Assessing (in) equalities in contraceptives use and family planning demand satisfied with modern contraceptives in Kenya
Abstract Background: Family planning plays an important role in reducing high-risk and unwanted pregnancies and associated complications. Kenya has made progress increasing the use of modern contraceptives. We assessed inequalities in contraceptive use and family planning demand satisfied.Methods: We used data from seven rounds of Performance, Monitoring and Accountability 2020 cross-sectional surveys, 2014-2018. Women aged 15-49 years were interviewed after informed consent was obtained. Contraceptive prevalence and demand for family planning satisfied standard definitions were used. Data were stratified by type of contraception (long-acting/permanent, short-acting, or traditional); wealth, residence, education, age, and wealth. Data were analysed using Stata v14.Results: Modern contraceptive prevalence has increased from 58.7% in 2014 to 64.2% in 2018 among sexually active married women. Total demand for family planning satisfied (DFPS) has increased from 70.5% in 2014 to 79.0% in 2018. There was a significant increase in long acting/permanent methods from 27.1% in 2014 to 42.9% in 2018 and a decrease in short acting methods from 71.6% in 2014 to 54.0% in 2018. The odds of contraception use among older women was 1.48 times higher than among adolescents (aOR=1.48; 95% CI: 1.21, 1.81); among married women 0.74 times compared to the unmarried women (aOR 0.74; 95% CI: 0.63, 0.86). The odds of contraception use increased with increasing education (secondary or higher education: aOR 3.78; 95% CI: 2.90, 4.92) and wealth quintiles (highest wealth quintile: aOR = 1.36; 95% CI: 1.12, 1.65). There were significant differences in DFPS by modern methods: older women vs adolescents (aOR = 2.40; 95% CI: 1.96, 2.93); married vs unmarried women (aOR = 1.53; 95% CI: 1.32, 1.78); secondary or higher education vs no education: aOR 2.39 (95% CI: 1.95, 2.94); and highest vs lowest wealth quintile: aOR = 1.53 (95% CI: 1.24, 1.89).Conclusion: Contraceptive use and specifically long-acting reversible contraceptives are on the rise in Kenya. However, persistent inequities need to be addressed if no women are going to be left behind to access and use family planning/contraceptives. Current achievements should be maintained while targeting women who are poor, uneducated/illiterate, young, and living in rural areas.