm may be high in
this setting, its use may be limited to certain types of relationships and
relationship context. (author's)
Language:
English
Keywords:
KENYA | RESEARCH REPORT | KAP SURVEYS | FOCUS GROUPS
| PROSPECTIVE STUDIES | WOMEN IN DEVELOPMENT | SEX
WORKERS | SEXUAL PARTNERS | VAGINAL DIAPHRAGM | HIV
PREVENTION | WOMEN'S EMPOWERMENT | CULTURE |
PERCEPTION | PARTNER COMMUNICATION | DEVELOPING
COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
AFRICA | SURVEYS | SAMPLING STUDIES | STUDIES |
RESEARCH METHODOLOGY | DATA COLLECTION | ECONOMIC
DEVELOPMENT | ECONOMIC FACTORS | SEX BEHAVIOR |
BEHAVIOR | VAGINAL BARRIER METHODS | BARRIER
METHODS | CONTRACEPTIVE METHODS | CONTRACEPTION |
FAMILY PLANNING | HIV INFECTIONS | VIRAL DISEASES |
DISEASES | WOMEN'S STATUS | SOCIOECONOMIC FACTORS |
SOCIOCULTURAL FACTORS | PSYCHOLOGICAL FACTORS |
3
Family Planning: 2005 - 2008
INTERPERSONAL RELATIONS
Document Number: 313968
Feasibility of recruitment for an efficacy trial of emergency
contraceptive pills.
Author:
Raymond EG; Liku J; Schwarz EB
Source:
Contraception. 2008 Feb;77(2):118-121.
Abstract:
The efficacy of emergency contraceptive pills (ECPs) is currently
uncertain. The best way to obtain a robust efficacy estimate would be to
conduct a placebo-controlled randomized trial. We aimed to assess the
feasibility of identifying women eligible for such a trial. We conducted a
survey of women aged 18-35 years in five sexually transmitted disease
clinics and urgent care centers in Kenya and the United States in 2006. Of
177 women surveyed, only 10 (6%) reported no reasons for exclusion
from a potential efficacy trial. Of the rest, 149 (83%) had not recently had
sex that conferred a substantial risk of pregnancy. At all sites combined,
the rate of identification of potentially eligible women was 0.6 per day of
interviewing. A placebo-controlled efficacy trial of ECPs would likely
require several thousand participants. Recruitment for such a trial in
these types of sites would be prolonged. (author's)
Language:
English
Keywords:
KENYA | UNITED STATES | RESEARCH REPORT | SURVEYS |
WOMEN | EMERGENCY CONTRACEPTION | CLINICAL TRIALS |
SCREENING | CONTRACEPTIVE SAFETY | DEVELOPING
COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
AFRICA | DEVELOPED COUNTRIES | NORTH AMERICA |
AMERICAS | SAMPLING STUDIES | STUDIES | RESEARCH
METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION |
CONTRACEPTION | FAMILY PLANNING | CLINICAL RESEARCH
| EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES
| MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE
| HEALTH | SAFETY | PUBLIC HEALTH
Document Number: 323985
4
Family Planning: 2005 - 2008
Reaching providers is not enough to increase IUD use: A factorial
experiment of 'academic detailing' in Kenya.
Author:
Wesson J; Olawo A; Bukusi V; Solomon M; Pierre-Louis B
Source:
Journal of Biosocial Science. 2008 Jan;40(1):69-82.
Abstract:
Although the IUD is an extremely effective and low-cost contraceptive
method, its use has declined sharply in Kenya in the past 20 years. A
study tested the effectiveness of an outreach intervention to family
planning providers and community-based distribution (CBD) agents in
promoting use of the IUD in western Kenya. Forty-five public health
clinics were randomized to receive the intervention for providers only,
for CBD agents only, for both providers and CBD agents, or no detailing
at all. The intervention is based on pharmaceutical companies' 'detailing'
models and included education/ motivation visits to providers and CBD
programmes, as well as provision of educational and promotional
materials. District health supervisors were given updates on
contraceptives, including the IUD, and were trained in communication
and message development prior to making their detailing visits. Detailing
only modestly increased the provision of IUDs, and only when both
providers and CBD agents were targeted. The two detailing visits do not
appear sufficient to sustain the effect of the intervention or to address
poor provider attitudes and lack of technical skills. The cost per 3.5 years
of pregnancy protection was US$49.57 for the detailing intervention
including the cost of the IUD, compared with US$15.19 for the
commodity costs of the current standard of care -- provision of the
injectable contraceptive depotmedroxyprogesterone acetate (DMPA). The
effectiveness of provider-based activities is amplified when concurrent
demand creation activities are carried out. However, the cost of the
detailing in comparison to the small number of IUDs inserted indicates
that this intervention is not cost-effective. (author's)
Language:
English
Keywords:
KENYA | RESEARCH REPORT | OPERATIONS RESEARCH |
FAMILY PLANNING PERSONNEL | COMMUNITY-BASED
DISTRIBUTION WORKERS | IUD | CONTRACEPTIVE USAGE |
INTERVENTIONS | KNOWLEDGE | ATTITUDE | TRAINING
ACTIVITIES | COST EFFECTIVENESS | AFRICA, EASTERN |
AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES |
RESEARCH METHODOLOGY | PROGRAM EVALUATION |
PROGRAMS | ORGANIZATION AND ADMINISTRATION |
FAMILY PLANNING PROGRAMS | FAMILY PLANNING |
COMMUNITY WORKERS | HEALTH PERSONNEL | DELIVERY OF
HEALTH CARE | HEALTH | CONTRACEPTIVE METHODS |
CONTRACEPTION | SOCIOCULTURAL FACTORS |
5
Family Planning: 2005 - 2008
PSYCHOLOGICAL FACTORS | BEHAVIOR | TRAINING
PROGRAMS | EDUCATION | EVALUATION INDEXES |
QUANTITATIVE EVALUATION | EVALUATION
Document Number: 322453
Acceptability of the diaphragm in Mombasa Kenya: A 6-month
prospective study.
Author:
Luchters S; Chersich MF; Jao I; Schroth A; Chidagaya S
Source:
European Journal of Contraception and Reproductive Health Care. 2007
Dec;12(4):345-353.
Abstract:
If proven acceptable, safe and effective, the diaphragm could be used as
a female-controlled method of preventing both sexually-transmitted
infections (STIs) and pregnancy. This study's aim was to assess the
acceptability and safety of the diaphragm among sexually-active women
in Mombasa, Kenya. We conducted a 6-month prospective study among
female sex workers (FSWs), and women attending sexual and
reproductive health services. Diaphragm acceptability was assessed using
continuation rates and factors associated with acceptability. Safety
evaluations included colposcopy findings and incidence of urinary tract
infections (UTIs) and STIs. Half the 185 participants were FSWs who had
less schooling and were less likely to be married than other women. After
6 months, 55% (56/102) of sexually-active women reported having used
the diaphragm each sex act during the preceding month. Women liked
using the diaphragm (95%, 104/109), and 96% (125/130) reported
willingness to continue using it. Colposcopy did not reveal significantly
more vaginal or cervical lesions. Use of the diaphragm was not associated
with an increase in bacterial vaginosis or UTIs. A pregnancy rate of 12 per
100 women/years was observed. After 6 months of diaphragm use in this
setting, continuation rates were sustained, user satisfaction was high and
adverse effects were few. (author's)
Language:
English
Keywords:
KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX
WORKERS | WOMEN | REPRODUCTIVE HEALTH | PROGRAM
ACCEPTABILITY | SAFETY | COLPOSCOPY | REPRODUCTIVE
TRACT INFECTIONS | SEXUALLY TRANSMITTED DISEASES |
HIV PREVENTION | DEVELOPING COUNTRIES | AFRICA,
EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES |
RESEARCH METHODOLOGY | SEX BEHAVIOR | BEHAVIOR |
DEMOGRAPHIC FACTORS | POPULATION | HEALTH |
6
Family Planning: 2005 - 2008
PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND
ADMINISTRATION | PUBLIC HEALTH | ENDOSCOPY |
PHYSICAL EXAMINATIONS AND DIAGNOSES | EXAMINATIONS
AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE |
HEALTH SERVICES | DELIVERY OF HEALTH CARE |
INFECTIONS | DISEASES | HIV INFECTIONS | VIRAL DISEASES
Document Number: 322478
Use of self home-made diaphragm for protection against pregnancy
and sexually-transmitted infections: Case report.
Author:
Schroth A; Luchters S; Chersich MF; Jao I; Temmerman M
Source:
East African Medical Journal. 2007 Jan;84(1):35-37.
Abstract:
This is a case report of a 44-year old woman who used a home-made
diaphragm for 16 years to protect herself from pregnancy and sexuallytransmitted infections. The woman stitched a piece of cloth with folded
polythene inside. This case report provides a vivid illustration of the
limitations of available methods of protection for women. It consists of an
introduction to the topic, a description of her experiences using her
home-made diaphragm and a discussion of the significance of the case.
This report supports the need for additional research on femalecontrolled methods of protection against sexually-transmitted infections,
methods that can be used without male knowledge and co-operation,
such as vaginal microbicides and cervical barriers against infection,
including the diaphragm. (author's)
Language:
English
Keywords:
KENYA | SUMMARY REPORT | WOMEN | VAGINAL
DIAPHRAGM | PREGNANCY | SEXUALLY TRANSMITTED
DISEASE PREVENTION | PREVENTION AND CONTROL | NEEDS
| CONTRACEPTION RESEARCH | DEVELOPING COUNTRIES |
AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
DEMOGRAPHIC FACTORS | POPULATION | VAGINAL BARRIER
METHODS | BARRIER METHODS | CONTRACEPTIVE METHODS
| CONTRACEPTION | FAMILY PLANNING | REPRODUCTION |
SEXUALLY TRANSMITTED DISEASES | REPRODUCTIVE TRACT
INFECTIONS | INFECTIONS | DISEASES | ECONOMIC FACTORS
Document Number: 319367
7
Family Planning: 2005 - 2008
[Comment on "Hormonal contraception and HIV prevalence in four
African countries"] [letter]
Author:
Gisselquist D
Source:
Contraception. 2008
Abstract:
To the Editor:
In a recent article, Leclerc et al. use data from the Demographic and
Health Surveys in four African countries to estimate an adjusted relative
risk of 1.28 for prevalent HIV infection in young women aged 15-24 years
associated with ever-use of depo-medroxyprogesterone acetate (DMPA).
Considering that 22% of young women had used DMPA, they calculate
that DMPA was responsible for 6% of HIV infections in young women
and conclude that "[t]he small effect of DMPA in the general population
is reassuring." I am not reassured. When we consider veterinary
medicine, we can focus on the herd. But DMPA is offered to individual
women. In many communities throughout Southern and East Africa, 1530% of women aged 24 years are HIV positive. If Leclerc et al. are correct,
ever-use of DMPA would be responsible for HIV infections in roughly 48% of users (calculating that 22% of women have used DMPA, and that
use increases HIV prevalence by 1.28 times). Health care professionals are
obligated to give clients accurate information about risks. On the basis of
Leclerc et al. analyses, governments in East and Southern Africa should
mandate that family planning programs warn women that DMPA use
increases their risk for HIV infection. And donors should reconsider their
support for DMPA in communities with generalized HIV epidemics. (To
put this situation in perspective, consider what European governments
would do if studies showed that a health intervention killed 4-8% of
women accepting the intervention.) These cautions could be reversed if
and when further research shows that DMPA use is not a risk for HIV
infection. It may be, for example, that the association that has often been
observed between HIV infection and DMPA use in Africa and Asia has
been due to unsafe injections delivering DMPA rather than to any
biological effect of DMPA. That possibility should be investigated. A
study in Tanzania identified DMPA injections as a risk for hepatitis C
infections. Reuse of syringes and/or needles without sterilization has
been common in Africa and parts of Asia. Unfortunately, Leclerc et al. did
not consider unsafe injections. If future research finds that unsafe
injections are the link between HIV and DMPA use, then it is an easy
matter to break that link by ensuring exclusive use of prefilled syringes or
single-dose vials and new disposable syringes. (full text)
Language:
English
8
Family Planning: 2005 - 2008
Keywords:
KENYA | LESOTHO | MALAWI | ZIMBABWE | CRITIQUE |
WOMEN | ADOLESCENTS, FEMALE | DEPO-PROVERA | HIV |
PREVALENCE | CONTRACEPTIVE AGENTS, ESTROGEN |
CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE
USAGE | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA
| DEVELOPING COUNTRIES | AFRICA, SOUTHERN |
DEMOGRAPHIC FACTORS | POPULATION | ADOLESCENTS |
YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE
AGENTS, FEMALE | CONTRACEPTIVE AGENTS |
CONTRACEPTION | FAMILY PLANNING | HIV INFECTIONS |
VIRAL DISEASES | DISEASES | MEASUREMENT | RESEARCH
METHODOLOGY
Document Number: 328088
Response to the comments made by David Gisselquist on our
article “Hormonal contraception and HIV prevalence in four
African countries.” [letter]
Author:
Leclerc PM; Garenne M
Source:
Contraception. DP: 2008 Oct, IP: 4, VI: 78
Abstract:
To the Editor:
The comments made by Gisselquist on our paper focus on the risk
associated with unsafe injections rather than with DMPA per se. Our
study was not designed to separate the effects of unsafe injections from
the effects of using DMPA in an HIV environment. Note, however, that
similar effects were found in Thailand, where injections are assumed to
be safe, and that the biological plausibility for an effect of hormonal
contraception is quite strong. This leads us to think that, in this case, the
effect is more likely to be due to the interactions with hormones than to
the injection per se. What we showed is that, in real life of an African
population, injectable contraception was associated with a minor increase
in risk of HIV infection, whatever the reason. Of course, for the individual
woman, the issue is whether she is at risk of Ivory not. If her partner is
infected with HIV, she should be using condoms, and not any other form
of contraception. Even if she is not exposed to HIV, she should use only
safe injections, whether for contraception or for other purpose, and be
protected from any type of contamination such as HIV, HBV, HCV or
other germs. Gisselquist is right in emphasizing the need for safe
injections in Africa for any type of therapy or prevention. For us,
recommending DMPA still appears legitimate for women who are not
exposed to HIV, and assuming that injections are safe. The control of HIV
9
Family Planning: 2005 - 2008
is likely to be efficient if such policies are followed and unlikely to be
enough by just shifting from injectable contraceptives to other types
beyond condoms. (full text)
Language:
English
Keywords:
KENYA | LESOTHO | MALAWI | ZIMBABWE | CRITIQUE |
WOMEN | ADOLESCENTS, FEMALE | DEPO-PROVERA | HIV |
PREVALENCE | CONTRACEPTIVE AGENTS, ESTROGEN |
CONTRACEPTIVE AGENTS, PROGESTIN | CONTRACEPTIVE
USAGE | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA
| DEVELOPING COUNTRIES | AFRICA, SOUTHERN |
DEMOGRAPHIC FACTORS | POPULATION | ADOLESCENTS |
YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS |
MEDROXYPROGESTERONE ACETATE | CONTRACEPTIVE
AGENTS, FEMALE | CONTRACEPTIVE AGENTS |
CONTRACEPTION | FAMILY PLANNING | HIV INFECTIONS |
VIRAL DISEASES | DISEASES | MEASUREMENT | RESEARCH
METHODOLOGY
Document Number: 328089
Feasibility, acceptability, effect and cost of integrating counseling
and testing for HIV within family planning services in Kenya.
Author:
Liambila W; Kibaru J; Warren C; Gathitu M; Mullick S
Source:
[Washington, D.C.], Population Council, Frontiers in Reproductive
Health, 2008 Jul.SE: USAID Cooperative Agreement No. HRN-A-00-9800012-00
Abstract:
Integrating counseling and testing (CT) for HIV into family planning (FP)
services potentially increases the range of services available for FP clients,
many of whom are at risk of STIs including HIV in high prevalence
settings. Systematic evidence about offering CT in FP settings has
remained extremely limited, despite the widespread interest in this model
of FP-HIV integration. FRONTIERS supported the Division of
Reproductive Health (DRH) and the National AIDS and STI Control
Program (NASCOP) of the Kenya Ministry of Health (MOH) to design,
implement and compare two models of integrating CT for HIV within FP
services in 23 health facilities in Nyeri and Thika Districts of Central
Province, Kenya in terms of their feasibility, acceptability, cost and effect
on the voluntary use of CT, as well as the quality of FP services. The
study utilized a pre-post intervention design to obtain information from
FP providers and their clients in 2006 to 2007. Data were collected
10
Family Planning: 2005 - 2008
through provider-client observations (554 at baseline and 530 at endline)
and client exit interviews (552 at baseline and 530 at end line), pre and
post intervention interviews and focus group discussions with health
providers, and a health facility assessment of the readiness of facilities to
offer HIV CT within FP services. Introduction and implementation
involved: (a) holding sensitization meetings at national, provincial and
district levels; (b) reviewing and developing training materials; (c)
application of the Balanced Counseling Strategy (BCS) Plus approach; (d)
modification of facility registers to record the required data; and (e)
training of health providers. The MOH provided all required equipment
and supplies, including HIV rapid test kits and FP commodities. Two
models were pilot-tested. The "testing" model was implemented in Nyeri
District, an area with relatively few VCT sites. In this model, FP clients
were educated about HIV prevention generally, and CT in particular, and
offered HIV CT during this consultation by the FP provider. The
"referral" model was implemented in Thika district, an area with good
accessibility to VCT services. In this model, FP clients were educated
about HIV CT, and those interested were instead referred to a specialized
CT service, either within the same facility or to another CT service (at
another health facility or a stand-alone VCT center). The study
demonstrated that both models were feasible and acceptable to providers
and to clients as means of integrating and linking HIV prevention
counseling, condom promotion and counseling and testing with FP
services, and are effective in increasing quality of care and service
utilization. (excerpt)
Language:
English
Keywords:
KENYA | SUMMARY REPORT | COMPARATIVE STUDIES |
INTEGRATED PROGRAMS | FAMILY PLANNING PROGRAMS |
PROGRAM ACCEPTABILITY | PROGRAM EFFECTIVENESS | HIV
PREVENTION | VOLUNTARY COUNSELING AND TESTING |
SEXUALLY TRANSMITTED DISEASES | PROVIDERS WITH
CLIENTS | FAMILY PLANNING ACCEPTOR CHARACTERISTICS |
COUNSELING | HIV/FP INTEGRATION | AFRICA, EASTERN |
AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES |
STUDIES | RESEARCH METHODOLOGY | PROGRAMS |
ORGANIZATION AND ADMINISTRATION | FAMILY PLANNING
| PROGRAM EVALUATION | HIV INFECTIONS | VIRAL
DISEASES | DISEASES | HIV TESTING | LABORATORY
EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
SERVICES | DELIVERY OF HEALTH CARE | HEALTH |
REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | FAMILY
PLANNING ACCEPTORS | CLINIC ACTIVITIES | PROGRAM
ACTIVITIES
Document Number: 328074
11
Family Planning: 2005 - 2008
Strengthening postnatal care services including postpartum family
planning in Kenya.
Author:
Mwangi A; Warren C; Koskei N; Blanchard H
Source:
Washington, D.C., Population Council, Frontiers in Reproductive Health,
2008 Jun.SE: USAID Cooperative Agreement No. HRN-A-00-98-00012-00
Abstract:
To improve the health and survival of mothers and infants in the
postnatal period, the Ministry of Health (MOH) in Kenya increased both
the recommended timing and content of postnatal services a women and
her infant should receive to at least three assessments within the first six
weeks after childbirth. The feasibility and acceptability of providing
postnatal care at these times has not been evaluated, however, and most
providers are not aware of this change in policy or how to implement it.
The objectives of the study were develop and introduce a strengthened
postnatal care package into one hospital and four health centers in one
district, to document the feasibility, acceptability and quality of care of
the strengthened postnatal care, and to evaluate the effectiveness of the
postnatal package on women's reproductive health behaviors. The study
was implemented jointly by the Population Council's Frontiers in
Reproductive Health (FRONTIERS) project and by Jhpiego's ACCESS-FP
project, both funded by USAID. The study was conducted in Embu
district, Eastern Province, between 2006 and 2008. The study used a prepost intervention design for assessing quality of care received within the
facilities and compared stratified samples of postpartum women
recruited and interviewed following childbirth and again six months later
before and after introduction of the intervention. For the quality of care
assessment, data were collected through interviews with health care
providers, structured observations of client -provider interactions during
the postnatal consultations and a facility inventory for assessing
availability of equipment, drugs, family planning commodities and
supplies. Postpartum women were recruited and interviewed following
childbirth on the postnatal ward in Embu Provincial General Hospital
and interviewed again in their community after six months. A postnatal
care -family planning (PNC-FP) orientation package for providers was
developed by ACCESS-FP, DRH and FRONTIERS. This incorporated
relevant maternal and newborn health care services in the postnatal
period with a specific focus on postpartum family planning. Job aids
were also produced. The three day orientation training included staff
from the maternity and MCH- FP units from the four health facilities, as
well as provincial and district RH trainers/supervisors. In total, 73 health
care providers were oriented in the PNC -FP package, as well as in the
use of a new postnatal register recently released by the MOH. Regular
supportive supervision visits were made during the intervention period
to reinforce application of the package. (author's)
12
Family Planning: 2005 - 2008
Language:
English
Keywords:
KENYA | RESEARCH REPORT | PILOT PROJECTS | PRE-POST
TESTS | POSTPARTUM WOMEN | INFANT | POSTPARTUM
PROGRAMS | FAMILY PLANNING PROGRAMS | COUNSELING |
INTERVENTIONS | QUALITY OF HEALTH CARE | PROGRAM
ACTIVITIES | PROGRAM EFFECTIVENESS | PROGRAM
EVALUATION | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH
METHODOLOGY | PROGRAMS | ORGANIZATION AND
ADMINISTRATION | PUERPERIUM | REPRODUCTION | YOUTH
| AGE FACTORS | POPULATION CHARACTERISTICS |
DEMOGRAPHIC FACTORS | POPULATION | FAMILY PLANNING
| CLINIC ACTIVITIES | HEALTH SERVICES EVALUATION
Document Number: 327992
Achieving the MDGs: the contribution of family planning, Kenya.
Author:
Constella Futures. Health Policy Initiative
Source:
Washington, D.C., Constella Futures, Health Policy Initiative, [2007].
Abstract:
In addition to the cost savings incurred by addressing unmet need,
greater use of FP services can contribute directly to the MDG goals to
reduce child morality and improve maternal health; family planning
helps reduce the number of high-risk pregnancies that result in high
levels of maternal and child illness and death. The study shows that
addressing unmet need in Kenya could be expected to avert 14,040
maternal deaths and 434,306 child deaths by the target date of 2015.
Increasing access to and use of family planning is not one of the MDGs;
however, as analysis has shown, it can make valuable contributions to
achieving many of the goals. Increased contraceptive use can significantly
reduce the costs of achieving selected MDGs and directly contribute to
reductions in maternal and child mortality. The cost savings in meeting
the five My satisfying unmet need outweigh the additional costs of family
planning by a factor of almost 4 to 1. (excerpt
Language:
English
Keywords:
KENYA | SUMMARY REPORT | COST EFFECTIVENESS | GOALS |
SOCIAL DEVELOPMENT | CHILD HEALTH | WOMEN'S HEALTH
| MATERNAL HEALTH | PRIMARY HEALTH CARE | HIV
PREVENTION | AIDS PREVENTION | MALARIA | EDUCATION |
SCHOOL ENROLLMENT | CHILD MORTALITY | NEEDS |
13
Family Planning: 2005 - 2008
SANITATION | FAMILY PLANNING | PROGRAM ACCESSIBILITY
| DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
SAHARAN | AFRICA | EVALUATION INDEXES | QUANTITATIVE
EVALUATION | EVALUATION | PLANNING | ORGANIZATION
AND ADMINISTRATION | ECONOMIC FACTORS | HEALTH |
HEALTH SERVICES | DELIVERY OF HEALTH CARE | HIV
INFECTIONS | VIRAL DISEASES | DISEASES | AIDS |
PARASITIC DISEASES | EDUCATIONAL STATUS |
SOCIOECONOMIC STATUS | SOCIOECONOMIC FACTORS |
MORTALITY | POPULATION DYNAMICS | DEMOGRAPHIC
FACTORS | POPULATION | PUBLIC HEALTH | PROGRAM
EVALUATION | PROGRAMS
Document Number: 323016
Evaluating the integration of family planning and voluntary
counseling and testing in Kenya.
Author:
Family Health International [FHI]
Source:
Research Triangle Park, North Carolina, FHI, 2007.
Abstract:
Operations research by Family Health International (FHI) and partners to
evaluate the integration of family planning into voluntary counseling and
testing (VCT) in Kenya suggests that it is feasible and acceptable. The
intervention in 14 VCT centers improved several aspects of family
planning provision without compromising VCT services. However,
although a large proportion of VCT clients were considered at risk of
unintended pregnancy, the intervention had little effect on contraceptive
method choice or distribution. Advocacy and training activities should
stress the importance of screening VCT clients for risk of unintended
pregnancy with the goal of reducing unmet contraceptive need. VCT
quality of care and contraceptive method choice, distribution, and uptake
should continue to be monitored. (author's
Language:
English
Keywords:
KENYA | PROGRESS REPORT | RECOMMENDATIONS |
OPERATIONS RESEARCH | KAP SURVEYS | COUNSELORS |
HEALTH PERSONNEL | HIV TESTING | INTEGRATED
PROGRAMS | COUNSELING | FAMILY PLANNING PROGRAM
EVALUATION | ADVOCACY | TRAINING PROGRAMS |
TRAINING OF TRAINERS | CURRICULUM | DEVELOPING
COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
AFRICA | PROGRAM EVALUATION | PROGRAMS |
14
Family Planning: 2005 - 2008
ORGANIZATION AND ADMINISTRATION | RESEARCH
METHODOLOGY | SURVEYS | SAMPLING STUDIES | STUDIES |
CLINIC ACTIVITIES | PROGRAM ACTIVITIES | DELIVERY OF
HEALTH CARE | HEALTH | LABORATORY EXAMINATIONS AND
DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
PROCEDURES | MEDICINE | HEALTH SERVICES | FAMILY
PLANNING PROGRAMS | FAMILY PLANNING |
COMMUNICATION | EDUCATION
Document Number: 322039
Kenya: final country report.
Author:
John Snow [JSI]. DELIVER
Source:
Arlington, Virginia, JSI, DELIVER, 2007 Mar.
Abstract:
The DELIVER project in Kenya began its operations in October 2000 after
the Family Planning Logistics Management III Project ended. The
primary goal of DELIVER at that time was improved availability of
contraceptives and other essential health commodities at service delivery
points. The main strategy toward this end was to strengthen health sector
logistics management systems, and the main partner was the Ministry of
Health Division of Reproductive Health. Over the next five years,
DELIVER saw an extraordinary increase in its scope of work. By the end
of the project in 2006, DELIVER was working with the National AIDS and
STI Control Program, the National Leprosy and Tuberculosis Program,
the STI Program, the National Public Health Laboratory Service, the
Kenya Medical Supplies Agency, and the Kenya Expanded Program on
Immunization. Its goal remained the same, but the number of essential
health commodities increased to include antiretroviral drugs, HIV test
kits and blood safety commodities, drugs for sexually transmitted
infections, opportunistic infection drugs, essential drugs, tuberculosis
drugs, laboratory reagents and consumable supplies, malaria bed nets,
and prophylactic drugs. As a consequence, DELIVER's strategies and
initiatives also increased. The story of DELIVER in Kenya is one that
exemplifies the complexities and paradoxes that can occur in a technical
assistance project when donor funding for the provision of essential
health commodities increases at a rapid pace without the commensurate
scale-up of capacity on the part of the host country government.
DELIVER was an important catalyst and agent for bringing about
capacity and change in the status quo. However, despite its many
successes, more efforts are required to achieve the goal of improved
availability of essential health commodities. (author's)
15
Family Planning: 2005 - 2008
Language:
English
Keywords:
KENYA | SUMMARY REPORT | CONTRACEPTIVE PREVALENCE
| CONTRACEPTIVE SECURITY | HIV TESTING |
IMMUNIZATION | ANTIRETROVIRAL DRUGS | MALARIA
PREVENTION | BED NETS | SEXUALLY TRANSMITTED
DISEASES | TUBERCULOSIS | BLOOD TRANSFUSION |
CONTRACEPTIVE AVAILABILITY | GOALS | USAID |
DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
SAHARAN | AFRICA | CONTRACEPTIVE USAGE |
CONTRACEPTION | FAMILY PLANNING | LABORATORY
EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND
DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH
SERVICES | DELIVERY OF HEALTH CARE | HEALTH | PRIMARY
HEALTH CARE | TREATMENT | MALARIA | PARASITIC
DISEASES | DISEASES | PARASITE CONTROL | PUBLIC HEALTH
| REPRODUCTIVE TRACT INFECTIONS | INFECTIONS |
PLANNING | ORGANIZATION AND ADMINISTRATION |
GOVERNMENT AGENCIES | ORGANIZATIONS | POLITICAL
FACTORS | SOCIOCULTURAL FACTORS
Document Number: 323744
Family planning in the era of HIV / AIDS: more important than
ever.
Author:
United States. Agency for International Development [USAID]
Source:
Washington, D.C., USAID, 2006 Jul.
Absract:
The AIDS epidemic is challenging health care systems in the developing
world. Many facilities are overcrowded, and the rising cost of providing
treatment is forcing health systems to reduce spending for other crucial
health interventions, including family planning. Family planning remains
an important health intervention. Family planning programs are
necessary in the ongoing effort to improve overall health and the lives of
women and children in the developing world. Each year, pregnancyrelated deaths claim the lives of half a million women, and 11 million
children die from causes associated with their mother's pregnancy or
from birth-related risks. Family planning programs could prevent onequarter of these infant and maternal deaths. Family planning can be
integral in mitigating the impact of AIDS. Family planning can help
achieve HIV prevention goals and improve maternal and child health
outcomes. Likewise, HIV services can help expand access to family
planning services. Family planning and HIV/AIDS programs often serve
16
Family Planning: 2005 - 2008
similar populations, particularly in countries with generalized HIV
epidemics driven by heterosexual transmission. When programs and
services meet multiple client needs, satisfaction with the health system
increases and scarce financial and human resources are better utilized.
(excerpt)
Language:
English
Keywords:
KENYA | UGANDA | SOUTH AFRICA | GHANA | HAITI |
SUMMARY REPORT | PERSONS LIVING WITH HIV/AIDS |
INFANT | MOTHERS | INTERVENTIONS | FAMILY PLANNING |
AIDS | MATERNAL-CHILD HEALTH SERVICES | MATERNAL
MORTALITY | VOLUNTARY COUNSELING AND TESTING | HIV
TESTING | PREVENTION OF MOTHER-TO-CHILD
TRANSMISSION | ANTIRETROVIRAL THERAPY | HOME CARE |
TREATMENT | DEVELOPING COUNTRIES | AFRICA, EASTERN |
AFRICA, SUB SAHARAN | AFRICA | AFRICA, SOUTHERN |
AFRICA, WESTERN | CARIBBEAN | AMERICAS | HIV
INFECTIONS | VIRAL DISEASES | DISEASES | YOUTH | AGE
FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC
FACTORS | POPULATION | PARENTS | FAMILY
RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND
HOUSEHOLD | SOCIOCULTURAL FACTORS | PROGRAMS |
ORGANIZATION AND ADMINISTRATION | PRIMARY HEALTH
CARE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
HEALTH | MORTALITY | POPULATION DYNAMICS |
LABORATORY EXAMINATIONS AND DIAGNOSES |
EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES |
MEDICINE | DISEASE TRANSMISSION CONTROL |
PREVENTION AND CONTROL | HIV | CARE AND SUPPORT
Document Number: 323030
Integrating family planning into HIV voluntary counseling and
testing services in Kenya: progress to date and lessons learned.
Author:
Fischer S
Source:
Research Triangle Park, North Carolina, Family Health International
[FHI], 2006.
Abstract:
In Kenya, as in most countries, family planning services and HIV
voluntary counseling and testing (VCT) services have traditionally been
offered separately. However, health policy-makers have begun to
recognize the opportunities missed and efficiencies lost in this parallel
17
Family Planning: 2005 - 2008
approach. Family planning plays an important role in HIV/AIDS
prevention, and VCT can reach clients who do not typically seek out
family planning services as well as HIV-positive women who wish to
prevent unintended pregnancy. Integration of services may also help to
once again focus attention on family planning. In recent years there have
been dramatic increases in HIV funding and programming, while
funding for family planning programs has remained stable, despite
increasing numbers of women of reproductive age and a substantial
unmet need for contraception. It was within this context that Family
Health International (FHI), with funding from the U.S. Agency for
International Development (USAID), undertook a study on the feasibility
of integrating family planning into VCT services in Kenya. When the
results proved generally positive, the Kenyan Ministry of Health (MOH)
charged FHI and other partners with determining the best way to
implement integration in VCT centers across the country. This report
documents the process of assessing the feasibility of integration, bringing
together stakeholders, developing an integration strategy, and
implementing that strategy. It summarizes successes, challenges, and
lessons learned at each step of the process. The document is not intended
to provide exhaustive detail, but rather to highlight key steps and
milestones. (excerpt)
Language:
English
Keywords:
KENYA | PROGRESS REPORT | OPERATIONS RESEARCH | KAP
SURVEYS | COUNSELORS | HEALTH PERSONNEL | HIV
TESTING | INTEGRATED PROGRAMS | COUNSELING | FAMILY
PLANNING PROGRAM EVALUATION | USAID | CAPACITY
BUILDING | PREVENTION OF MOTHER-TO-CHILD
TRANSMISSION | HEALTH SERVICES EVALUATION |
DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB
SAHARAN | AFRICA | PROGRAM EVALUATION | PROGRAMS |
ORGANIZATION AND ADMINISTRATION | RESEARCH
METHODOLOGY | SURVEYS | SAMPLING STUDIES | STUDIES |
CLINIC ACTIVITIES | PROGRAM ACTIVITIES | DELIVERY OF
HEALTH CARE | HEALTH | LABORATORY EXAMINATIONS AND
DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL
PROCEDURES | MEDICINE | HEALTH SERVICES | FAMILY
PLANNING PROGRAMS | FAMILY PLANNING | GOVERNMENT
AGENCIES | ORGANIZATIONS | POLITICAL FACTORS |
SOCIOCULTURAL FACTORS | PROGRAM SUSTAINABILITY |
DISEASE TRANSMISSION CONTROL | PREVENTION AND
CONTROL | DISEASES
Document Number: 322038
18
Family Planning: 2005 - 2008
Revitalizing the IUD in Kenya.
Author:
Rajani N
Source:
New York, New York, EngenderHealth, ACQUIRE Project, 2006.
Abstract:
Kenya has been a leader in family planning (FP) in Africa. It was the first
Sub-Saharan African country to adopt a national FP program. From the
mid-1970s to 1998, Kenya's total fertility rate fell from 8.1 to 4.7 lifetime
births per woman--a decrease of 42% in 20 years. Between 1978 and 2003,
the use of modern FP rose from 4% to 31% among married women. Yet,
there is still a large unmet need for FP in Kenya, and long-acting and
permanent methods like the IUD are underutilized. While the percentage
of Kenyan women using any modern method has more than tripled in the
past 20 years, the IUD has virtually disappeared from the mix of modern
FP methods. In 1984, nearly one in three Kenyan women using
contraception were using the IUD, but by 2004, this figure had dropped
to fewer than one in 10. (excerpt
Language:
English
Keywords:
KENYA | SUMMARY REPORT | TOTAL FERTILITY RATE | IUD |
NEEDS | UTILIZATION OF HEALTH CARE | HEALTH SERVICES |
IMPLEMENTATION | PROGRAM ACCESSIBILITY | FAMILY
PLANNING PROGRAMS | AFRICA, EASTERN | AFRICA SOUTH
OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES |
FERTILITY RATE | BIRTH RATE | FERTILITY MEASUREMENTS |
FERTILITY | POPULATION DYNAMICS | DEMOGRAPHIC
FACTORS | POPULATION | CONTRACEPTIVE METHODS |
CONTRACEPTION | FAMILY PLANNING | ECONOMIC FACTORS
| DELIVERY OF HEALTH CARE | HEALTH | PROGRAMS |
ORGANIZATION AND ADMINISTRATION | PROGRAM
EVALUATION
Document Number: 310860
Implementing integrated family planning and HIV / AIDS policies
and programs: tools and resources.
Author:
Sanders R; Hardee K; Shepherd C
Source:
[Unpublished] [2006].
Abstract:
With the pressing needs related to the HIV/AIDS pandemic, is there any
need to devote resources to supporting the provision of family planning
19
Family Planning: 2005 - 2008
(FP)? Given the strong links between HIV/AID and FP, the answer is an
emphatic yes. The same unprotected sexual act can lead to unintended
pregnancy and HIV infections. Given that an estimated 80 percent of HIV
cases are transmitted sexually and an additional 10 percent are
transmitted from mothers to children perinatally or during breastfeeding,
linking HIV and reproductive health (RH) programs is crucial. Women
and men have a need for both protection against pregnancy and
protection against HIV and other sexually transmitted infections (STIs).
However, programs to prevent unintended pregnancy and to prevent
infection have typically been separate. This reliance on separate programs
is beginning to change. The International Conference on Population and
Development (ICPD) held in Cairo in 1994 called for a holistic approach
to meeting women's and men's RH needs throughout their lives, from
childhood, through adolescence and adulthood. ICPD called for
integrated services to meet these needs, including to help individuals and
couples meet their reproductive intentions and prevent disease. Cairo + 5,
held 5 years after the 1994 ICPD, reiterated the call for integration. Most
efforts to date have focused on integrating HIV prevention and care into
FP services. However, now the focus is shifting to integrating FP into HIV
prevention, care, and treatment services, including in countries such as
Kenya, Uganda, and Jamaica. Other countries, including Cambodia and
Zambia,
Language:
English
Keywords:
KENYA | UGANDA | JAMAICA | CAMBODIA | ZAMBIA |
SUMMARY REPORT | INTEGRATED PROGRAMS | FAMILY
PLANNING PROGRAMS | IMPLEMENTATION | HEALTH POLICY
| HIV PREVENTION | AIDS PREVENTION | PROGRAM
DEVELOPMENT | AFRICA, EASTERN | AFRICA SOUTH OF THE
SAHARA | AFRICA | DEVELOPING COUNTRIES | CARIBBEAN |
AMERICAS | ASIA, SOUTHEASTERN | ASIA | AFRICA,
SOUTHERN | PROGRAMS | ORGANIZATION AND
ADMINISTRATION | FAMILY PLANNING | POLICY | POLITICAL
FACTORS | SOCIOCULTURAL FACTORS | HIV INFECTIONS |
VIRAL DISEASES | DISEASES | AIDS
Document Number: 311450
Family planning and HIV / AIDS waste disposal practices in
Kenya: A formative assessment.
Author:
Family Health International [FHI]
Source:
[Research Triangle Park, North Carolina], FHI, 2005 Jul.
20
Family Planning: 2005 - 2008
Abstract: :
Procurement statistics for Kenya's public-sector family planning
programs suggest dramatic increases in the use of male and female
condoms and injectable contraceptives during the past five years. The
number of HIV voluntary counseling and testing centers has also soared,
and long-term care of people living with HIV/AIDS has moved largely
from hospitals to communities and households. These trends indicate a
commensurate increase in the waste generated by family planning and
HIV/AIDS services and some shifts in responsibility for safe disposal of
such waste. Unsafe disposal of medical wastes, including used condoms,
hypodermic syringes, needles, hormonal preparations, and expired
medicines, can be hazardous to human health and the environment. A
formative assessment of the waste disposal practices of family planning
and HIV/AIDS services in Kenya found many gaps in medical waste
management policies and practices. Most healthcare facilities do not
adhere to minimum levels of safety for medical waste disposal and suffer
from inadequate funding and monitoring of medical waste management.
Kenyan households and communities have no guidelines on safe disposal
of infectious materials, and many are not served by any waste disposal
services. Their waste, including medical waste, is commonly dumped or
burned at sites within or near residential areas, particularly in the
burgeoning peri-urban slums. Effective implementation of Kenya's
Environmental Management and Co-ordination Act (EMCA) would
significantly improve waste disposal practices in Kenya, the assessment
team found. Team members and local stakeholders recommended
developing guidelines and enforcement mechanisms to implement the
EMCA at all levels. This law does not, however, apply to the informal
settlements where most Kenyans live. Innovative methods are needed to
achieve safe waste disposal in these settlements and should be carefully
designed to avoid further marginalizing slum residents. Other
recommendations called for training of waste handlers and healthcare
providers in medical waste management and public education campaigns
to promote safe waste disposal. (excerpt)
Language:
English
Keywords:
KENYA | RESEARCH REPORT | FORMATIVE RESEARCH |
POLICYMAKERS | HEALTH PERSONNEL | WASTE
MANAGEMENT | SANITATION | LEGISLATION | HIV
PREVENTION | AIDS | USAID | HEALTH POLICY | FAMILY
PLANNING PROGRAMS | FAMILY PLANNING PROGRAM
EVALUATION | CONTRACEPTIVE SAFETY | AFRICA, EASTERN |
AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING
COUNTRIES | RESEARCH METHODOLOGY | ADMINISTRATIVE
PERSONNEL | ORGANIZATION AND ADMINISTRATION |
DELIVERY OF HEALTH CARE | HEALTH | ENVIRONMENT |
PUBLIC HEALTH | POLITICAL FACTORS | SOCIOCULTURAL
21
Family Planning: 2005 - 2008
FACTORS | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
GOVERNMENT AGENCIES | ORGANIZATIONS | POLICY |
FAMILY PLANNING | PROGRAMS | SAFETY
Document Number: 302663
Hormonal Contraception and HIV: Science and Policy. Africa
Regional Meeting, Nairobi 19-21 September 2005. Statement (final).
Author:
Hormonal Contraception and HIV: Science and Policy. Africa Regional
Meeting (2005: Nairobi)
Source:
[Unpublished] 2005.
Abstract:
The World Health Organization Headquarters Office and Regional Office
for Africa, in partnership with the Reproductive Health and HIV
Research Unit of the University of Witwatersrand in South Africa (a
WHO Collaborating Centre), International Planned Parenthood
Federation Africa Region and Family Health International (FHI),
convened a meeting of 72 representatives from 17 francophone,
lusophone and Anglophone sub-Saharan African countries on
“Hormonal Contraception and HIV: Science and Policy”. The participants
included policymakers and programme managers involved with family
planning, sexual and reproductive health, and HIV/AIDS, women’s
health advocates, people living with HIV and scientists and clinicians
involved with family planning and HIV research. They were joined by 13
representatives from international donor and non-governmental
organizations and agencies. The goal of the meeting was to promote
evidence-based discussion and decision-making in response to new
information on any potential association between hormonal contraceptive
use and the acquisition of HIV. (excerpt)
Language:
English
Keywords:
KENYA | UGANDA | THAILAND | ZIMBABWE | SOUTH AFRICA
| RESEARCH REPORT | RECOMMENDATIONS | WOMEN | SEX
WORKERS | CLIENTS | RISK FACTORS | CONTRACEPTIVE
USAGE | ORAL CONTRACEPTIVES | HIV PREVENTION |
PROMOTION | DEVELOPING COUNTRIES | AFRICA, EASTERN |
AFRICA SOUTH OF THE SAHARA | AFRICA | ASIA,
SOUTHEASTERN | ASIA | AFRICA, SOUTHERN |
DEMOGRAPHIC FACTORS | POPULATION | SEX BEHAVIOR |
BEHAVIOR | PROGRAM ACTIVITIES | PROGRAMS |
ORGANIZATION AND ADMINISTRATION | BIOLOGY |
CONTRACEPTION | FAMILY PLANNING | CONTRACEPTIVE
22
Family Planning: 2005 - 2008
METHODS | HIV INFECTIONS | VIRAL DISEASES | DISEASES |
MARKETING | ECONOMIC FACTORS
Document Number: 291228
Integrating family planning into VCT services. Guest editorial.
Author:
Aradhya KW
Source:
Pop Reporter. 2005 Jan 31
Abstract:
As efforts begin to integrate family planning into HIV/AIDS services,
voluntary counseling and testing (VCT) centers are emerging as primary
targets for integration. Research from Africa and the Caribbean shows
that such integration is feasible and acceptable, and large-scale
integration efforts are being launched and expanded there. VCT services
have become one of the most common means of preventing, detecting,
and improving access to care and support for HIV/AIDS. And VCT
services are likely to greatly expand with support from the five-year U.S.
President's Emergency Plan for AIDS Relief (PEPFAR), which focuses on
fighting the HIV/AIDS epidemic in 15 resource-poor countries, mostly in
Africa and the Caribbean. (excerpt)
Language:
English
Keywords:
KENYA | HAITI | CRITIQUE | AIDS PREVENTION | HIV
PREVENTION | FAMILY PLANNING PROGRAMS | COUNSELING
| HIV TESTING | INTEGRATED PROGRAMS | FOREIGN AID |
AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA
| DEVELOPING COUNTRIES | CARIBBEAN | AMERICAS | AIDS
| HIV INFECTIONS | VIRAL DISEASES | DISEASES | FAMILY
PLANNING | PROGRAMS | ORGANIZATION AND
ADMINISTRATION | CLINIC ACTIVITIES | PROGRAM
ACTIVITIES | LABORATORY EXAMINATIONS AND DIAGNOSES
| EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES
| MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE
| HEALTH | FINANCIAL ACTIVITIES | ECONOMIC FACTORS
Document Number: 296251
23
Family Planning: 2005 - 2008
Addressing the family planning needs of HIV-positive PMTCT
clients: baseline findings from an operations research study.
Author:
Baek C; Rutenberg N
Source:
Washington, D.C., Population Council, Horizons, 2005 Apr.
Abstract:
Preventing unintended pregnancy among HIV-positive women is an
effective approach to reducing pediatric HIV infection and vital to
meeting HIV-positive women’s sexual and reproductive health needs
(WHO 2002, 2004; UNFPA 2004). Although contraceptive services for
HIV-positive women is one of the four cornerstones of a comprehensive
program for prevention of mother-to-child transmission of HIV (PMTCT),
a review of PMTCT programs found that implementers have not
prioritized family planning. While there is increasing awareness about
the importance of family planning and HIV integration, data about family
planning from PMTCT clients are lacking. The Horizons Program, in
collaboration with International Medical Corps (IMC) and Steadman
Research Services International (SRSI), is conducting an operations
research study testing several community-based strategies to reduce
mother-to-child transmission of HIV in a densely settled urban slum area
in Nairobi, Kenya. The strategies being piloted by IMC include moving
PMTCT services closer to the population via a mobile clinic, and
increasing psychosocial support for HIV-positive women through the use
of traditional birth attendants and peer counselors. Peer counselors are
HIV-positive women who have already received PMTCT services. The
effectiveness of each of these strategies on women’s utilization of key
PMTCT services, including family planning, will be measured by
comparing baseline to follow-up data. This research update presents key
findings about family planning at PMTCT sites, including the interaction
between providers and clients as well as HIV-positive women’s fertility
desires and demand for contraceptives, from the baseline cross-sectional
survey and qualitative interviews with postpartum women. (excerpt)
Language:
English
Keywords:
KENYA | OPERATIONS RESEARCH | CROSS SECTIONAL
ANALYSIS | MOTHERS | CHILD | HIV POSITIVE PERSONS |
MOTHER-TO-CHILD TRANSMISSION | PREVENTION AND
CONTROL | PREGNANCY | HIV PREVENTION | FAMILY
PLANNING PROGRAMS | DEVELOPING COUNTRIES | AFRICA,
EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
RESEARCH METHODOLOGY | PROGRAM EVALUATION |
PROGRAMS | ORGANIZATION AND ADMINISTRATION |
PARENTS | FAMILY RELATIONSHIPS | FAMILY
CHARACTERISTICS | FAMILY AND HOUSEHOLD | YOUTH |
AGE FACTORS | POPULATION CHARACTERISTICS |
24
Family Planning: 2005 - 2008
DEMOGRAPHIC FACTORS | POPULATION | PERSONS LIVING
WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES |
DISEASES | TRANSMISSION | INFECTIONS | REPRODUCTION |
FAMILY PLANNING
Document Number: 292589
Community-based family planning in Kenya: meeting new
challenges.
Author:
Casey L; Onduso P; Omuodo D; Wilder J
Source:
Nairobi, Kenya, Pathfinder International, 2005.
Abstract:
Although Kenya has been touted as one of Africa’s family planning
successes, with a relatively high contraceptive prevalence rate of 39% and
a long history of making services available, there is still significant unmet
need for family planning services. Poor access to family planning services
is a major constraint to contraceptive use in large parts of the country,
particularly in Coast, Nyanza and Rift Vally provinces, the sites of
Pathfinder’s ongoing efforts to support FP programs in Kenya. Delays
and setbacks are endemic in the implementation of a new contraceptive
logistics system and new decentralization policies. Attempts to reform the
government package of free health services will most certainly encounter
obstacles. In this context, the unmet need for FP is difficult, if not
impossible to address, without significant NGO and private sector
involvement. The situation is made still more complex by strong
community demands for HIV/AIDS information and services, which
calls for maximizing resources and expertise by integrating efforts at both
the community and clinic level. (excerpt)
Language:
English
Keywords:
KENYA | PROGRESS REPORT | EVALUATION | COMMUNITY
WORKERS | COMMUNITY | COMMUNITY HEALTH SERVICES |
FAMILY PLANNING PROGRAM EVALUATION | TECHNICAL
ASSISTANCE | HIV PREVENTION | SEXUALLY TRANSMITTED
DISEASE PREVENTION | DELIVERY OF HEALTH CARE |
CONTRACEPTIVE DISTRIBUTION | RELIGIOUS ASPECTS |
DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA
SOUTH OF THE SAHARA | AFRICA | HEALTH PERSONNEL |
HEALTH | RESIDENCE CHARACTERISTICS | POPULATION
DISTRIBUTION | GEOGRAPHIC FACTORS | POPULATION |
PRIMARY HEALTH CARE | HEALTH SERVICES | FAMILY
PLANNING PROGRAMS | FAMILY PLANNING | PROGRAMS |
25
Family Planning: 2005 - 2008
ORGANIZATION AND ADMINISTRATION | HIV INFECTIONS |
VIRAL DISEASES | DISEASES | SEXUALLY TRANSMITTED
DISEASES | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS
| DISTRIBUTIONAL ACTIVITIES | PROGRAM ACTIVITIES |
RELIGION
Document Number: 291030
Post abortion family planning benefits clients and providers.
Author:
Foreit JR
Source:
Baltimore, Maryland, Johns Hopkins Bloomberg School of Public Health,
Center for Communication Programs, Information and Knowledge for
Optimal Health Project [INFO], 2005 Sep 19.
Abstract:
A woman’s fertility can return quickly after an abortion or miscarriage-as soon as two weeks after (Bongaarts 1983). Yet recent data show high
levels of unmet need for family planning among women who have been
treated for incomplete abortion. This leaves many women at risk of
another unintended pregnancy and in some cases subsequent repeated
abortions and abortion-related complications (Savelieva et al. 2002). Thus
it is vital for programs to provide a comprehensive package of post
abortion care (PAC) services that includes medical treatment; family
planning counseling and other reproductive health services such as
sexually transmitted infection (STI) evaluation and treatment, HIV
counseling and possibility testing; and community support and
mobilization. Facilities that can effectively treat women with incomplete
abortions can also provide contraceptive services, including counseling
and appropriate methods. Appropriate pre-discharge contraception can
be provided in conjunction with all emergency procedures including
inpatient and outpatient dilation and curettage (D&C) and manual or
electric vacuum aspiration. Any provider who can treat incomplete
abortion can also provide most family planning methods. (excerpt)
Language:
English
Keywords:
KENYA | RUSSIA | SUMMARY REPORT | CLIENTS |
POSTABORTION CARE | FAMILY PLANNING PROGRAMS |
ABORTION | COUNSELING | DEVELOPING COUNTRIES |
AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | ASIA,
NORTHERN | ASIA | PROGRAM ACTIVITIES | PROGRAMS |
ORGANIZATION AND ADMINISTRATION | HEALTH SERVICES
| DELIVERY OF HEALTH CARE | HEALTH | FAMILY PLANNING
26
Family Planning: 2005 - 2008
| FERTILITY CONTROL, POSTCONCEPTION | CLINIC
ACTIVITIES
Document Number: 292564
Cost-effectiveness of two interventions to avert HIV-positive
births. Draft.
Author:
Reynolds H; Janowitz B; Homan R; Johnson L
Source:
[Unpublished] [2005].
Abstract: :
Prevention of mother-to-child transmission (PMTCT) of HIV efforts focus
primarily on providing voluntary counseling and testing (VCT) services
in prenatal care (PNC) and providing anti-retroviral (ARV) prophylaxis
to HIV-infected mothers. However, HIV-positive births could be averted
if HIV-infected women who did not want to get pregnant used effective
contraception. We compare the cost-effectiveness of increasing
contraceptive use among non-pregnant women versus increasing the
coverage of services in PNC that provide and promote nevirapine for
PMTCT. We estimated the number of HIV-positive births averted by
simulating an increase in contraceptive use from none to 50% among noncontracepting women who do not want to get pregnant. We also
simulated an increase in the availability of nevirapine for HIV-infected
mothers in PNC from current levels (10%) to 50%. Costs included firstyear costs of providing family planning services and outreach to
stimulate demand. Program costs of nevirapine for HIV-infected mothers
included costs of promotion, training, VCT, and nevirapine. At any level
of expenditure, increasing contraceptive use among non-pregnant women
averted more HIV-positive births than increasing the coverage of
nevirapine for PMTCT. The relative cost-effectiveness depended on the
cost of crucial services such as VCT and family planning services.
Increasing contraceptive use among non-users of contraception who do
not want to get pregnant is at least as cost-effective as an equivalent
investment in PNC programs that provide and promote nevirapine to
HIV-infected mothers. Our data underscore prevention of unintended
pregnancies as a key strategy to prevent mother-to-child transmission of
HIV. (author's)
Language:
English
Keywords:
SENEGAL | KENYA | RESEARCH REPORT | COST
EFFECTIVENESS | COMPARATIVE STUDIES | PREGNANT
WOMEN | MOTHERS | PREVENTION OF MOTHER-TO-CHILD
TRANSMISSION | HIV PREVENTION | CONTRACEPTIVE USAGE
27
Family Planning: 2005 - 2008
| PREGNANCY, UNPLANNED | TREATMENT | AFRICA,
WESTERN | AFRICA SOUTH OF THE SAHARA | AFRICA |
DEVELOPING COUNTRIES | AFRICA, EASTERN | EVALUATION
INDEXES | QUANTITATIVE EVALUATION | EVALUATION |
STUDIES | RESEARCH METHODOLOGY | POPULATION
CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION
| PARENTS | FAMILY RELATIONSHIPS | FAMILY
CHARACTERISTICS | FAMILY AND HOUSEHOLD |
SOCIOCULTURAL FACTORS | DISEASE TRANSMISSION
CONTROL | PREVENTION AND CONTROL | DISEASES | HIV
INFECTIONS | VIRAL DISEASES | CONTRACEPTION | FAMILY
PLANNING | REPRODUCTIVE BEHAVIOR | FERTILITY |
POPULATION DYNAMICS | MEDICAL PROCEDURES |
MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE |
HEALTH
Document Number: 311449
Using strength of fertility motivations to identify family planning
program strategies.
Author:
Speizer IS
Source:
Department of Maternal and Child Health, University of North Carolina
School of Public Health, Chapel Hill, NC, USA. speizer@email.unc.edu
Abstract:
Context:
Use of unmet need for family planning to identify prospective clients may
misrepresent the actual family planning needs of a population, given that
a large proportion of women have ambivalent fertility desires.
Methods: Survey data for 1998 and 2003 from Burkina Faso, Ghana and
Kenya were used to examine the fertility desires and motivations of
women who said they wanted to delay or limit childbearing. A question
on how much of a problem it would be if women found out they were
pregnant in the next few weeks measured the strength of their fertility
motivations.
Results:
In Burkina Faso and Ghana, about a quarter of women who said they
wanted to delay or limit childbearing also reported that it would be no
problem or a small problem if they became pregnant soon. This response
pattern was equally common among contraceptive users and nonusers. In
Kenya, more than four in 10 women gave such ambivalent responses.
Among women with an unmet need for means of delaying or limiting
childbearing, 16-31% of those in Burkina Faso and Ghana, and 30-56% of
28
Family Planning: 2005 - 2008
those in Kenya, said that getting pregnant in the next few weeks would
be no problem or a small problem.
Conclusions:
It is critical to consider the strength of fertility motivations when
determining which women have family planning needs. Targeting
women who are the most motivated to avoid childbearing will likely
have the greatest impact on reducing unintended pregnancy in SubSaharan Africa.
Language:
English
Keywords:
|ADOLESCENT |ADULT |ATTITUDE TO HEALTH |BURKINA
FASO |CONTRACEPTION BEHAVIOR |PSYCHOLOGY |FAMILY
CHARACTERISTICS |FAMILY PLANNING
SERVICES|UTILIZATION |FEMALE |FERTILITY |GHANA
|HEALTH SURVEYS |HUMANS |KENYA |MOTIVATION
|NEEDS ASSESSMENT |PREGNANCY |PREGNANCY,
UNPLANNED/*PSYCHOLOGY
Document Number: 20070123
Women's educational attainment and intergenerational patterns of
fertility behaviour in Kenya.
Author:
Omariba DW
Source:
Offord Centre for Child Studies, McMaster University, Hamilton,
Ontario, Canada. - J Biosoc Sci. 2006 Jul;38(4):449-79
Abstract:
There is a strong theoretical and empirical relationship between
educational attainment and fertility behaviour. However, a fundamental
issue that has largely been neglected is the change in this relationship
across cohorts resulting from differential improvement in educational
opportunities for women over time and how it relates to fertility
transition. Utilizing the 1998 DHS data from Kenya this study examines
the differential effect of educational attainment on women's useof
modern contraception and desire for cessation of childbearing across
generations. The findings indicate that even after controlling for
husband's education and other relevant factors, a woman's advanced
education is positively associated with use of modern contraception.
However, support for a similar hypothesis on a woman's desire for family
limitation was only found among the youngest cohort of women. The
results suggest that for Kenya's incipient fertility transition to be
29
Family Planning: 2005 - 2008
sustained the government needs to continue efforts to improve female
education and support access to family planning among younger
women.
Language:
English
Keywords:
|Adolescent |Adult |Contraception/*statistics & numerical data/trends
|Educational Status |Family |Female |Health Surveys |Humans
|Intergenerational Relations |Kenya |Logistic Models |Male |Middle
Aged |Socioeconomic Factors
Document Number: 20060629
High uptake of postpartum hormonal contraception among HIV-1seropositive women in Kenya.
Author:
Balkus, J.; Bosire, R.; John-Stewart, G.; Mbori-Ngacha, D.; Schiff, M. A.;
Wamalwa, D.; Gichuhi, C.; Obimbo, E.; Wariua, G., and Farquhar, C.
Source:
Transm Dis. 2007 Jan; 34(1):25-9.
Abstract:
Objectives:
The objectives of this study were to determine patterns of contraceptive
utilization among sexually active HIV-1-seropositive women postpartum
and to identify correlates of hormonal contraception uptake.
Goal:
The goal of this study was to improve delivery of family planning
services to HIV-1-infected women in resource-limited settings.
Study design:
HIV-1-infected pregnant women were followed prospectively in a
perinatal HIV-1 transmission study. Participants were referred to local
clinics for contraceptive counseling and management.
Results:
Among 319 HIV-1-infected women, median time to sexual activity
postpartum was 2 months and 231 (72%) women used hormonal
contraception for at least 2 months during follow-up, initiating use at
approximately 3 months postpartum (range, 1-11 months). Overall, 101
(44%) used DMPA, 71 (31%) oral contraception, and 59 (25%) switched
methods during follow-up. Partner notification, infant mortality, and
condom use were similar between those using and not using
contraception.
30
Family Planning: 2005 - 2008
Conclusions:
Using existing the healthcare infrastructure, it is possible to achieve high
levels of postpartum hormonal contraceptive utilization among HIV-1seropositive women
Fertility intentions: are the undecided more like those who want
more or want no more children?
Author:
Becker, S. and Sutradhar, S. C.
Source:
J Biosoc Sci. 2007 Jan; 39(1):137-45.
Abstract:
In fertility surveys often women (and sometimes men) are asked their
fertility desires, i.e. whether they want a/no the birth or not. Some
respond that they are undecided. This study examines whether these
persons are more like those who say they want more births or like those
who say they want no more births. Data on married men and women in
29 Demographic and Health Surveys with sample sizes ranging from 300
to 3000 are used. A logistic regression equation is estimated within each
country for those with known desires and then used to classify each
person who was undecided. In all sub-Saharan African countries (n=20)
and for both sexes, 50% or more of the undecided persons are classified as
wanting more children (with one exception of wives in Kenya). By
contrast in all five Latin American countries for both sexes less than 50%
of the undecided were classified in the 'want more' group (with an
exception of husbands in the Dominican Republic). Generally, the
undecided tend to be classified the same as the majority among those in
the survey with stated desires.
Objectives:
To determine the usage of family planning services and safer sex
practices among HIV infected mothers who had gone through the
prevention of mother to child transmission (PMTCT) process.
Design:
Descriptive cross-sectional study.
Setting:
The maternal and child health and family planning (MCH-FP) clinics in
Kitale District Hospital, Western Kenya.
Results:
A total of 146 respondents were recruited for this study. Only 44% of the
respondents were using some form of family planning. The most popular
method of contraception was the hormonal injectable contraceptives.
Although 73% of respondents were no longer planning to have more
31
Family Planning: 2005 - 2008
babies, only 45% of them were using a family planning method. Only
38% of respondents reported condom use with their partners for safe sex.
Married women and those who had revealed their HIV status to their
partners were more likely to use condoms (p<0.05).
Conclusions:
Usage of family planning services in this studywas low. A large
percentage of the women were still planning to have more babies and
very few women were using condoms for safe sex. Women who had
informed their partners about their HIV status were more likely to use
condoms than those who had not. Male partner involvement is crucial in
decisions-pertaining to family planning use and safe sex practices.
Fertility in Kenya and Uganda: a comparative study of trends and
determinants.
Author:
Blacker, J.; Opiyo, C.; Jasseh, M.; Sloggett, A., and Ssekamatte-Ssebuliba,
J.
Source:
Popul Stud (Camb). 2005 Nov; 59(3):355-73.
Abstract:
Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent,
from some eight births per woman to around five. During the same
period, fertility in Uganda declined by less than 10 per cent. An analysis
of the proximate determinants shows that the difference was due
primarily to greater contraceptive use in Kenya, though in Uganda there
was also a reduction in pathological sterility. The Demographic and
Health Surveys show that women in Kenya wanted fewer children than
those in Uganda, but that in Uganda there was also a greater unmet need
for contraception. We suggest that these differences may be attributed, in
part at least, first, to the divergent paths of economic development
followed by the two countries after Independence; and, second, to the
Kenya Government's active promotion of family planning through the
health services, which the Uganda Government did not promote until
1995.
The causes of stalling fertility transitions.
Author:
Bongaarts, J.
Source:
Stud Fam Plann. 2006 Mar; 37(1):1-16.
Abstract:
An examination of fertility trends in countries with multiple DHS surveys
found that in the 1990s fertility stalled in midtransition in seven countries:
32
Family Planning: 2005 - 2008
Bangladesh, Colombia, Dominican Republic, Ghana, Kenya, Peru, and
Turkey. In each of these countries fertility was high (more than six births
per woman) in the 1950s and declined to fewer than five births per
woman in the early or mid-1990s, before stalling. The level of stalling
varied from 4.7 births per woman in Kenya to 2.5 births per woman in
Turkey. An analysis of trends in the determinants of fertility revealed a
systematic pattern of leveling off or near leveling in a number of
determinants, including contraceptive use, the demand for contraception,
and number of wanted births. The stalling countries did not experience
significant increases in unwanted births or in the unmet need for
contraception during the late 1990s, and program effort scores improved
slightly, except in the Dominican Republic. These findings suggest no
major deterioration in contraceptive access during the stall, but levels of
unmet need and unwanted births are relatively high, and improvements
in access to family planning methods would, therefore, be desirable. No
significant link was found between the presence of a stall and trends in
socioeconomic development, but at the onset of the stall the level of
fertility was low relative to the level of development in all but one of the
stalling countries
Changing fortunes: analysis of fluctuating policy space for family
planning in Kenya.
Author:
Crichton, J.
Source:
Health Policy Plan. 2008 Sep; 23(5):339-50.
Abstract:
Policies relating to contraceptive services (population, family planning
and reproductive health policies) often receive weak or fluctuating levels
of commitment from national policy elites in Southern countries, leading
to slow policy evolution and undermining implementation. This is true of
Kenya, despite the government's early progress in committing to
population and reproductive health policies, and its success in
implementing them during the 1980s. This key informant study on
family planning policy in Kenya found that policy space contracted, and
then began to expand, because of shifts in contextual factors, and because
of the actions of different actors. Policy space contracted during the mid1990s in the context of weakening prioritization of reproductive health in
national and international policy agendas, undermining access to
contraceptive services and contributing to the stalling of the country's
fertility rates. However, during the mid-2000s, champions of family
planning within the Kenyan Government bureaucracy played an
important role in expanding the policy space through both public and
hidden advocacy activities. The case study demonstrates that policy space
analysis can provide useful insights into the dynamics of routine policy
33
Family Planning: 2005 - 2008
and programme evolution and the challenge of sustaining support for
issues even after they have reached the policy agenda.
Contraceptive implants in Kenya: current status and future
prospects.
Author:
Hubacher, D.; Kimani, J.; Steiner, M. J.; Solomon, M., and Ndugga, M. B.
Source:
Contraception. 2007 Jun; 75(6):468-73.
Abstract:
Background:
Since introducing Norplant over 20 years ago in Kenya, demand for
contraceptive implants has remained high and implant costs are
dropping substantially.
Methods:
An assessment of the Kenyan experience with implants was conducted to
understand level of demand, capacity to provide services and
reproductive health impact of possible increased use. Interviews were
conducted with 35 key Kenyan informants. By modeling increases in
national implant use (at the expense of oral contraceptives), reductions in
the annual number of unintended pregnancies were estimated.
Results:
Kenya has an unmet need for implants and the current network of trained
providers appears ready to increase the volume of services. If 100,000
users of oral contraceptives switch to implants, then an estimated 26,000
unintended pregnancies can be averted over a 5-year period.
Conclusion:
With increased purchases of implants by international donor agencies,
Kenya can reduce reliance on short-term hormonal methods and reduce
the 45% prevalence rate of unintended pregnancy.
Acceptability of the diaphragm in Mombasa Kenya: A 6-month
prospective study.
Author:
Luchters, S.; Chersich, M. F.; Jao, I.; Schroth, A.; Chidagaya, S.;
Mandaliya, K., and Temmerman, M.
Source:
Eur J Contracept Reprod Health Care. 2007 Dec; 12(4):345-53
34
Family Planning: 2005 - 2008
Abstract:
Objectives:
If proven acceptable, safe and effective, the diaphragm could be used as a
female-controlled method of preventing both sexually-transmitted
infections (STIs) and pregnancy. This study's aim was to assess the
acceptability and safety of the diaphragm among sexually-active women
in Mombasa, Kenya.
Methods:
We conducted a 6-month prospective study among female sex workers
(FSWs), and women attending sexual and reproductive health services.
Diaphragm acceptability was assessed using continuation rates and
factors associated with acceptability. Safety evaluations included
colposcopy findings and incidence of urinary tract infections (UTIs) and
STIs.
Results:
Half the 185 participants were FSWs who had less schooling and were
less likely to be married than other women. After 6 months, 55% (56/102)
of sexually-active women reported having used the diaphragm each sex
act during the preceding month. Women liked using the diaphragm (95%,
104/109), and 96% (125/130) reported willingness to continue using it.
Colposcopy did not reveal significantly more vaginal or cervical lesions.
Use of the diaphragm was not associated with an increase in bacterial
vaginosis or UTIs. A pregnancy rate of 12 per 100 women/years was
observed.
Conclusion:
After 6 months of diaphragm use in this setting, continuation rates were
sustained, user satisfaction was high and adverse effects were few.
Sexual behavior, fertility desires and unmet need for family
planning among home-based care clients and caregivers in Kenya.
Author:
McCarraher, D.; Cuthbertson, C.; Kung'u, D.; Otterness, C.; Johnson, L.,
and Magiri, G.
Source:
AIDS Care. 2008 Oct; 20(9):1057-65.
Abstract:
As antiretroviral treatment becomes more available, community homebased care (CHBC) clients may begin to resume normal daily activities
including the resumption of sexual relationships. This study examines
sexual behavior, contraceptive use, unmet need for family planning and
attitudes toward pregnancy in the context of HIV among CHBC
participants (clients and caregivers), many of whom are HIV-positive or
at risk for HIV, of the COPHIA project in Kenya. The COPHIA project
was implemented by Pathfinder International with support from
35
Family Planning: 2005 - 2008
USAID/Kenya. We interviewed 171 CHBC clients and 183 CHBC
caregivers and conducted four focus groups with caregivers. Data were
collected from randomly selected COPHIA-affiliated CHBC programs in
Western Province and in Nairobi between September and November
2004. Forty-four percent of clients and 55% of caregivers had been
sexually active in the past six months. The reproductive health needs of
this population are complex; a significant percentage of study
participants have an unmet need for family planning and some desire
more children. A small proportion of study participants were pregnant
during the time of the interview. The majority of those who use
contraception reported relying solely on the male condom to prevent
pregnancy. While vital for HIV prevention and easily distributed by
CHBC programs, the male condom is not as effective as other methods in
preventing pregnancy. Community home-based care program
participants need counseling related to contraception, fertility desires and
pregnancy. The promotion of dual method use is crucial to this
population. Besides referring participants to family planning services,
CHBC programs need to consider how and if they can meet the family
planning and other reproductive health needs of their participants.
Identifying appropriate IUD candidates in areas with high
prevalence of sexually transmitted infections.
Author:
Morrison, C. S.; Murphy, L.; Kwok, C., and Weiner, D. H.
Source:
Contraception. 2007 Mar; 75(3):185-92
Abstract:
Background:
The IUD is a highly effective, safe, inexpensive and long-lasting
contraceptive. However, IUDs may increase PID risk during the early
post insertion period when inserted in women with cervical infections.
We developed a simple algorithm to identify women at low risk of
current sexually transmitted infection (STI) who are appropriate IUD
candidates in regions with moderate or high STI prevalence. Methods:
We used data sets from family planning populations in Kenya,
Zimbabwe, Jamaica and the United States to develop optimum
algorithms. We then validated these algorithms using data sets from
family planning populations in Thailand and Uganda.
Results:
A simple unweighted algorithm based on age, living with partner,
education, bleeding between periods and a behavioral risk score (number
of sex partners, condom use) was the most useful. Adding clinical signs
did not improve algorithm performance. Women categorized at low risk
by this algorithm were at substantially reduced risks of cervical infection.
Women identified at high STI risk had at least twice the risk as the overall
36
Family Planning: 2005 - 2008
clinic populations. Women in the moderate-risk group had STI risks
similar to the overall clinic populations.
Conclusion:
Women categorized as low risk by the algorithm can be referred for IUD
insertion while women categorized at high risk should not receive an
IUD without further testing or treatment. Women in the moderate-risk
group should be triaged based on the STI prevalence of the overall clinic
population. A simple checklist has been developed to help providers
estimate a client's risk of current STI and to guide appropriate triage.
Contraceptive use among HIV infected women attending
Comprehensive Care Centre.
Author:
Mutiso, S. M.; Kinuthia, J., and Qureshi, Z.
Source:
East Afr Med J. 2008 Apr; 85(4):171-7.
Abstract:
Objective:
To determine contraceptive use among HIV infected women attending
Comprehensive Care Centre at Kenyatta National Hospital. Design:
Hospital based cross-sectional descriptive study.
Setting:
Comprehensive Care Centre (CCC), Kenyatta National Hospital.
Subjects:
The study group was non-pregnant HIV positive women on follow up at
the CCC. A total of 94 HIV infected women were interviewed between
May 2006 and August 2006 through a pretested interviewer administered
questionnaire. Consecutive women willing to participate in the study
were interviewed.
Main outcome measures:
Current contraceptive use, contraceptive methods, source of
contraception, reproductive intention and unmet need of family
planning.
Results:
The mean age of the respondents was 34 years, 47.9% were married, all
had formal education and 74.6% were employed. Eighty six percent of
the respondents did not have reproduction intentions in the next two
years; however, only 44.2% of the respondents were using contraception.
Condoms were the most popular (81.5%) contraceptive method. Female
condom was used by 10.5% of the respondents. Norplant was the only
long-term contraceptive method and was used by only 2.6%. Dual
37
Family Planning: 2005 - 2008
method of contraception was practiced by 13.5% of the respondents.
Majority of the respondents obtained contraceptives from private sector
(42.9%) with less than 10% getting them from CCC. The unmet need for
family planning among the study group was 30%. Marital status and
regular sexual partner were significantly associated with contraceptive
use.
Conclusion:
Although majority of respondents did not have reproduction intentions
in the next two years, use of contraception was low with only 44% being
on a method. Use of long-term contraceptive methods was low among
respondents. Majority of the respondents obtained contraceptives away
from CCC. The unmet need for family planning was high at 30%.
Comparative acceptability of combined and progestin-only
injectable contraceptives in Kenya.
Author:
Ruminjo, J. K.; Sekadde-Kigondu, C. B.; Karanja, J. G.; Rivera, R.;
Nasution, M., and Nutley, T.
Source:
Contraception. 2005 Aug; 72(2):138-45.
Abstract:
Objective:
We compared 12-month continuation rates, menstrual bleeding patterns
and other aspects of acceptability between users of Cyclofem and users of
Depo-Provera.
Methods:
The life-table method was used to calculate quarterly continuation rates.
In all, 360 Kenyan women were randomly assigned to one of the two
contraceptives. User-satisfaction questionnaires were administered at 6
and 12 months or at discontinuation, whichever occurred first.
Results:
The 1-year continuation rate was 75.4% for Depo-Provera users versus
56.5% for Cyclofem users (p<.001). Main reasons for discontinuation
included difficulty making clinic visits (45.1% for Cyclofem vs. 40% for
Depo-Provera), menstrual changes (14.1% vs. 12.5%) and no menstrual
problems (15.5% vs. 12.5%). None of the Depo-Provera users and 8.5% of
the Cyclofem users claimed frequency of visits as the main reason for
discontinuation. In all, 70.6% of the Depo-Provera users were
amenorrheic after 12 months, as were 20.8% of the Cyclofem users.
Conclusions:
The 1-year continuation rate was higher for Depo-Provera than for
Cyclofem. There was no important difference in discontinuation rates
38
Family Planning: 2005 - 2008
because of menstrual problems; the difference mainly reflected the
frequency of visits required.
Modelling cost-effectiveness of different vasectomy methods in
India, Kenya, and Mexico.
Author:
Seamans, Y. and Harner-Jay, C. M
Source:
Cost Eff Resour allc. 2007; 5:8.
Abstract:
Background:
Vasectomy is generally considered a safe and effective method of
permanent contraception. The historical effectiveness of vasectomy has
been questioned by recent research results indicating that the most
commonly used method of vasectomy--simple ligation and excision (L
and E)--appears to have a relatively high failure rate, with reported
pregnancy rates as high as 4%. Updated methods such as fascial
interposition (FI) and thermal cautery can lower the rate of failure but
may require additional financial investments and may not be appropriate
for low-resource clinics. In order to better compare the cost-effectiveness
of these different vasectomy methods, we modelled the costs of different
vasectomy methods using cost data collected in India, Kenya, and Mexico
and effectiveness data from the latest published research.
Methods:
The costs associated with providing vasectomies were determined in each
country through interviews with clinic staff. Costs collected were
economic, direct, programme costs of fixed vasectomy services but did
not include large capital expenses or general recurrent costs for the health
care facility. Estimates of the time required to provide service were
gained through interviews and training costs were based on the total
costs of vasectomy training programmes in each country. Effectiveness
data were obtained from recent published studies and comparative costeffectiveness was determined using cost per couple years of protection
(CYP).
Results:
In each country, the labour to provide the vasectomy and follow-up
services accounts for the greatest portion of the overall cost. Because each
country almost exclusively used one vasectomy method at all of the
clinics included in the study, we modelled costs based on the additional
material, labour, and training costs required in each country. Using a
model of a robust vasectomy program, more effective methods such as FI
and thermal cautery reduce the cost per CYP of a vasectomy by $0.08$0.55.
39
Family Planning: 2005 - 2008
Conclusion:
Based on the results presented, more effective methods of vasectomy-including FI, thermal cautery, and thermal cautery combined with FI--are
more cost-effective than L and E alone. Analysis shows that for a
programme in which a minimum of 20 clients undergo vasectomies per
month, the cost per CYP is reduced in all three countries by updated
vasectomy methods.
Sex preparation and diaphragm acceptability in sex work in
Nairobi, Kenya.
Author:
Sharma, A.; Bukusi, E.; Posner, S.; Feldman, D.; Ngugi, E., and Cohen, C.
R.
Source:
Sex Health. 2006 Dec; 3(4):261-8.
Abstract:
Background:
Women in sex work stand to benefit if the contraceptive diaphragm alone
or combined with a microbicide proves to be an effective barrier method
against HIV and sexually transmissible infection (STI). Currently,
contraceptive diaphragm users are advised to leave the diaphragm in
situ without concomitant use of other intravaginal substances for at least
6 h after intercourse.
Methods:
We conducted in-depth interviews on sexual behaviour including postcoital intravaginal practices with 36 women in sex work and 26 of their
clients and held two focus-group discussions, each with 10 women.
Results:
The women described adapting several potentially harmful substances,
such as cloth and soapy water, for post-coital vaginal use to ensure
personal hygiene, disease prevention and client pleasure. Some wanted to
clean themselves and remove the diaphragm early, fearing exposure to
HIV infection for themselves and their subsequent clients. Clients
indicated their desire for 'dry sex', vaginal cleanliness and reduced risk of
infection through vaginal cleaning.
Conclusions: The diaphragm as a female-controlled barrier method for
HIV/STI prevention may have limited acceptability among women in sex
work if its effectiveness depends on a 6-h post-coital wait before removal,
along with avoidance of concomitant use of intravaginal substances. In
keeping with the beliefs of the female sex workers and their needs and
practices, alternative intravaginal substances and modes of insertion that
will not disrupt vaginal flora, injure vaginal epithelium, damage the
diaphragm or counteract potentially beneficial effects of microbicides are
40
Family Planning: 2005 - 2008
needed. The possibility of removing the diaphragm sooner than the
recommended 6 h for contraception should be further studied.
Using strength of fertility motivations to identify family planning
program strategies.
Author:
Speizer, I. S.
Source:
Int Fam Plan Perspect. 2006 Dec; 32(4):185-91.
Abstract:
Context:
Use of unmet need for family planning to identify prospective clients may
misrepresent the actual family planning needs of a population, given that
a large proportion of women have ambivalent fertility desires.
Methods:
Survey data for 1998 and 2003 from Burkina Faso, Ghana and Kenya were
used to examine the fertility desires and motivations of women who said
they wanted to delay or limit childbearing. A question on how much of a
problem it would be if women found out they were pregnant in the next
few weeks measured the strength of their fertility motivations.
Results:
In Burkina Faso and Ghana, about a quarter of women who said they
wanted to delay or limit childbearing also reported that it would be no
problem or a small problem if they became pregnant soon. This response
pattern was equally common among contraceptive users and nonusers. In
Kenya, more than four in 10 women gave such ambivalent responses.
Among women with an unmet need for means of delaying or limiting
childbearing, 16-31% of those in Burkina Faso and Ghana, and 30-56% of
those in Kenya, said that getting pregnant in the next few weeks would
be no problem or a small problem.
Conclusions:
It is critical to consider the strength of fertility motivations when
determining which women have family planning needs. Targeting
women who are the most motivated to avoid childbearing will likely
have the greatest impact on reducing unintended pregnancy in SubSaharan Africa.
41
Family Planning: 2005 - 2008
Improving adherence to family planning guidelines in Kenya
Author:
Stanback, J.; Griffey, S.; Lynam, P.; Ruto, C., and Cummings, S.
Source:
An experiment. Int J Qual Health Care. 2007 Apr; 19: (2):68-73.
Abstract:
Quality problem:
Research in Kenya in the mid-1990s suggested poor quality family
planning services and limited access to services. Clinical guidelines for
family planning and reproductive health were published in 1991 and
updated in 1997, but never widely distributed.
Choice of Solution:
Managers and trainers chose intensive, district-level training workshops
to disseminate guidelines and update health workers on guideline
content and best practices.
Intervention: Training workshops were held in 41 districts in 1999.
Trainees were instructed to update their untrained co-workers
afterwards. As a reinforcement, providers in randomly selected areas
received a 'cascade training package' of instructional materials and
training tips. Providers in 15 randomly selected clinics also received
'supportive supervision' visits as a second reinforcement.
Evaluation methodology:
A cluster-randomized experiment in 72 clinics assessed the overall impact
of the training and the marginal benefits of the two reinforcing activities.
Researchers and trainers created several dozen indicators of provider
knowledge, attitudes, beliefs and practices. Binomial and multivariate
analyses were used to compare changes over time in indicators and in
aggregated summary scores. Data from patient interviews were analysed
to corroborate provider practice self-reports. Cost data were collected for
an economic evaluation.
Results:
Post-test data collected in 2000 showed that quality of care and access
increased after the intervention. The cascade training package showed
less impact than supportive supervision, but the former was more costeffective.
Lessons learned:
Service delivery guidelines, when properly disseminated, can improve
family planning practices in sub-Saharan Africa
42
Family Planning: 2005 - 2008
Does assessment of signs and symptoms add to the predictive
value of an algorithm to rule out pregnancy?
Author:
Stanback, J.; Nakintu, N.; Qureshi, Z., and Nasution, M.
Source:
J Fam Plann Reprod Health Care. 2006 Jan; 32(1):27-9.
Abstract:
Background:
A World Health Organization-endorsed algorithm, widely published in
international guidance documents and distributed in the form of a
'pregnancy checklist', has become a popular tool for ruling out pregnancy
among family planning clients in developing countries. The algorithm
consists of six criteria excluding pregnancy, all conditional upon a
seventh 'master criterion' relating to signs or symptoms of pregnancy.
Few data exist on the specificity to pregnancy among family planning
clients of long-accepted signs and symptoms of pregnancy. The aim of the
present study was to assess whether reported signs and symptoms of
pregnancy add to the predictive value of an algorithm to rule out
pregnancy.
Methods:
Data from a previous observational study were used to assess the
performance of the algorithm with and without the 'signs and symptoms'
criterion. The study group comprised 1852 new, non-menstruating family
planning clients from seven clinics in Kenya.
Results:
Signs and symptoms of pregnancy were rare (1.5%) as was pregnancy
(1%). Signs and symptoms were more common (18.2%) among the 22
clients who tested positive for pregnancy than among the 1830 clients
(1.3%) who tested negative, but did not add significantly to the
predictive value of the algorithm. Most women with signs or symptoms
were not pregnant and would have been unnecessarily denied a
contraceptive method using the current criteria.
Conclusions:
The 'signs and symptoms' criterion did not substantially improve the
ability of the algorithm to exclude pregnant clients, but several reasons
(including use of the algorithm for intrauterine device clients) render it
unlikely that the algorithm will be changed.
43
Family Planning: 2005 - 2008
Period and cohort dynamics in fertility norms at the onset of the
demographic transition in Kenya 1978-1998.
Author:
White, R. G.; Hall, C., and Wolff, B.
Source:
J Biosoc Sci. 2007 May; 39(3):443-54.
Abstract:
A characteristic of African pre-transitional fertility regimes is large ideal
family size. This has been used to support claims of cultural
entrenchment of high fertility. Yet in Kenya fertility rates have fallen. In
this paper this fall is explored in relation to trends in fertility norms and
attitudes using four sequential cross-sectional surveys spanning the
fertility transition in Kenya (1978, 1984, 1989 and 1998). The most rapid
fall in the reported ideal family size occurred between 1984 and 1989,
whilst the most rapid fall in the total fertility rate occurred 5 to 10 years
later, between 1989 and 1998. Thus these data, spanning the fertility
transition in Kenya, support the traditional demographic model that
demand for fertility limitation drives fertility decline. These data also
suggest that the decline in fertility norms over time was partly a period
effect, as the reported ideal family size was seen to fall simultaneously in
all age cohorts, and partly a cohort effect, as older age cohorts reporting
higher ideal family sizes were replaced by younger cohorts reporting
lower ideal family sizes. These data also suggest that a new fertility norm
of four children may have developed by 1989 and continued until 1998.
This is consistent with, and perhaps could have been used to predict, the
stall in the Kenyan fertility decline after 1998.
A closer look at KDHS 2003: Further analysis of the contraceptive
prevalence and fertility stalls.
Source:
KDHS 2003: Summaries of selected NCAPD Working Papers 2005.
Abstract:
While contraceptive use has risen impressively in many countries over
the past two to three decades, there have been occasional periods of
stalling, raising serious concerns about the effectiveness of national
family planning programmes. The stalls have been caused by, among
others, a narrow choice of family planning methods, lack of focus or other
weaknesses in reproductive health programmes, and difficulty in coping
with the rapid increases in the population of reproductive age. Kenya has
had an impressive record of success in providing family planning
services in the past. This success yielded substantial declines in the total
fertility rate from the late 1970s to the early 1990s. Recent trends in both
contraceptive prevalence and total fertility rates are less impressive,
however, as determined by the findings of the 2003 Kenya Demographic
and Health Survey. These new trends have raised concerns among
44
Family Planning: 2005 - 2008
Government of Kenya policy makers as well as family planning
programme managers. (excerpt)
Evaluating the integration of family planning and voluntary
counseling and testing in Kenya.
Source:
Family Health International (FHI)
Abstract:
Operations research by Family Health International (FHI) and partners to
evaluate the integration of family planning into voluntary counseling and
testing (VCT) in Kenya suggests that it is feasible and acceptable. The
intervention in 14 VCT centers improved several aspects of family
planning provision without compromising VCT services. However,
although a large proportion of VCT clients were considered at risk of
unintended pregnancy, the intervention had little effect on contraceptive
method choice or distribution. Advocacy and training activities should
stress the importance of screening VCT clients for risk of unintended
pregnancy with the goal of reducing unmet contraceptive need. VCT
quality of care and contraceptive method choice, distribution, and uptake
should continue to be monitored. (author's)
Expanding access to injectable contraception.
Abstract:
Demand for family planning in many countries across sub-Saharan Africa
continues to steadily rise, but unmet need for contraception remains high,
especially in rural areas. Health programs working to meet this
contraceptive need have found that the injectable contraceptive depotmedroxyprogesterone acetate (DMPA or Depo-Provera) is a popular
choice among women for many reasons, including its safety,
effectiveness, ease of use, privacy, and convenience. However, many
women cannot access clinics where DMPA is typically provided.
Experience from Africa, Asia, and Latin America shows that women's
desire for access to DMPA can be addressed by offering DMPA through
community-based distribution (CBD) programs. Yet, this approach is
underutilized in Africa. For example, while both Kenya and Uganda have
large rural populations, low modern contraceptive method prevalence
and high unmet need for family planning services, CBD and other
outreach programs provide only 0.5 percent and 0.8 percent, respectively,
of injectable contraceptives. (excerpt)
45
Family Planning: 2005 - 2008
Family planning in the era of HIV / AIDS: more important than
ever.
Abstract:
The AIDS epidemic is challenging health care systems in the developing
world. Many facilities are overcrowded, and the rising cost of providing
treatment is forcing health systems to reduce spending for other crucial
health interventions, including family planning. Family planning remains
an important health intervention. Family planning programs are
necessary in the ongoing effort to improve overall health and the lives of
women and children in the developing world. Each year, pregnancyrelated deaths claim the lives of half a million women, and 11 million
children die from causes associated with their mother's pregnancy or
from birth-related risks. Family planning programs could prevent onequarter of these infant and maternal deaths. Family planning can be
integral in mitigating the impact of AIDS. Family planning can help
achieve HIV prevention goals and improve maternal and child health
outcomes. Likewise, HIV services can help expand access to family
planning services. Family planning and HIV/AIDS programs often serve
similar populations, particularly in countries with generalized HIV
epidemics driven by heterosexual transmission. When programs and
services meet multiple client needs, satisfaction with the health system
increases and scarce financial and human resources are better utilized.
(excerpt)
Fertility and family planning in the 2003 Kenya DHS.
Source:
2003 Kenya Demographic and Health Survey (KDHS)
Abstract:
According to the 2003 Kenya Demographic and Health Survey (KDHS),
Kenyan women have about 5 children, on average. This rate has not
changed much in the last 15 years. Many women wish to delay or end
childbearing, yet only 39 percent of currently married women is using a
modern contraceptive method. The KDHS also collects information on
other determinants of fertility, including birth intervals, women's age at
first birth and teenage childbearing. Almost all married women in Kenya
know about at least one modern method of contraception, but only 39
percent currently use a modern method. (excerpt)
46
Family Planning: 2005 - 2008
Studies in Family Planning.
Source:
2003: results from the Demographic and Health Survey. 2005 Jun;
36(2):163-167.
Abstract:
The Kenya Demographic and Health Survey 2003 (KDHS) was conducted
by the Central Bureau of Statistics and the Ministry of Health, with
technical assistance from the MEASURE/DHS Program of ORC Macro.
Data for the nationally representative KDHS were collected from 8,561
households, and complete interviews were conducted with 8,195 women
aged 15–49 and 3,578 men aged 15– 54. The fieldwork took place between
18 April and 15 September 2003. The summary statistics presented below
were taken from the Kenya country report, with exceptions as noted.
(excerpt)
Addressing the family planning needs of HIV-positive PMTCT
clients.
Author:
Baek C and Rutenberg, N
Abstract:
Preventing unintended pregnancy among HIV-positive women is an
effective approach to reducing pediatric HIV infection and vital to
meeting HIV-positive women’s sexual and reproductive health needs
(WHO 2002, 2004; UNFPA 2004). Although contraceptive services for
HIV-positive women is one of the four cornerstones of a comprehensive
program for prevention of mother-to-child transmission of HIV (PMTCT),
a review of PMTCT programs found that implementers have not
prioritized family planning. While there is increasing awareness about
the importance of family planning and HIV integration, data about family
planning from PMTCT clients are lacking. The Horizons Program, in
collaboration with International Medical Corps (IMC) and Steadman
Research Services International (SRSI), is conducting an operations
research study testing several community-based strategies to reduce
mother-to-child transmission of HIV in a densely settled urban slum area
in Nairobi, Kenya. The strategies being piloted by IMC include moving
PMTCT services closer to the population via a mobile clinic, and
increasing psychosocial support for HIV-positive women through the use
of traditional birth attendants and peer counselors. Peer counselors are
HIV-positive women who have already received PMTCT services. The
effectiveness of each of these strategies on women’s utilization of key
PMTCT services, including family planning, will be measured by
comparing baseline to follow-up data. This research update presents key
findings about family planning at PMTCT sites, including the interaction
between providers and clients as well as HIV-positive women’s fertility
47
Family Planning: 2005 - 2008
desires and demand for contraceptives, from the baseline cross-sectional
survey and qualitative interviews with postpartum women. (excerpt)
Hormonal contraceptive use, herpes simplex virus infection, and
risk of HIV-1 acquisition among Kenyan women.
Author:
Baeten, J. M.; Benki, S.; Chohan, V.; Lavreys, L.; McClelland, R. S.;
Mandaliya, K.; Ndinya-Achola, J. O.; Jaoko, W., and Overbaugh, J.
Source:
AIDS. 2007 Aug 20; 21(13):1771-7.
Abstract:
Background:
Studies of the effect of hormonal contraceptive use on the risk of HIV-1
acquisition have generated conflicting results. A recent study from
Uganda and Zimbabwe found that women using hormonal
contraception were at increased risk for HIV-1 if they were seronegative
for herpes simplex virus type 2 (HSV-2), but not if they were HSV-2
seropositive.
Objective:
To explore the effect of HSV-2 infection on the relationship between
hormonal contraception and HIV-1 in a high-risk population. Hormonal
contraception has previously been associated with increased HIV-1 risk
in this population.
Methods:
Data were from a prospective cohort study of 1206 HIV-1 seronegative
sex workers from Mombasa, Kenya who were followed monthly.
Multivariate Cox proportional hazards analyses were used to adjust for
demographic and behavioral measures and incident sexually transmitted
diseases.
Results:
Two hundred and thirty-three women acquired HIV-1 (8.7/100 personyears). HSV-2 prevalence (81%) and incidence (25.4/100 person-years)
were high. In multivariate analysis, including adjustment for HSV-2,
HIV-1 acquisition was associated with use of oral contraceptive pills
[adjusted hazard ratio (HR), 1.46; 95% confidence interval (CI), 1.00-2.13]
and depot medroxyprogesterone acetate (adjusted HR, 1.73; 95% CI, 1.282.34). The effect of contraception on HIV-1 susceptibility did not differ
significantly between HSV-2 seronegative versus seropositive women.
HSV-2 infection was associated with elevated HIV-1 risk (adjusted HR,
3.58; 95% CI, 1.64-7.82).
48
Family Planning: 2005 - 2008
Conclusions:
In this group of high-risk African women, hormonal contraception and
HSV-2 infection were both associated with increased risk for HIV-1
acquisition. HIV-1 risk associated with hormonal contraceptive use was
not related to HSV-2 serostatus.
Family planning and safer sex practices among HIV infected
women receiving prevention of mother-to-child transmission
services at Kitale District Hospital.
Author:
Bii, S. C.; Otieno-Nyunya, B.; Siika, A., and Rotich, J. K.
Source:
East Afr Med J. 2008 Jan; 85(1):46-50.
Abstract:
Objectives:
To determine the usage of family planning services and safer sex
practices among HIV infected mothers who had gone through the
prevention of mother to child transmission (PMTCT) process.
Design:
Descriptive cross-sectional study.
Setting:
The maternal and child health and family planning (MCH-FP) clinics in
Kitale District Hospital, Western Kenya.
Results:
A total of 146 respondents were recruited for this study. Only 44% of the
respondents were using some form of family planning. The most popular
method of contraception was the hormonal injectable contraceptives.
Although 73% of respondents were no longer planning to have more
babies, only 45% of them were using a family planning method. Only
38% of respondents reported condom use with their partners for safe sex.
Married women and those who had revealed their HIV status to their
partners were more likely to use condoms (p<0.05).
Conclusions:
Usage of family planning services in this studywas low. A large
percentage of the women were still planning to have more babies and
very few women were using condoms for safe sex. Women who had
informed their partners about their HIV status were more likely to use
condoms than those who had not. Male partner involvement is crucial in
decisions-pertaining to family planning use and safe sex practices.
49
Family Planning: 2005 - 2008
Fertility in Kenya and Uganda: a comparative study of trends and
determinants.
Author:
Blacker, J.; Opiyo, C.; Jasseh, M.; Sloggett, A., and Ssekamatte-Ssebuliba,
J.
Source:
Popul Stud (Camb). 2005 Nov; 59(3):355-73.
Abstract:
Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent,
from some eight births per woman to around five. During the same
period, fertility in Uganda declined by less than 10 per cent. An analysis
of the proximate determinants shows that the difference was due
primarily to greater contraceptive use in Kenya, though in Uganda there
was also a reduction in pathological sterility. The Demographic and
Health Surveys show that women in Kenya wanted fewer children than
those in Uganda, but that in Uganda there was also a greater unmet need
for contraception. We suggest that these differences may be attributed, in
part at least, first, to the divergent paths of economic development
followed by the two countries after Independence; and, second, to the
Kenya Government's active promotion of family planning through the
health services, which the Uganda Government did not promote until
1995.
When ancient meets modern: the relationship between postpartum
non-susceptibility and contraception in sub-Saharan Africa.
Author:
Brown, M.
Source:
J Biosoc Sci. 2007 Jul; 39(4):493-515.
Abstract:
Extended durations of postpartum non-susceptibility (PPNS) comprising
lactational amenorrhoea and associated taboos on sex have been a central
component of traditional reproductive regimes in sub-Saharan Africa. In
situations of rising contraceptive prevalence this paper draws on data
from the Demographic Health Surveys to consider the neglected interface
between ancient and modern methods of regulation. The analysis reports
striking contrasts between countries. At one extreme a woman's natural
susceptibility status appears to have little bearing on the decision to use
contraception in Zimbabwe, with widespread 'double-protection'. By
contrast, contraceptive use in Kenya and Ghana builds directly onto
underlying patterns of PPNS. Possible explanations for the differences
and the implications for theory and policy are discussed.
50
Family Planning: 2005 - 2008
Community-based family planning in Kenya: meeting new
challenges.
Author:
Casey L; Onduso P; Omuodo D, and Wilder, J.
Abstract:
Although Kenya has been touted as one of Africa’s family planning
successes, with a relatively high contraceptive prevalence rate of 39% and
a long history of making services available, there is still significant unmet
need for family planning services. Poor access to family planning services
is a major constraint to contraceptive use in large parts of the country,
particularly in Coast, Nyanza and Rift Valley provinces, the sites of
Pathfinder’s ongoing efforts to support FP programs in Kenya. Delays
and setbacks are endemic in the implementation of a new contraceptive
logistics system and new decentralization policies. Attempts to reform the
government package of free health services will most certainly encounter
obstacles. In this context, the unmet need for FP is difficult, if not
impossible to address, without significant NGO and private sector
involvement. The situation is made still more complex by strong
community demands for HIV/AIDS information and services, which
calls for maximizing resources and expertise by integrating efforts at both
the community and clinic level. (excerpt)
Fortunes: analysis of fluctuating policy space for family planning
in Kenya.
Author:
Crichton, J. Changing fortunes: analysis of fluctuating policy space for
family planning in Kenya.
Source:
Health Policy Plan. 2008 Sep; 23(5):339-50.
Abstract:
Policies relating to contraceptive services (population, family planning
and reproductive health policies) often receive weak or fluctuating levels
of commitment from national policy elites in Southern countries, leading
to slow policy evolution and undermining implementation. This is true of
Kenya, despite the government's early progress in committing to
population and reproductive health policies, and its success in
implementing them during the 1980s. This key informant study on
family planning policy in Kenya found that policy space contracted, and
then began to expand, because of shifts in contextual factors, and because
of the actions of different actors. Policy space contracted during the mid1990s in the context of weakening prioritization of reproductive health in
national and international policy agendas, undermining access to
contraceptive services and contributing to the stalling of the country's
fertility rates. However, during the mid-2000s, champions of family
planning within the Kenyan Government bureaucracy played an
51
Family Planning: 2005 - 2008
important role in expanding the policy space through both public and
hidden advocacy activities. The case study demonstrates that policy space
analysis can provide useful insights into the dynamics of routine policy
and program evolution and the challenge of sustaining support for issues
even after they have reached the policy agenda.
Integrating family planning into HIV voluntary counseling and
testing services in Kenya: progress to date and lessons learned.
Author:
Fischer, S.
Abstract:
In Kenya, as in most countries, family planning services and HIV
voluntary counseling and testing (VCT) services have traditionally been
offered separately. However, health policy-makers have begun to
recognize the opportunities missed and efficiencies lost in this parallel
approach. Family planning plays an important role in HIV/AIDS
prevention, and VCT can reach clients who do not typically seek out
family planning services as well as HIV-positive women who wish to
prevent unintended pregnancy. Integration of services may also help to
once again focus attention on family planning. In recent years there have
been dramatic increases in HIV funding and programming, while
funding for family planning programs has remained stable, despite
increasing numbers of women of reproductive age and a substantial
unmet need for contraception. It was within this context that Family
Health International (FHI), with funding from the U.S. Agency for
International Development (USAID), undertook a study on the feasibility
of integrating family planning into VCT services in Kenya. When the
results proved generally positive, the Kenyan Ministry of Health (MOH)
charged FHI and other partners with determining the best way to
implement integration in VCT centers across the country. This report
documents the process of assessing the feasibility of integration, bringing
together stakeholders, developing an integration strategy, and
implementing that strategy. It summarizes successes, challenges, and
lessons learned at each step of the process. The document is not intended
to provide exhaustive detail, but rather to highlight key steps and
milestones. (excerpt)
Postabortion family planning benefits clients and providers.
Author:
Foreit, J. R. Postabortion family planning benefits clients and providers.
Abstract:
A woman’s fertility can return quickly after an abortion or miscarriage-as soon as two weeks after (Bongaarts 1983). Yet recent data show high
levels of unmet need for family planning among women who have been
52
Family Planning: 2005 - 2008
treated for incomplete abortion. This leaves many women at risk of
another unintended pregnancy and in some cases subsequent repeated
abortions and abortion-related complications (Savelieva et al. 2002). Thus
it is vital for programs to provide a comprehensive package of
postabortion care (PAC) services that includes medical treatment; family
planning counseling and other reproductive health services such as
sexually transmitted infection (STI) evaluation and treatment, HIV
counseling and possibility testing; and community support and
mobilization. Facilities that can effectively treat women with incomplete
abortions can also provide contraceptive services, including counseling
and appropriate methods. Appropriate pre-discharge contraception can
be provided in conjunction with all emergency procedures including
inpatient and outpatient dilation and curettage (D&C) and manual or
electric vacuum aspiration. Any provider who can treat incomplete
abortion can also provide most family planning methods. (excerpt)
[Comment on "Hormonal contraception and HIV prevalence in four
African countries"] [letter].
Author:
Gisselquist, D
Source:
Contraception. 2008 Oct; 78(4):346
Abstract:
To the Editor:
In a recent article, Leclerc et al. use data from the Demographic and
Health Surveys in four African countries to estimate an adjusted relative
risk of 1.28 for prevalent HIV infection in young women aged 15-24 years
associated with ever-use of depo-medroxyprogesterone acetate (DMPA).
Considering that 22% of young women had used DMPA, they calculate
that DMPA was responsible for 6% of HIV infections in young women
and conclude that "[t]he small effect of DMPA in the general population
is reassuring." I am not reassured. When we consider veterinary
medicine, we can focus on the herd. But DMPA is offered to individual
women. In many communities throughout Southern and East Africa, 1530% of women aged 24 years are HIV positive. If Leclerc et al. are correct,
ever-use of DMPA would be responsible for HIV infections in roughly 48% of users (calculating that 22% of women have used DMPA, and that
use increases HIV prevalence by 1.28 times). Health care professionals are
obligated to giveclients accurate information about risks. On the basis of
Leclerc et al. analyses, governments in East and Southern Africa should
mandate that family planning programs warn women that DMPA use
increases their risk for HIV infection. And donors should reconsider their
support for DMPA in communities with generalized HIV epidemics. (To
put this situation in perspective, consider what European governments
would do if studies showed that a health intervention killed 4-8% of
women accepting the intervention.) These cautions could be reversed if
53
Family Planning: 2005 - 2008
and when further research shows that DMPA use is not a risk for HIV
infection. It may be, for example, that the association that has often been
observed between HIV infection and DMPA use in Africa and Asia has
been due to unsafe injections delivering DMPA rather than to any
biological effect of DMPA. That possibility should be investigated. A
study in Tanzania identified DMPA injections as a risk for hepatitis C
infections. Reuse of syringes and/or needles without sterilization has
been common in Africa and parts of Asia. Unfortunately, Leclerc et al. did
not consider unsafe injections. If future research finds that unsafe
injections are the link between HIV and DMPA use, then it is an easy
matter to break that link by ensuring exclusive use of prefilled syringes or
single-dose vials and new disposable syringes. (full text)
Family planning in Kenya in the 1960s and 1970s.
Author:
Heisel, D. F. 393-417
Abstract:
In the 1960s, motivated by a desire to lower the rate of natural population
increase, Kenya became the first nation in Sub-Saharan Africa to formally
adopt a national family planning program. Yet more than 10 years after
the adoption of its policy, Kenya was reporting the highest total fertility
rate in the world, eight births per woman, resulting in a population
growth rate of around 4 percent per year. After a decade of experience
with a family planning program that the international donor community
supported relatively well, but that was universally described as weak and
ineffectual, fertility began to decline. A few years later, the family
planning program improved and enjoyed support at the highest political
levels in the Kenyan government and among the international donor
community. By the end of the century, the total fertility rate had fallen
between 35 and 40 percent to about five births per women. The fertility
transition was clearly under way. (excerpt)
Trends in contraceptive use in Kenya, 1989 -- 1998: The role of
socio-economic, cultural and family planning factors.
Author:
Kimani, M.
Source:
African Population Studies. 2006; 21(2):[23] p.
Abstract:
This paper uses the 1989 and 1998 KDHS data sets to examine the role of
socioeconomic, cultural and family planning factors in explaining the
observed increase in contraceptive use in Kenya during the 1989-1998
period. The key finding of the study is that the increase in the use of
modern methods of contraception during this period was not due to the
54
Family Planning: 2005 - 2008
socio-economic changes or the improved family planning environment
which occurred during the period, but was rather due to the increased
use of contraceptives among those who approved family planning and
those who had not experienced an infant/child death. The main
conclusion drawn from these findings is that studies focusing on
explaining the trends in contraceptive use should take into account the
changing patterns of association between the various factors on one hand
and contraceptive use on the other. (author's)
Family size, economics and child gender preference: a case study in
the Nyeri district of Kenya.
Author:
Kiriti, T. W. and . = Tisdell C.
Source:
International Journal of Social Economics. 2005; 32(6):492-509.
Abstract:
Purpose:
The objective is to determine the influence of economic and
social/cultural factors on family size and child gender preferences in
rural Kenya and to draw public policy implications from the results. This
is an important matter because the fertility rate in Kenya is high; higher
than in most developing countries. It is especially high in rural areas. This
may be an impediment to Kenya’s development.
Design/methodology/approach:
First relevant economic literature is reviewed to identify factors that
economists and others claim are important influences on family size.
Then follows a case study of families in the Nyeri district of Kenya. Data
are obtained from a random sample of households in this district using a
semi-structured questionnaire in direct interviews. The survey results are
summarised and then analysed using Tobit analysis and least squares
regression. Findings – Both economic and social/cultural factors are
found to be important influences on family size. For example, preference
for male children has an important positive influence on family size in the
Nyeri district. Women are found to prefer male offspring to daughters,
possibly because they are afraid of being disinherited if they do not
produce a male heir for their husbands. Research
limitations/implications – Support for the conclusions reached could be
strengthened or further assessed by increasing the sample size in the
Nyeri district and be conducting similar surveys in other rural districts of
Kenya.
Practical implications:
Introducing social security systems in Kenya to assist the elderly and the
infirm would reduce the need for Kenyan women to have many children
as security and women should be granted greater inheritance rights,
55
Family Planning: 2005 - 2008
especially to land. Furthermore, education of women should be promoted
as a way to reduce family size.
Originality/value:
This paper reinforces the view that both economic and social/cultural
factors must be considered simultaneously when examining determinants
of the number of children in a family and child gender preference.
(author's)
Factors influencing couples' unmet need for contraception in
Kenya.
Author:
Omwago, M. O. and . = Khasakhala AA.
Source:
African Population Studies. 5642006; 21(2):[25] p.
Abstract:
Many studies on unmet need have been women-based with some passing
inferences made for men and couples yet reproductive decisions are not
made by women alone, but are dyadic in nature. This paper examines
couple's unmet need for contraception in Kenya by using the married
couple as the unit of analysis, rather than the individual man or woman.
The paper specifically estimates couple's unmet need and identifies
factors that have influenced this. The data used is from the matched
couple data derived from the Kenya Demographic and Health Survey,
1998 (KDHS). Only fecund couples in monogamous unions are included
in the analysis. The results give the total couple's unmet need of 16.5
percent (which is 7.5 percent lower than the level of unmet need for
currently married women and 3.7 percent higher than the Bankole-Ezeh
estimate of couples' unmet need, using 1993 KDHS). About 7 percent of
this accounted for unmet need for limiting while 9.8 percent accounted
for unmet need for spacing. In terms of factors influencing couple's
unmet needs, region of residence, ethnicity, number of living children
and couples' discussion of and other reproductive health issues, were the
most significant predictors of couples' unmet need. In order to reduce the
unmet need, region specific programs should be emphasized and that
couple's should be encouraged to make joint decisions on reproductive
health issues. (author's)
56
Family Planning: 2005 - 2008
Feasibility of recruitment for an efficacy trial of emergency
contraceptive pills.
Author:
Raymond, E. G.; Liku, J., and Schwarz, E. B.
Source:
Contraception. 2008 Feb; 77(2):118-21.
Abstract:
Background:
The efficacy of emergency contraceptive pills (ECPs) is currently
uncertain. The best way to obtain a robust efficacy estimate would be to
conduct a placebo-controlled randomized trial. We aimed to assess the
feasibility of identifying women eligible for such a trial.
Study design:
We conducted a survey of women aged 18-35 years in five sexually
transmitted disease clinics and urgent care centers in Kenya and the
United States in 2006.
Results:
Of 177 women surveyed, only 10 (6%) reported no reasons for exclusion
from a potential efficacy trial. Of the rest, 149 (83%) had not recently had
sex that conferred a substantial risk of pregnancy. At all sites combined,
the rate of identification of potentially eligible women was 0.6 per day of
interviewing.
Conclusion:
A placebo-controlled efficacy trial of ECPs would likely require several
thousand participants. Recruitment for such a trial in these types of sites
would be prolonged.
Integrating family planning services into voluntary counseling and
testing centers in Kenya. Operations research results.
Author:
Reynolds, H. W. = Liku J; Beaston-Blaakman A; Kimani J, and Burke H.
Abstract:
Current investments by the international HIV/AIDS sector to expand
health services offer unprecedented opportunities to reinforce health care
infrastructures. Strengthened reproductive health services, and
contraceptive services in particular, are imperative, since their benefits
are highly complementary to and synergistic with HIV/AIDS control
objectives. Evidence is accumulating that contraception is a potentially
powerful and cost-effective HIV prevention strategy, enabling HIVinfected women to prevent undesired pregnancies, thereby averting
mother-to-child HIV transmission. One strategy for extending the
benefits of contraceptive services to people affected by HIV is to integrate
57
Family Planning: 2005 - 2008
these services into HIV/AIDS services. Contraceptive services are
integral components of HIV services, as opposed to mere complements,
since they lead to the same outcome, namely a decrease in HIV infections.
For both individuals who are HIV infected and those who are not,
contraception offers a variety of established benefits to the mother, her
family, and her community. (excerpt)
Comparative acceptability of combined and progestin-only
injectable contraceptives in Kenya.
Author:
Ruminjo, J. K.; Sekadde-Kigondu, C. B.; Karanja, J. G.; Rivera, R.;
Nasution, M., and Nutley, T.
Source:
Contraception. 2005 Aug; 72(2):138-45.
Abstract:
Objective:
We compared 12-month continuation rates, menstrual bleeding patterns
and other aspects of acceptability between users of Cyclofem and users of
Depo-Provera.
Methods:
The life-table method was used to calculate quarterly continuation rates.
In all, 360 Kenyan women were randomly assigned to one of the two
contraceptives. User-satisfaction questionnaires were administered at 6
and 12 months or at discontinuation, whichever occurred first.
Results:
The 1-year continuation rate was 75.4% for Depo-Provera users versus
56.5% for Cyclofem users (p<.001). Main reasons for discontinuation
included difficulty making clinic visits (45.1% for Cyclofem vs. 40% for
Depo-Provera), menstrual changes (14.1% vs. 12.5%) and no menstrual
problems (15.5% vs. 12.5%). None of the Depo-Provera users and 8.5% of
the Cyclofem users claimed frequency of visits as the main reason for
discontinuation. In all, 70.6% of the Depo-Provera users were
amenorrheic after 12 months, as were 20.8% of the Cyclofem users.
Conclusions:
The 1-year continuation rate was higher for Depo-Provera than for
Cyclofem. There was no important difference in discontinuation rates
because of menstrual problems; the difference mainly reflected the
frequency of visits required.
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Family Planning: 2005 - 2008
Field experiences integrating family planning into programs to
prevent mother-to-child transmission of HIV.
Author:
Rutenberg, N. and Baek, C
Source:
Stud Fam Plann. 2005 Sep; 36(3):235-45.
Abstract:
This article reviews field experiences with provision of family planning
services in prevention of mother-to-child transmission (PMTCT)
programs in ten countries in Africa, Asia, and Latin America. Family
planning is a standard component of most antenatal care and maternalchild health programs within which PMTCT programs are offered. Yet
PMTCT sites often miss opportunities to provide HIV-positive clients
with family planning counseling. Demand for family planning among
HIV-positive women varies depending on the extent of communities'
openness about HIV/AIDS, fertility norms, and knowledge of PMTCT
programs. In Kenya and Zambia, no differences were observed in use of
contraceptives between HIV-positive and HIV-negative women in the
study communities, but HIV-positive women have more affirmative
attitudes about condoms and use them significantly more frequently than
do their HIV-negative counterparts. In the Dominican Republic, India,
and Thailand, where HIV prevalence is low and sterilization rates are
high, HIV-positive women are offered sterilization, which most women
accept. This article draws out the policy implications of these findings
and recommends that policies be based on respect for women's right to
informed reproductive choice in the context of HIV/AIDS.
Implementing integrated family planning and HIV / AIDS policies
and programs: tools and resources.
Author:
Sanders R; Hardee K, and Shepherd, C.
Abstract:
With the pressing needs related to the HIV/AIDS pandemic, is there any
need to devote resources to supporting the provision of family planning
(FP)? Given the strong links between HIV/AID and FP, the answer is an
emphatic yes. The same unprotected sexual act can lead to unintended
pregnancy and HIV infections. Given that an estimated 80 percent of HIV
cases are transmitted sexually and an additional 10 percent are
transmitted from mothers to children perinatally or during breastfeeding,
linking HIV and reproductive health (RH) programs is crucial. Women
and men have a need for both protection against pregnancy and
protection against HIV and other sexually transmitted infections (STIs).
However, programs to prevent unintended pregnancy and to prevent
infection have typically been separate. This reliance on separate programs
is beginning to change. The International Conference on Population and
59
Family Planning: 2005 - 2008
Development (ICPD) held in Cairo in 1994 called for a holistic approach
to meeting women's and men's RH needs throughout their lives, from
childhood, through adolescence and adulthood. ICPD called for
integrated services to meet these needs, including to help individuals and
couples meet their reproductive intentions and prevent disease. Cairo + 5,
held 5 years after the 1994 ICPD, reiterated the call for integration. Most
efforts to date have focused on integrating HIV prevention and care into
FP services. However, now the focus is shifting to integrating FP into HIV
prevention, care, and treatment services, including in countries such as
Kenya, Uganda, and Jamaica. Other countries, including Cambodia and
Zambia, perceive a clear need to integrate services. (excerpt
Use of self home-made diaphragm for protection against pregnancy
and sexually-transmitted infections: case report.
Author:
Schroth, A.; Luchters, S.; Chersich, M. F.; Jao, I., and Temmerman, M.
Source:
East Afr Med J. 2007 Jan; 84(1):35-7.
Abstract:
This is a case report of a 44-year-old woman who used a home-made
diaphragm for 16 years to protect herself from pregnancy and sexuallytransmitted infections. The woman stitched a piece of cloth with folded
polythene inside. This case report provides a vivid illustration of the
limitations of available methods of protection for women. It consists of an
introduction to the topic, a description of her experiences using her
home-made diaphragm and a discussion of the significance of the case.
This report supports the need for additional research on femalecontrolled methods of protection against sexually-transmitted infections,
methods that can be used without male knowledge and co-operation,
such as vaginal microbicides and cervical barriers against infection,
including the diaphragm.
Modelling cost-effectiveness of different vasectomy methods in
India, Kenya, and Mexico.
Author:
Seamans, Y. and Harner-Jay, C. M. Modelling
Source:
Cost Eff Resour Alloc. 2007; 5:8.
Abstract:
Background:
Vasectomy is generally considered a safe and effective method of
permanent contraception. The historical effectiveness of vasectomy has
been questioned by recent research results indicating that the most
commonly used method of vasectomy--simple ligation and excision (L
60
Family Planning: 2005 - 2008
and E)--appears to have a relatively high failure rate, with reported
pregnancy rates as high as 4%. Updated methods such as fascial
interposition (FI) and thermal cautery can lower the rate of failure but
may require additional financial investments and may not be appropriate
for low-resource clinics. In order to better compare the cost-effectiveness
of these different vasectomy methods, we modelled the costs of different
vasectomy methods using cost data collected in India, Kenya, and Mexico
and effectiveness data from the latest published research.
Methods:
The costs associated with providing vasectomies were determined in each
country through interviews with clinic staff. Costs collected were
economic, direct, programme costs of fixed vasectomy services but did
not include large capital expenses or general recurrent costs for the health
care facility. Estimates of the time required to provide service were
gained through interviews and training costs were based on the total
costs of vasectomy training programmes in each country. Effectiveness
data were obtained from recent published studies and comparative costeffectiveness was determined using cost per couple years of protection
(CYP).
Results:
In each country, the labour to provide the vasectomy and follow-up
services accounts for the greatest portion of the overall cost. Because each
country almost exclusively used one vasectomy method at all of the
clinics included in the study, we modelled costs based on the additional
material, labour, and training costs required in each country. Using a
model of a robust vasectomy program, more effective methods such as FI
and thermal cautery reduce the cost per CYP of a vasectomy by $0.08$0.55.
Conclusion:
Based on the results presented, more effective methods of vasectomy-including FI, thermal cautery, and thermal cautery combined with FI--are
more cost-effective than L and E alone. Analysis shows that for a
programme in which a minimum of 20 clients undergo vasectomies per
month, the cost per CYP is reduced in all three countries by updated
vasectomy methods.
61
Family Planning: 2005 - 2008
Screening tool helps rule out pregnancy.
Author:
Shears, K. H.
Source:
Mera. 2007 Nov; (32):[3] p.
Abstract:
Studies show that a checklist developed and tested by Family Health
International (FHI) is highly effective in ruling out pregnancy and can be
used with confidence when laboratory tests are not available. The
checklist was originally designed as a screening tool for women seeking
family planning services, and research has found that its use increases
access to such services. But the checklist also can be useful for ruling out
pregnancy in other situations. For example, providers can use the
pregnancy checklist before prescribing medications that should be
avoided during pregnancy, including certain antibiotic or anti-seizure
drugs. (author's)
Improving adherence to family planning guidelines in Kenya: an
experiment.
Author:
Stanback, J.; Griffey, S.; Lynam, P.; Ruto, C., and Cummings, S
Source:
Int J Qual Health Care. 2007 Apr; 19(2):68-73.
Abstract:
Quality problem:
Research in Kenya in the mid-1990s suggested poor quality family
planning services and limited access to services. Clinical guidelines for
family planning and reproductive health were published in 1991 and
updated in 1997, but never widely distributed.
Choice of solution:
Managers and trainers chose intensive, district-level training workshops
to disseminate guidelines and update health workers on guideline
content and best practices.
Intervention:
Training workshops were held in 41 districts in 1999. Trainees were
instructed to update their untrained co-workers afterwards. As a
reinforcement, providers in randomly selected areas received a 'cascade
training package' of instructional materials and training tips. Providers in
15 randomly selected clinics also received 'supportive supervision' visits
as a second reinforcement.
Evaluation Methodology:
A cluster-randomized experiment in 72 clinics assessed the overall impact
of the training and the marginal benefits of the two reinforcing activities.
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Family Planning: 2005 - 2008
Researchers and trainers created several dozen indicators of provider
knowledge, attitudes, beliefs and practices. Binomial and multivariate
analyses were used to compare changes over time in indicators and in
aggregated summary scores. Data from patient interviews were analysed
to corroborate provider practice self-reports. Cost data were collected for
an economic evaluation.
Results:
Post-test data collected in 2000 showed that quality of care and access
increased after the intervention. The cascade training package showed
less impact than supportive supervision, but the former was more costLessons learned:
Service delivery guidelines, when properly disseminated, can improve
family planning practices in sub-Saharan Africa.
Does assessment of signs and symptoms add to the predictive
value of an algorithm to rule out pregnancy?
Author:
Stanback, J.; Nakintu, N.; Qureshi, Z., and Nasution, M.
Source:
J Fam Plann Reprod Health Care. 2006 Jan; 32(1):27-9.
Abstract:
Background:
A World Health Organization-endorsed algorithm, widely published in
international guidance documents and distributed in the form of a
'pregnancy checklist', has become a popular tool for ruling out pregnancy
among family planning clients in developing countries. The algorithm
consists of six criteria excluding pregnancy, all conditional upon a
seventh 'master criterion' relating to signs or symptoms of pregnancy.
Few data exist on the specificity to pregnancy among family planning
clients of long-accepted signs and symptoms of pregnancy. The aim of the
present study was to assess whether reported signs and symptoms of
pregnancy add to the predictive value of an algorithm to rule out
pregnancy.
Methods:
Data from a previous observational study were used to assess the
performance of the algorithm with and without the 'signs and symptoms'
criterion. The study group comprised 1852 new, non-menstruating family
planning clients from seven clinics in Kenya.
Results:
Signs and symptoms of pregnancy were rare (1.5%) as was pregnancy
(1%). Signs and symptoms were more common (18.2%) among the 22
clients who tested positive for pregnancy than among the 1830 clients
(1.3%) who tested negative, but did not add significantly to the
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Family Planning: 2005 - 2008
predictive value of the algorithm. Most women with signs or symptoms
were not pregnant and would have been unnecessarily denied a
contraceptive method using the current criteria.
Conclusions:
The 'signs and symptoms' criterion did not substantially improve the
ability of the algorithm to exclude pregnant clients, but several reasons
(including use of the algorithm for intrauterine device clients) render it
unlikely that the algorithm will be changed.
Reaching providers is not enough to increase IUD use: a factorial
experiment of 'academic detailing' in Kenya.
Author:
Wesson, J.; Olawo, A.; Bukusi, V.; Solomon, M.; Pierre-Louis, B.;
Stanback, J., and Janowitz, B.
Source:
J Biosoc Sci. 2008 Jan; 40(1):69-82.
Abstract:
Although the IUD is an extremely effective and low-cost contraceptive
method, its use has declined sharply in Kenya in the past 20 years. A
study tested the effectiveness of an outreach intervention to family
planning providers and community-based distribution (CBD) agents in
promoting use of the IUD in western Kenya. Forty-five public health
clinics were randomized to receive the intervention for providers only,
for CBD agents only, for both providers and CBD agents, or no detailing
at all. The intervention is based on pharmaceutical companies' "detailing"
models and included education/motivation visits to providers and CBD
programmes, as well as provision of educational and promotional
materials. District health supervisors were given updates on
contraceptives, including the IUD, and were trained in communication
and message development prior to making their detailing visits. Detailing
only modestly increased the provision of IUDs, and only when both
providers and CBD agents were targeted. The two detailing visits do not
appear sufficient to sustain the effect of the intervention or to address
poor provider attitudes and lack of technical skills. The cost per 3.5 years
of pregnancy protection was US$49.57 for the detailing intervention
including the cost of the IUD, compared with US$15.19 for the
commodity costs of the current standard of care--provision of the
injectable contraceptive depot-medroxyprogesterone acetate (DMPA).
The effectiveness of provider-based activities is amplified when
concurrent demand creation activities are carried out. However, the cost
of the detailing in comparison to the small number of IUDs inserted
indicates that this intervention is not cost-effective
64
Family Planning: 2005 - 2008
The Kenya stall.
Author:
Westoff, C. F. and . = Cross AR.
Abstract:
Three statistics from the Kenya 2003 Demographic and Health Survey
have alarmed the family planning and population community: The lack
of further increases in contraceptive prevalence (since 1998); The absence
of any further decline in fertility; A reversal of the trend toward
preferences for fewer children. Among all women in the sample, there
has been no change in the level of contraceptive use in the population:
29.5 percent in 2003 and 29.9 percent in 1998. The prevalence of modern
methods is 23.6 percent at both times. Among currently married women,
overall use is up but only slightly from 39.0 to 41.0 percent while, in
contrast, among unmarried sexually active women, a substantial increase
in use is evident - from 46.5 to 54.4 percent. There is a clear change in the
types of methods used, a change that began a decade earlier (1993). The
use of the pill, sterilization and the IUD collectively has declined, while
the use of injectables and implants has increased. Condom use has
remained very low among married women but has increased
significantly among the unmarried. The use of traditional methods has
changed little. (excerpt)
The stall in the fertility transition in Kenya.
Abstract:
For the past 25 years, Kenya has been a prominent example of the fertility
transition in sub-Saharan Africa. From one of the world's highest fertility
rates, 8.1 births per woman in 1975-78, fertility dropped dramatically to
4.7 by 1995-98. At the same time, contraceptive use increased rapidly as
women began wanting fewer children. These trends came to an abrupt
halt in the first few years of this century according to the findings of the
2003 Kenya Demographic and Health Survey. The following analytical
study examines this recent development, describing the details of the stall
in the fertility transition and attempting to explain its dynamics. The 2003
Kenya Demographic and Health Survey (KDHS) data used throughout
this analysis exclude the Northeast province and several other districts
not represented in the earlier surveys. The analysis begins with a
description of the changes that have occurred in fertility in Kenya,
followed by trends in contraceptive prevalence, and concludes with a
discussion of the changes in reproductive preferences. (excerpt)
65
Family Planning: 2005 - 2008
Family planning needs in the context of the HIV/AIDS epidemic:
Findings from country assessments in Kenya, South Africa and
Zimbabwe.
Author:
Pierre Ngome,
Source:
Family Health International, Nairobi, Kenya
Abstract:
Background and Objectives:
To provide guidance on how to strengthen family planning (FP) services in the
context of the HIV/AIDS epidemic, Family Health International (FHI), in
collaboration with Ministries of Health (MOH), conducted programmatic
assessments in Kenya, Zimbabwe, and South Africa. The objectives were to
assess the current status of FP and HIV/AIDS programs in each country, identify
needs of and opportunities for FP programs, and reveal strategies for
strengthening FP programs in light of the burden of the epidemic.
Methods:
A systematic assessment process was followed in all countries. Core components
of the process included the formation of an in-country steering committee to
provide technical oversight and ensure the assessment produced locally relevant
information; a desk review of epidemiological, programmatic, and policy
documents; in-depth interviews with FP and HIV/AIDS policymakers, donors,
program managers, and providers; and a working meeting with stakeholders to
build consensus regarding program gaps and opportunities.
Findings:
Findings from the assessments suggest that all three countries are experiencing a
shift in priorities and resources from FP programs to HIV/AIDS programs. Key
informants reported that they perceived the quality of FP services to be declining
due to high staff turnover, limited training opportunities for providers, and erratic
supplies of FP commodities. In addition, national-level program managers
reported that providers were not adequately prepared to address the family
planning needs of HIV-infected clients. In the absence of scientific evidence, key
informants were mixed in their opinions on how the HIV/AIDS epidemic has
affected fertility desires and use of contraception. While the desk reviews
indicated that many of the FP and HIV/AIDS policies in the three study countries
recognize linkages between the two programs, most key informants agreed that
policies were poorly disseminated to and implemented at the service delivery
level. .
Conclusion:
The majority of key informants interviewed in all three countries thought that
integrating family planning and HIV/AIDS services offered an opportunity to
make the best use of available financial and human resources to provide
comprehensive, convenient health care. However, they also acknowledged the
challenges to integrating services, including the need to train providers and avoid
overburdening staff. Key informants also agreed that policies and provider skills
need to be updated to better meet the contraceptive needs of HIV-infected clients.
66
Family Planning: 2005 - 2008
Finally, key informants argued that governments need to reaffirm their political
commitment to FP so that gains made in recent decades are not eroded.
Keywords:
Family panning|HIV/A1DS| Integration
Development Related Socio-Demographic and Reproductive
Health Factors Affecting Women Undergoing Voluntary Surgical
Contraception Between 1994 and 2005 in Nairobi Province, Kenya.
Author:
Osur J.,
Source:
Family Health Options, Kenya
Abstract:
The decision to permanently stop bearing children is affected by many
factors. These can be social, demographic m reproductive health in
nature. These same factors have a direct bearing on the socio-economic
development of the community. Hence, trends in socio-demographic and
reproductive health factors are a manifestation of trends in socioeconomic development of a community. In women, socio-demographic
and reproductive health factors contribute directly to the decision to stop
bearing children. Noting this intricate relationship between reproductive
health decisions and socio-demographic as well as economic factors,
maternal health is being used as an indicator of development in the
Millennium Development Goals and targets have been set to reduce
maternal mortality by two thirds by the year 2015. This is despite the fact
that little is known about factors that influence maternal health. This
study defined trends in socio demographic and reproductive health
characteristics in women undergoing bilateral tubal ligation (BTL) in
Nairobi and related the trends to socio-economic development. The
trends were studied over the span 1994 to 2005. Data was obtained from
hospital records and from interviews with antenatal clients and key
informants. Data was managed using Statistical Package for Social
Sciences (SPSS) and has been presented by use of tables and figures. The
study showed that there is an increasing tendency for women in Nairobi
to deliver at advanced ages above 35 years. This may increases their risks
for maternal mortality. It also showed that an increasing number of
women are disregarding what their religions teach and end up doing
BTL. Further, it showed that married women depend on their husbands'
consent to be able to do BTL and also that more pregnancies are not
ending up into living children over the years. Overall, the majority of
socio-demographic and reproductive health characteristics in women
undergoing BTL in Nairobi were found to show signs of positive
economic development. These included level of education, number of
children before doing BTL, influences related to ethnicity and those
related to marital status. The government and NGOs working in the areas
67
Family Planning: 2005 - 2008
of population and development will find these findings important in
planning interventions to enhance socio-economic development.
Strengthening Early Postpartum Family Planning through
Postnatal care in Kenya 2006-2007
Authors:
Mwangi A., Warren C.
Source:
Population Council, P O Box17643, Nairobi. Telephone: 2713480
Abstract:
Objective:
About 24% of married women in Kenya have an unmet need for family
planning, 14% for spacing and 10% for limiting, yet family planning is
considered one of the easiest and most affordable pillars of Safe
Motherhood. Antenatal providers attend to so many details that it is easy
to overlook discussing family planning intentions, while very little
attention is given to postpartum and family planning care in developing
countries.
Methodology:
The study involved the assessment of provider knowledge and practice,
quality of postnatal care and women fertility intentions in four public
health facilities of Eastern Province . Data were collected through in
depth interviews with service providers and clients and observation of
client-provider interactions during consultations/ service delivery in
Maternity and MCH/FP clinics in Provincial General Hospital Embu,
Karurumo, Kibugu, and Kianjokoma health centres.
Results:
Among the mothers interviewed, 58% indicated having wanted the
pregnancy, while 29% would have preferred if they had delayed and 14%
did not actually want any more children inclusive of the one they had just
delivered. Information from the data farther indicated that women
preferred FP information at 6 weeks (36%) in MCH/FP. Around half of
the providers recalled the correct signs and action for PPH and less than
half for signs and actions for puerperal sepsis. Only 20% of all providers
mentioned emptying the woman’s bladder as an essential action to take if
heavy bleeding developed after childbirth.
Summary:
Post partum family planning is feasible and acceptable to both providers
and clients. Providers appreciate the advantages of integrating postnatal
care and postpartum family planning into MCH services but lack capacity
due to system logistics, shortage of staff, supplies and knowledge gap.
68
Family Planning: 2005 - 2008
Recommendations:
1. Training on postpartum family planning with emphasis on the role of
LAM on child spacing for providers during pre service and in service
to be institutionalized
2. Scale up the project to other districts in the country
3. Logistics, supplies, drugs and equipment in MCH modified to suit
integrated services
4. Create community awareness of the available services in MCH
starting with women during FANC
Key words:
Kenya| Postpartum| Family planning| Safe Motherhood
Unipron is a fully effective Non-hormonal reversible
Contraceptive.
Authors:
Mburu, N., Obiero, J. A., Mwaura, B., Langoi, D., Mwethera, P.G.
Source:
Institute of Primate Research, P.O. Box 24481, Karen, Nairobi. Kenya
Abstract:
Summary:
The choice of a contraceptive method involves factors such as efficacy,
safety, non-contraceptive benefits, cost, religion and personal
considerations. Access to a safe and effective contraceptive would benefit
both men and women. Women’s need for a protective method that they
can control is of great importance.
Objectives:
 To determine the efficacy of UniPron as a contraceptive.
 To determine the reversibility of UniPron.
 To determine the effect of UniPron on sperm motility.
Measures:
To determine the contraceptive effect and reversibility of UniPron,
sexually mature females were mated with sexually mature males of
proven fertility. On sperm motility, freshly ejaculated sperm from male
baboons were mixed with UniPron at different concentrations.
Results:
None of the experimental animals conceived, while all the controls
conceived. After UniPron administration was stopped, all experimental
animals conceived. increase in UniPron concentration lead to increased
sperm immotility. at a concentration of 40 (v/v), all sperm cells were
dead.
69
Family Planning: 2005 - 2008
Conclusion:
UniPron is therefore an effective contraceptive and its effects maybe
easily reversed.
Recommendations:
These studies may be extended to humans.
Family planning service provision update in the context of
HIV/AIDs.
Authors:
Dr Marsden Solomon*, Anne Njeru*, Rose Maina*, Dr Francis Xavier
Odawa**, Violet Bukusi***, Erin McGinn***
Source:
Division of Reproductive Health – Ministry of Health, Kenya, **Kenya
Obstetrics/Gynecological Society, ***Family Health International
Abstract:
Background and introduction:
The Kenya National Reproductive Health strategy 1997-2010 was
launched by the Ministry of Health as a national response to the
Programme of Action of ICPD (1994). The goal of the strategy was to
provide a comprehensive and integrated system of reproductive health
(RH) care that offers a full range of services through government, NGOs
and the private sector in Kenya. The Family Planning program which
forms one of the priority RH components has been a well-known success
story. Use of modern contraceptives rose from 4% to 39% among married
women between 1978 and 2003. The total fertility rate (TFR) decreased
from 8.1 to 4.7 within the same period. The program, however, faces
many challenges in meeting the needs of a growing population. Nearly
one quarter (24%) of married women have an unmet need for family
planning. Nearly half of the population (12.5m) is under 15 years of age
and an estimated 100,000 young people turn 16 years of age annually
(onset of sexual activity), a pattern that will continue for over a decade.
This large cohort is likely to put a heavy demand on reproductive health
services, including Family Planning services.
Within this context, available evidence shows that new and emerging
issues now face the Kenya RH/FP program. These include a method mix
that is biased towards short-term and costly methods. Findings from the
2003 KDHS show that injectables and the pill remain the most widely
used modern contraceptive methods in Kenya. Secondly, the same KDHS
shows a stagnation of the CPR resulting in a plateau in contraceptive use
in sharp contrast with previous trends. Also, within the context of a high
unmet need for FP there exist an increased number of HIV+ women who
need contraceptives. Increased access to antiretroviral (ARV) drugs
presents a theoretical risk of drug interaction with hormonal
contraceptives and is considered category 1 or 2 by World Health
Organisation medical eligibility criteria depending on whether or not the
70
Family Planning: 2005 - 2008
client is doing clinically well on ARV therapy. An integrated approach to
providing services becomes imperative since it creates the opportunity to
discuss many other issues with the clients.
Health providers recognize the value of new global medical information
that is relevant to their profession to fully address the new and emerging
issues in their practice. The WHO provides recommendations for
appropriate medical eligibility criteria (MEC) for contraceptive use based
on the latest clinical and epidemiological data; this MEC was recently
updated (2004).
Methodology:
The two hour session will be interactive with 4 presentations namely; FP
challenges and achievements in Kenya; New MOH Community
Reproductive Health Package; the recent WHO MEC changes and; the
revised MOH FP guidelines. All these presentations will be made
bearing in mind the implications on service provision. Adequate time for
discussion will be provided to offer the participants an opportunity to
share experiences. Please refer to the attached session guide for more
details.
Session objectives:
1. To disseminate the current FP challenges and achievements, the
MOH Community RH package, and the 3rd edition of the Kenya FP
guidelines;
2. To sensitize participants on the latest changes in the WHO MEC and
their implications for service provision;
3. To facilitate creation of a network of Obstetrics Gynecologists
through whom RH updates in FP can be shared periodically to ensure
continuity.
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Family Planning: 2005 - 2008
Session plan:
Title: RH/FP Service Provision update in the Context of HIV/AIDS
TOPIC
PLAN
METHODOLOGY
Overview of FP
FP Achievements & Challenges
Brainstorming on challenges participants
situation in Kenya: FP
presentation
perceive, (5 mins).
Achievements &
Summary presentation: (15 mins)
challenges (MOH)
New MOH Community The New Community RH package
Presentation on introduction of the
Reproductive Health
presentation
community package
Package (MOH)
led by facilitator [2 slides]:
(5 mins)
Presentation by facilitator on RH
components in relation
to community package: (10 mins)
Presentation on effective communication
of RH issues
with the community: ( 10 mins)
Review of FP service
delivery guidelines/RH
curriculum (MOH)
Comments on existing FP service
delivery guidelines
- Do they know?
- Have they seen?
- Do they use?
- Any comments
--ideas from participants on how
they can be better disseminated?
Brainstorming: (5 mins)
Summary presentation on the FP
service delivery guidelines.
Presentation: (20 mins)
Introduction to WHO
MEC for contraceptive
use (KOGS)
Overview of MEC using
conceptual framework
Provide information on categories
used in MEC
Presentation on WHO MEC (10 mins)
Example on provision
of FP in the era of HIV
and AIDS using the
new MEC to
contraceptive provision
(KOGS)
Present evidenced-based
information on IUCD
Presentation on the evidence (10 mins)
Plenary discussion (10 mins)
Discussion/ Q&A
72
Family Planning: 2005 - 2008
The Effect of DMPA contraceptive on body weight and blood
pressure among indigenous Kenya women in Kenyatta National
Hospital.
Author:
Dr. Aruasa/Dr. Wanyoike
Source:
Kenyatta National Hospital, P.O. Box 19676, Nairobi.
Abstract:
Background:
Concern has been raised that depot medroxyprogesterone acetate
(DMPA) contraceptive leads to weight gain and possibly rise in blood
pressure among its users.
Objectives:
The objectives of this study were to determine the magnitude of body
weight and blood pressure changes in indigenous Kenyan women on
DMPA contraceptive and assess whether these changes lead to stoppage
of its use as a contraceptive.
Study Design:
This was a prospective cohort study.
Study Setting:
Family Welfare Centre at Kenyatta National Hospital, Nairobi, Kenya.
Subjects and Methods:
The study subjects were 50 black normotensive Kenyan women aged 2040 years newly accepting DMPA as a method of contraception while the
control group comprised 50 black normotensive Kenyan women aged 2040 years newly accepting non-hormonal copper-bearing intrauterine
contraceptive devices (IUCD) for contraception. The subjects and control
group were chosen through simple random sampling technique from 1st
to 31st July 2004, and followed up 3-monthly for a total of 12 months until
the last subject was seen on 29th July 2005.
Data was collected by completion of a set out precoded questionnaire by
the principal investigator. The main outcome measures were the
magnitude of blood pressure and weight changes of clients on DMPA at
3, 6, 9 and 12 months from the baseline. These were compared
accordingly with those of IUCD users at the same time intervals.
Results:
The mean age of DMPA users was 27.880 years vs 30.260 years for IUCD
users, 2-tailed p-value 0.0269. The mean parity, marital status,
73
Family Planning: 2005 - 2008
occupation, religion and number of years in school were similar among
DMPA and IUCD users.
The mean weight change from baseline remained significantly higher
among DMPA users compared to IUCD users up to the end of the study.
The total mean weight change from baseline to 12 months was 2.919kg for
DMPA users vs 1.550kg for IUCD users, 2-tailed, p-value 0.0000, which is
significant.
Mean systolic blood pressure changes were minimal at every visit in the 2
groups and no significant differences were appreciable throughout the
study period. The total mean systolic blood pressure changes from
baseline to 12 months were 3.216mmHg for DMPA users vs 4.250mmHg
for IUCD users, 2-tailed p-value 0.4.
Mean diastolic blood pressure changes were minimal and no significant
differences were encountered among the 2 groups throughout the study
period. The total mean diastolic blood pressure changes from baseline to
12 months were 1.216mmHg for DMPA users vs 1.250mmHg for IUCD
users, 2-tailed p-value 0.7
By the end of the 1 year of study, 26.0% of DMPA users had quit using
the method and the commonest reasons were irregular menses (30.8%),
amenorrhoea (23.1%) and weight gain (23.1%). At the end of the study
period 20% of IUCD users had quit using the method and the commonest
reasons were pelvic inflammatory disease (40.0%), cramping and spotting
(30%) and no obvious reason (20%).
Conclusions:
There is a significant weight gain among indigenous Kenyan women on
DMPA contraception after 1 year of use. However, there is no significant
increase in both systolic and diastolic blood pressure after the same
period of use. Hence DMPA is a safe enough contraceptive that can be
recommended for those willing and fit to use it.
Recommendations:
1:Discontinuation of DMPA contraceptive by its users can be reduced
considerably by adequate counseling of clients at the time of its
acceptance as a contraceptive.
2:A similar study should be carried out on a longer term (like over 5
years) to further determine the weight and blood pressure changes
among DMPA users and whether or not these changes may predispose to
cerebrovascular accidents and ischemic heart diseases.
74
Family Planning: 2005 - 2008
Intrauterine Contraceptive Device (IUCD) Re-Introduction
Initiative in Kenya.
Authors:
E.Teri, V. Bukusi, B. N. Maggwa
Source:
Family Health International, Nairobi, Kenya
Abstract:
Introduction:
The Family Planning Program in Kenya is a Well-known success story.
Use of modem contraceptive arose from 4% to 32% among married
women between 1978 and 1998. however a review of the national
contraceptive method mix in Kenya has shown a decline in IUCD use
from about 30% in 1984 to about 8% in 1998 despite the high proportion
of women in reproductive age with unmet need for contraception and a
rapidly deteriorating economic situation. The IUCD is a very effective
and safe method for most women; it is cost effective, reversible and long
lasting and the probability of pregnancy over 10 years of use is only 2.6%
making the IUCD one of the most effective methods available. The
challenge therefore for policy makers and donors is how to balance
provision of family planning services with diminishing resources and
how to re-introduce the IUCD in the contraceptive method mix and
achieve a sustainable family planning program with a method mix that
emphasizes quality and cost-effective long term methods.
Objective:
The major objective of the initiative is to increase and sustain access,
demand and utilization of high quality IUCD services offered by the
public and private sectors.
Methods:
The MOH requested USAID, FHI and the AMKENI project on this
initiative. The team adopted the following methods to rehabilitate the
IUCD: held consultative meetings with key stakeholders, developed an
IUCD task force to spearhead its re-introduction. Selected existing project
sites to conduct a pilot introduction and developed re-introduction and
Behavior Change and Communication (BCC} strategies.
Results:
A stakeholders’ meeting was held in October 2001 to engage policy
makers, researchers, obstetricians, gynecologists, government officials,
donors and program managers in a discussion on the role of the IUCD in
the Kenya method mix and develop strategies to reintroduce the IUCD in
the Kenya Family Planning Program. Consequent to the meeting, a task
force was formed to develop an IUCD re-introduction strategy, work plan
and budget. The strategy includes advocacy, training of providers,
community mobilization through behaviour change communication
efforts, buy-ins, provision of data on IUCD safety and continuous process
75
Family Planning: 2005 - 2008
monitoring. Regular consultative meetings were held with stakeholders
to agree on roles and responsibilities as well as specific re-introduction
activities. Approval of the IUCD re-introduction strategy and work plan
by the Reproductive Health Advisory Board has been obtained and is
ready for implementation. Also, a Behavior Change and Communication
(BCC} strategy has been developed, implementation of which will ensure
demand creation for IUCD services in the project sites. Two studies are
being carried out to 1) review MOH policies and guidelines that might
influence IUCD service provision and 2) to review data on clinical service
delivery and examine readiness for IUCD rehabilitation. The Project will
be implemented by MOH, FHI and the AMKENI Project in 13 sites in
Western Kenya and if found viable then it will be extended to other parts
or Kenya.
Conclusion:
The strategies and activities being undertaken for the rehabilitation of
IUCD into the national contraceptive method mix in Kenya provides a
basis that can be used by other developing countries that are trying to
balance provision at family planning services with diminishing resources.
Assessment of Voluntary Counseling and Testing Centers in
Kenya: How can Family planning services be integrated?
Authors:
J.Liku, A.B.N. Maggwa, V, Bukusi, H. Reynolds
Source:
Family Health International (FHI), Nairobi, Kenya FHI, RTP, NC
Abstract:
Introduction:
Like most countries in sub-Saharan Africa, Kenya continues to experience
high HIV prevalence, a high proportion or women of reproductive age
with an unmet need for contraception, and a rapidly deteriorating
economic situation. The challenge, therefore, for policy makers, program
Implementer& and donors is how to respond to these Issues in an
efficient, cost effective and sustainable manner.
0bjective:
The study aimed at gathering information about VCT services In Kenya
In order to identify and formulate programmatic options for effective
Integration of family planning into VCT services.
Methods:
The study used both quantitative and qualitative methods Including
Interviews and observations. A total of 20 VCT centers were purposively
selected to represent three types of VCT models operational in the
country (integrated, stand alone and community based) and the different
76
Family Planning: 2005 - 2008
client loads served by the centers. Trained VCT counselors conducted 70
observations of client-provider Interactions while social scientists
conducted 84 exit interviews with clients at the end of the VCT sessions.
Twenty facility-in charges and 41 VCT service providers were also
interviewed.
Results:
The majority of the clients were aged 30 years or less and they were
almost equally distributed between men and women (51% and 49%
respectively). Of the 74 out of 84 total clients (88.1%) who were sexually active.
26 (35.1%) reported using no contraception and18 (24.3%), reported using
condoms. the most common family planning method. The Injectable
(n=13 users) and the birth control pill (n=9 users) were the next most
commonly used methods. All current users obtained their supplies from
sources other than the VCT center they had visited. Most of the VCT
providers (33 out of 41) felt that their clients would benefit from the
provision of family planning services as part of the VCT service package,
Over half of the in-charges and VCT provides felt that discussions about
family planning should be undertaken during the pre test consultation
period. Most clients (89.3%) thought is was a good to provide family
planning services as part of VCT, and more than half of the clients fell
that such discussions should take place during the post-test consultation
or even a follow-up visit. In 97.1% of VCT sessions, clients were educated
on actions to reduce the risk of infection or transmission of HIV
information on the basic facts on HIV and AIDS was given in only 79.2%
of the sessions observed. In 90.3% of sessions counsellors discussed the
need for condom use but condom use demonstration occurred in 42.9% of
sessions and information on how condoms prevent pregnancy occurred
in 80.7% of the sessions. Condoms were offered in 44.6% of sessions. On
training, majority of VCT provides indicated that they would need
further training in the provision of family panning services in order,
provide quality services
Conclusion:
Given that men and women's combined current use of any modem
contraception is Iow (42 out of 84) and that respondents reported
favorable attitudes about adding family planning services. It is likely that
there is latent family planning demand that should be addressed.
However, questions remain about the appropriate methods and timing to
deliver this message
77
Family Planning: 2005 - 2008
Period and cohort dynamics in fertility norms at the onset of the
demographic transition in Kenya 1978-1998.
Author:
White RG; Hall C; Wolff B
Source:
Journal of Biosocial Science. 2007 May;39(3):443-454.
Abstract:
A characteristic of African pre-transitional fertility regimes is large ideal
family size. This has been used to support claims of cultural
entrenchment of high fertility. Yet in Kenya fertility rates have fallen. In
this paper this fall is explored in relation to trends in fertility norms and
attitudes using four sequential cross-sectional surveys spanning the
fertility transition in Kenya (1978, 1984, 1989 and 1998). The most rapid
fall in the reported ideal family size occurred between 1984 and 1989,
whilst the most rapid fall in the total fertility rate occurred 5 to 10 years
later, between 1989 and 1998. Thus these data, spanning the fertility
transition in Kenya, support the traditional demographic model that
demand for fertility limitation drives fertility decline. These data also
suggest that the decline in fertility norms over time was partly a period
effect, as the reported ideal family size was seen to fall simultaneously in
all age cohorts, and partly a cohort effect, as older age cohorts reporting
higher ideal family sizes were replaced by younger cohorts reporting
lower ideal family sizes. These data also suggest that a new fertility norm
of four children may have developed by 1989 and continued until 1998.
This is consistent with, and perhaps could have been used to predict, the
stall in the Kenyan fertility decline after 1998. (author's)
Language:
English
Keywords:
KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS |
DEMOGRAPHIC AND HEALTH SURVEYS | QUESTIONNAIRES |
FERTILITY SURVEYS | WOMEN | FAMILY SIZE, IDEAL |
DEMOGRAPHIC TRANSITION | CONTRACEPTIVE PREVALENCE
| TOTAL FERTILITY RATE | DEVELOPING COUNTRIES |
AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA |
RESEARCH METHODOLOGY | DEMOGRAPHIC SURVEYS |
POPULATION DYNAMICS | DEMOGRAPHIC FACTORS |
POPULATION | FERTILITY MEASUREMENTS | FERTILITY |
FAMILY SIZE | FAMILY CHARACTERISTICS | FAMILY AND
HOUSEHOLD | SOCIOCULTURAL FACTORS | CONTRACEPTIVE
USAGE | CONTRACEPTION | FAMILY PLANNING | FERTILITY
RATE | BIRTH RATE
Document Number: 313239
78
Family Planning: 2005 - 2008
The stall in the fertility transition in Kenya.
Author:
Westoff CF; Cross AR
Source:
Calverton, Maryland, ORC Macro, MEASURE DHS, 2006 May.
SE: DHS Analytical Studies No. 9
Abstract:
For the past 25 years, Kenya has been a prominent example of the fertility
transition in sub-Saharan Africa. From one of the world's highest fertility
rates, 8.1 births per woman in 1975-78, fertility dropped dramatically to
4.7 by 1995-98. At the same time, contraceptive use increased rapidly as
women began wanting fewer children. These trends came to an abrupt
halt in the first few years of this century according to the findings of the
2003 Kenya Demographic and Health Survey. The following analytical
study examines this recent development, describing the details of the stall
in the fertility transition and attempting to explain its dynamics. The 2003
Kenya Demographic and Health Survey (KDHS) data used throughout
this analysis exclude the Northeast province and several other districts
not represented in the earlier surveys. The analysis begins with a
description of the changes that have occurred in fertility in Kenya,
followed by trends in contraceptive prevalence, and concludes with a
discussion of the changes in reproductive preferences. (excerpt
Language:
English
Keywords:
KENYA | RESEARCH REPORT | KAP SURVEYS | WOMEN IN
DEVELOPMENT | COUPLES | USAID | FERTILITY DECLINE |
CONTRACEPTIVE PREVALENCE | CONTRACEPTION FAILURE |
CONTRACEPTION TERMINATION | DEMOGRAPHIC FACTORS |
SOCIOECONOMIC FACTORS | CONTRACEPTIVE METHODS
CHOSEN | HIV INFECTIONS | AFRICA, EASTERN | AFRICA
SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES
| SURVEYS | SAMPLING STUDIES | STUDIES | RESEARCH
METHODOLOGY | ECONOMIC DEVELOPMENT | ECONOMIC
FACTORS | FAMILY CHARACTERISTICS | FAMILY AND
HOUSEHOLD | SOCIOCULTURAL FACTORS | GOVERNMENT
AGENCIES | ORGANIZATIONS | POLITICAL FACTORS |
FERTILITY CHANGES | FERTILITY | POPULATION DYNAMICS |
POPULATION | CONTRACEPTIVE USAGE | CONTRACEPTION |
FAMILY PLANNING | VIRAL DISEASES | DISEASES
Document Number: 306081
79
Family Planning: 2005 - 2008
Fertility in Kenya and Uganda: a comparative study of trends and
determinants.
Author:
Blacker J, Opiyo C, Jasseh M, Sloggett A, Ssekamatte-Ssebuliba J
Source:
Centre for Population Studies, London School of Hygiene and Tropical
Medicine, London WC1B 3DP, UK. john.blacker@lshtm.ac.uk
Abstract:
Between 1980 and 2000 total fertility in Kenya fell by about 40 per cent,
from some eight births per woman to around five. During the same
period, fertility in Uganda declined by less than 10 per cent. An analysis
of the proximate determinants shows that the difference was due
primarily to greater contraceptive use in Kenya, though in Uganda there
was also a reduction in pathological sterility. The Demographic and
Health Surveys show that women in Kenya wanted fewer children than
those in Uganda, but that in Uganda there was also a greater unmet need
for contraception. We suggest that these differences may be attributed, in
part at least, first, to the divergent paths of economic development
followed by the two countries after Independence; and, second, to the
Kenya Government's active promotion of family planning through the
health services, which the Uganda Government did not promote until
1995.
Language:
English
Keywords:
| CONTRACEPTION/UTILIZATION |FEMALE |FERTILITY |HEALTH SURVEYS |HUMANS|INFERTILITY/EPIDEMIOLOGY
|KENYA/EPIDEMIOLOGY |MALE |MARITAL STATUS
|SOCIOECONOMIC FACTORS |UGANDA/EPIDEMIOLOGY
Document Number: 20051206
Higher community HIV prevalence predicts higher recent marital
fertility in Kenya.
Author:
DeRose, L. F.
Abstract:
I estimate the effect of community prevalence of HIV on recent martial
fertility in Kenya. The general consensus in the existing literature on the
relationship between HIV and fertility is that the relationship is negative,
and even that the HIV/AIDS epidemic has contributed to fertility decline
in severely affected countries. The negative individual-level relationship
between HIV and fertility is fairly unambiguous: what few proximate
determinants would contribute to higher fertility (like earlier intercourse)
80
Family Planning: 2005 - 2008
are outweighed by a set of others that produce lower fertility among the
infected (higher rates of miscarriage, lower coital frequency because of
illness, widowhood, divorce, lower fecundity). Some of the best studies
have concluded that the overall fertility of HIV positive women is 25-40%
lower than among the uninfected. However, the community-level
relationship between HIV and fertility is also believed to be negative, but
with far less evidence. (excerpt)
Hormonal contraception and HIV prevalence in four African
countries.
Author:
Leclerc, P. M.; Dubois-Colas, N., and Garenne, M.
Source:
Contraception. 2008 May; 77(5):371-6.
Abstract:
Background:
The HIV seroprevalence among women aged 15-24 years was compared
according to their pattern of contraceptive use in four African countries:
Kenya, Lesotho, Malawi and Zimbabwe.
Study design:
Data were derived from Demographic and Health Surveys (DHS)
conducted between 2003 and 2006 on representative samples, totaling
4549 women.
Results:
It is indicated that users of depo-medroxyprogesterone acetate (DMPA)
have a significantly higher seroprevalence than nonusers [odds ratio
(OR)=1.82, 95% CI=1.63-2.03] and higher than users of oral
contraceptives and users of traditional methods. The results were
confirmed in a multivariate analysis including as controls, age, duration
since first intercourse, urban residence, education, number of sexual
partners in the last 12 months and marital status. A somewhat smaller net
effect (OR=1.34, 95% CI=1.10-1.63) was found. In contrast, oral
contraceptives and traditional methods did not show any risk for HIV
(OR=0.96 and 0.92, respectively).
Conclusion: The increased risk of DMPA was present in three of the four
countries investigated, and significant in Zimbabwe and Lesotho, the
countries with the highest HIV seroprevalence. The HIV risk attributable
to DMPA remained small altogether and was estimated as 6% in the four
countries combined
81
Family Planning: 2005 - 2008
Contraceptive implants in Kenya: Current status and future
prospects.
Author:
Hubacher D; Kimani J; Steiner MJ; Solomon M; Ndugga MB
Source:
Contraception. 2007 Jun;75(6):468-473.
Abstract:
Since introducing Norplant over 20 years ago in Kenya, demand for
contraceptive implants has remained high and implant costs are
dropping substantially. An assessment of the Kenyan experience with
implants was conducted to understand level of demand, capacity to
provide services and reproductive health impact of possible increased
use. Interviews were conducted with 35 key Kenyan informants. By
modeling increases in national implant use (at the expense of oral
contraceptives), reductions in the annual number of unintended
pregnancies were estimated. Kenya has an unmet need for implants and
the current network of trained providers appears ready to increase the
volume of services. If 100,000 users of oral contraceptives switch to
implants, then an estimated 26,000 unintended pregnancies can be
averted over a 5-year period. With increased purchases of implants by
international donor agencies, Kenya can reduce reliance on short-term
hormonal methods and reduce the 45% prevalence rate of unintended
pregnancy. (author's)
Language:
English
Keywords:
KENYA | RESEARCH REPORT | QUALITATIVE RESEARCH |
HEALTH PERSONNEL | FAMILY PLANNING PERSONNEL |
CONTRACEPTIVE IMPLANTS | PRICES | CAPACITY BUILDING |
CONTRACEPTIVE DISTRIBUTION | REPRODUCTIVE HEALTH |
INTERVIEWS | AFRICA, EASTERN | AFRICA, SUB SAHARAN |
AFRICA | DEVELOPING COUNTRIES | RESEARCH
METHODOLOGY | DELIVERY OF HEALTH CARE | HEALTH |
FAMILY PLANNING PROGRAMS | FAMILY PLANNING |
CONTRACEPTIVE METHODS | CONTRACEPTION | COMMERCE
| MACROECONOMIC FACTORS | ECONOMIC FACTORS |
PROGRAM SUSTAINABILITY | PROGRAMS | ORGANIZATION
AND ADMINISTRATION | DISTRIBUTIONAL ACTIVITIES |
PROGRAM ACTIVITIES | DATA COLLECTION
Document Number: 313557
82