By George Morara
Kenya’s young rural women begin having sex earlier but start using contraception later than their urban counterparts, a new study shows. The Performance Monitoring and Accountability 2017 survey, conducted between November and December 2017 in eleven counties, further shows that the gap between first sex encounter and first contraceptive use among rural women is 6 years and 3.5 years for urban women.
This thus, shows that the burden of unintended pregnancies in Kenya is heaviest among poor rural girls aged 16 years old compared to their 18-year old for urban counterparts, the survey has revealed. “The median age at which women in rural Kenya begin having sex is 16.7 years old, about six years before they first use contraception and four years before they are married. Whereas, women in Kenya’s urban set ups, begin having sex at age 18.4 years old, about three years before they first use contraception and about four years before they are married,” the survey says.
The survey also shows that 13 per cent of all women and 15 per cent of those with spouses, despite wanting to avoid pregnancy in two years time, are currently not using contraception. Again, according to the survey presented by Prof. Peter Gichangi, the Country Director, International Centre for Reproductive Health Kenya (ICRHK), the unmet need was highest for women in the lowest wealth quintile standing at 19.6 per cent and lowest among women in the wealthiest quintile at 11.1 per cent.
Since 2014, Performance Monitoring and Accountability 2020 (PMA2020) has been tracking trends in contraceptive use and family planning service delivery in Kenya. Gichangi said however, Kenya is making positive strides in improving family planning access among women. “It is worth noting that women are using contraception at early ages, and they are increasingly choosing effective long-acting contraceptive methods.
But generally, rural women on average have an early sexual debut, marry early, and use contraception later in life compared with their urban counterparts,” he added. ICRHK is collecting data on core Family Planning indicators using mobile technology in Nairobi; Kiambu, Kilifi, Kitui, Kericho, Nandi, Nyamira, Siaya, Bungoma, Kakamega and West Pokot Counties. “We have completed six rounds of data collection so far,” he said.
According to Dr. Josephine Kibaru, the Director General, National Council for Population and Development (NCPD), despite the progress made in reversing maternal deaths in the country, Kenya still records high numbers of maternal deaths as a result of unplanned pregnancies. An estimated 6,300 women die each year during pregnancy and childbirth.
She said many Kenyan women are at risk of unplanned pregnancies noting that one in every five women, an estimated 18 per cent, who are in marriage in Kenya, and want to postpone their next birth for two years or more, or not have any more children, were not using any method of contraception. “Access to family planning services, including access to contraceptives, can go a long way in reducing these maternal injuries and deaths,” she said adding the government plans to reduce teenage pregnancy from 18 per cent to 12 per cent.
She said to achieve this, the government seeks to increase reproductive health services in the country from 40 per cent to 50 per cent. “We are doing well, but we need to put more effort,” she added. One of the strategies meant to address teenage pregnancies, she said, is through the National Family Planning Costed Implementation Plan (FP-CIP) 2017-2020 with an estimated budget of Sh30.5 billion (US$305 million).
“However, we need to urgently address a funding gap that stands at Sh8.3 billion (US$83 million),” she added. Increased use of FP, Kibaru told Health Business Magazine, would save the country an estimated Sh5.2 billion (US$52 million) in healthcare costs by 2020. Unfortunately, NHIF does not entirely cover members seeking family planning services, with access to contraceptives not included as part of the cover.
The survey found out that in Kenya, the modern contraceptive prevalence rate (mCPR) for married women is 59 per cent and 44 per cent for all women. And as expected according to Gichangi, the mCPR is consistent with PMA2020 survey findings in previous years. It is noted that, among women in union who are modern contraceptive users, injectable use makes up a large proportion of the method mix at 46 per cent while those using implants stand at 35 per cent; 3 per cent for the Intra-Uterine Devices (IUDs) users and 4 per cent for women using sterilisation.
“Among unmarried, sexually active modern contraceptive users, 30 per cent use injectables, 24 per cent use implants; while 2 per cent use IUDs, and 3 per cent are on female sterilisation,” Gichangi added from the survey report. Only approximately 12 per cent of women in union mCPR surveyed use other modern methods including shortacting methods. It indicates that nearly 42 per cent of unmarried mCPR users are on other modern methods including short-acting procedures.
The survey further found out that 98 per cent of all mCPR users who were interviewed obtain their preferred method during their last family planning visit reflecting the quality of family planning services at disposal in Kenya. Most of these users, an estimated 94 per cent according to the survey, choose the method by themselves or jointly with their partners.
