Insights into Unmet Need in Kenya

Background Despite the recent increase in contraceptive prevalence, a quarter of women of reproductive age in Kenya reported unmet need for family planning in 2008/9. Any advances in our understanding of the causes of unmet need could have profound implications for programmes. Objectives This study aims to establish the relative importance of lack of access and attitudinal resistance towards use of contraception in different population and geographical strata of Kenya. It is intended to inform policy makers on the priority that should be given to behaviour change communication or improved access/information, and also helpful to interventions to reduce health concerns and fear of side effects, such as provision of broader method mix and better counselling. Methods Data from the Kenya DHS 2008/9 were used for the analysis. All analyses were based on married/cohabiting fecund women who were exposed to risk of pregnancy at the time of the survey We identified whether married women with unmet need have access (defined by knowledge of pills and injectables, and a supply source) and attitudinal acceptance (defined by intention to use in the future). We assessed variations of unmet need across different strata by bivariate and multivariate analyses. Self-reported reasons for unmet need were assessed. Results Among 2676 exposed women, 28% had unmet need. Of these, half were classified as possessing both access and a positive attitude and a further one-third as having access but no intention to use in the future. The majority in both groups had previously used a modern method, in most cases pills or injectables. The main self-reported reason for non-use in both groups was health concerns and fear of side effects. Small minorities (6-7%) of women with an unfavourable attitude reported that they were opposed to contraception or mentioned religious reasons for non-use. Lack of access was associated with unmet need in 16% of cases and lack of information was the most common reason for non-use among these women. With the exception of the North Eastern Province where access was very limited, regional variations were minor. However, lack of access (i.e. method and/or supply source), was much more common in women with no schooling and the poorest segment than among other strata. Lack of access also appeared to be one reason why postpartum women have higher unmet need than other women. Discussion and implications Most women having unmet need for family planning in Kenya were aware of the two main contraceptive methods and a supply source, but many of the poorest, least educated women and those living in North Eastern Province were disadvantaged in this regard. Targeted expansion of access/information is a priority to meet the need of the disadvantaged populations. Among those with access, most (68%) have previously tried a modern method. Thus the origin of unmet need stems largely from discontinuation of use than outright rejection of contraception based on personal or religious opposition. The central problem appears to be health concerns and side effects. Many women try a modern method but discontinue use because of these concerns and do not switch to an alternative