Contraceptive Switching among Homeless Women in Kenya
DOI:
https://doi.org/10.47604/ijecon.2201Keywords:
Contraceptives, Switching, Homelessness, MortalityAbstract
Purpose: The paper examines contraceptive-switching behaviors among homeless women in Nairobi, Kenya. High mortality and morbidity rates in Kenya are mainly a result of unplanned pregnancies, discontinuation of contraceptives, and switching of contraceptives. These incidences can be reduced through improved access to a wide variety of contraception and counseling services that allow homeless women to make informed decisions. Switching from one contraceptive to the other often lowers contraceptive preventive abilities putting women at risk of unplanned pregnancies
Methodology: The study was carried out in Nairobi, Kenya. The study utilized primary data collected from a sample of 384 households in Nairobi. A Cluster case-control and observational study design was used to sample the population. Off slum settlements were randomly chosen and systematic random sampling was used to select female household members to be interviewed. The study sampled 8 groups of subjects per study area which are the CBD alleys and the off-slum settlements of Kibra, Korogocho, Mathare, Mukuru Kwa Reuben, Majengo, Kawangware, and Huruma Slums. Questionnaire responses were then extracted and analyzed using STATA software. Estimates were then regressed using logistic regression.
Findings: The logistic estimates further reveal that as a homeless woman gets more educated, she will tend to switch contraception less often. The study found the predicted probability of educated women switching contraceptives to be 1.32%. The study also found that women who had lived in the streets had a 0.89% possibility of switching contraceptives. The study further noted that women who experienced miscarriages, stillbirths, or had aborted in the past 12 months were 4 times more likely to switch contraceptives than women who hadn't. Results derived from the regression show further show that immigrating from an urban area and having knowledge of Intra-uterine devices (IUDs), increases the chances that a homeless woman will switch contraceptives.
Unique Contribution to Theory, Practice and Policy: There exists limited research on the reproductive health practices of homeless women in Kenya as more studies are focused on refugees, street children, and slum dwellers. This study therefore adds to knowledge on contraceptive utilization among homeless women. Over the years the government has initiated programs and policies to reduce the population in Kenya. However, these policies have had less impact on population control among street families in Kenya. The government in its efforts to control fertility, can utilize the findings of this study to come up with an optimal contraceptive mix, unique to the needs of homeless women in Kenya. The study is also critical in understanding the role of knowledge on contraceptive utilization among homeless women. Knowledge of contraceptives can also be improved through outdoor reproductive health campaigns and the establishment of mobile clinics to improve homeless women's accessibility to reproductive health services.
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Ali, M., Azmat, S.K. & Hamza, H.B. (2018). Assessment of modern contraceptives continuation, switching, and discontinuation among clients in Pakistan: study protocol of 24-months post family planning voucher intervention follow up. BMC Health Serv Res 18, 359. https://doi.org/10.1186/s12913-018-3156-0
Ali, M., Cleland, J. and Iqbal S. (2012). Causes and Consequences of Contraceptive Discontinuation: Evidence from 60 Demographic and Health Surveys. World Health Organization.
Aloo, S. (2013). Family Planning Method Switch and Discontinuation among Women aged 15-24 years in Kenya. International Conference on Family Planning 10,13140/2.
Atnafe, M., Assefa, N. & Alemayehu, T. (2016). Long-acting family planning method switching among revisit clients of public health facilities in Dire Dawa, Ethiopia. Contraception and reproductive medicine, 1, 18. https://doi.org/10.1186/s40834-016-0028-z
Barden-O'Fallon, J., Speizer, I.S. & Calhoun, L.M. (2018). Women's contraceptive discontinuation and switching behavior in urban Senegal, 2010-2015. BMC Women's Health 18, 35. https://doi.org/10.1186/s12905-018-0529-9
Barden-O'Fallon, J. & Speizer, I. (2011). What differentiates method stoppers from switchers? Contraceptive discontinuation and switching among Honduran women. International perspectives on sexual and reproductive health, 37(1), 16-23. https://doi.org/10.1363/3701611
Bereku, T., Habtu, Y., Abreham, B., Ayele, M. & Eliso, M. (2022). Magnitude and factors for method discontinuation and switching among long acting reversible contraceptive users in health facilities of Southern Ethiopia. Reproductive health, 19(1), 47. https://doi.org/10.1186/s12978-022-01357-2
Borda, M. & William W. (2010). Postpartum fertility and contraception: An analysis of findings from 17 countries. ACCESS-FP: Baltimore, Maryland.
Caldwell. J. C. (1982). Theory of fertility decline. London. https://nla.gov.au/nla.cat-vn1713933
Collumbien, M., Gerressu, M. & Cleland, J. (2004). Non-use and use of ineffective methods of contraception. World Health Organization. http://researchonline.lshtm.ac.uk/17866/
Corey, E., Frazin, S. & Heywood, S. (2020). Desire for and barriers to obtaining effective contraception among women experiencing homelessness. Contracept Reprod Med 5, 12. https://doi.org/10.1186/s40834-020-00113
Curtis, KM., Jatlaoui, TC. & Tepper NK. (2016). U.S Selected Practice Recommendations for Contraceptive Use. MMWR Recomm ;65(No. RR-4):1-66.
DaVanzo, J., Razzaque, A., Rahman, M., Hale, L., Ahmed, K., Khan, M.A., Mustafa, G. and Gausia, K. (2004). The effects of birth spacing on infant and child mortality, pregnancy outcomes, and maternal morbidity and mortality in Matlab. Bangladesh: Technical Consultation and Review of the Scientific Evidence for Birth Spacing.
McDevitt, T, M. (1999). World Population Profile: 1998, Washington, DC, US Government Printing Office
Easterlin. R. A. (1961). The American Baby Boom in Historical Perspective. American Economic Review 51, (5): 869-911. https://www.jstor.org/stable/1813841
Easterlin. R. A. (1975). An economic framework for fertility analysis. Studies in family planning, 6(3), 54-63., 6 (3): 54-63. https://pubmed.ncbi.nlm.nih.gov/1118873/
Embleton, L., Shah, P., Gayapersad, A., Kiptui, R., Ayuku, D. and Braitstein, P. (2020). Characterizing street-connected children and youths' social and health inequities in Kenya: a qualitative study. International journal for equity in health, 19,.1-18. https://doi.org/10.1186/s12939-020-01255-8
Fotso, Jean, C., Ilene, S., Speizer, Mukiira, C., Kizito, P. and Lumumba, V. (2013). Closing the poor-rich gap in contraceptive use in urban Kenya: Are family planning programs increasingly reaching the urban poor. International Journal for Equity in Health 12: 71. https://doi.org/10.1186/1475-9276-12-71
Gebreselassie, Tesfayi, Shea, Rutstein. & Vinod, M. (2008). Contraceptive use, breastfeeding, amenorrhea and abstinence during the postpartum period: An analysis of four countries. DHS Analytical Study No. 14. Calverton. MD: Macro International. https://api.semanticscholar.org/CorpusID:56946790
Gill, J., Johnson, P. & Clark, M. (2010). Research Methods for Managers. SAGE Publications
Grossman, M. (1972). A stock approach to the demand for health. The Demand for Health: A Theoretical and Empirical Investigation ,1-10. NBER.
Heald, S. (1995). The power of sex: Some reflections on the Caldwell's' "˜African sexuality' thesis. Africa, 65(4), 489-505.
Heckman, J. J. & Mosso, S. (2014). The Economics of Human Development and Social Mobility of economics. Annual review of Economics, 6, 689-733. https://www.annualreviews.org/doi/abs/10.1146/annurev-economics-080213-040753
Holzer, J, Z. (2003). Demografia, PWE, Warszawa
Jain, A. K., Francis, O., Saumya, R. and Askew. I. (2013). Reducing unmet need by supporting women with met need. International Perspectives on Sexual and Reproductive Health 39(3): 133-41. https://doi.org/10.1363/3913313
Kabra, R., Danansuriya, M. & Moonesinghe, L. (2022). Improving access to quality family planning services in Nepal and Sri Lanka: insights from a South-South learning exchange, BMJ Global Health 2022;7: e008691. https://doi.org/10.1136/bmjgh-2022-008691
Kelbore, W., Yesuf, N. & Alto, G. (2020). Long-Acting Reversible Contraceptive Methods Switching and Associated Factors among Women Attending Family Planning Clinic at Public Health Facilities of Dilla Town, Southern Ethiopia. International Journal of Sciences: Basic and Applied Research (IJSBAR), 53(2), 59-72. https://www.gssrr.org/index.php/JournalOfBasicAndApplied/article/view/11558
Kennedy, Kathy, I. & Cynthia, M. V. (2022). Contraceptive efficacy of lactational amenorrhea. The Lancet, 339(8787): 227-230. https://doi.org/10.1016/0140-6736(92)90018-X
Kurkiewicz, J. (1998). Models of fertility changes in selected European countries in the light. Studia demograficzne, 19-36. https://pubmed.ncbi.nlm.nih.gov/12286706/
Leite, IC., Gupta, N. & Rodrigues, RN. (2004). Female sterilization in Latin America: cross-national perspectives. Journal of Biosocial Science, 36(6): 683-69. doi:10.1017/s0021932003006369
Liu, D.H. and Raftery, A.E. (2020). How do education and family planning accelerate fertility decline? Population and development review, 46(3), 409-441. doi:10.1111/padr.12347
Mahlangu, T. and Kgadima, P. (2021). Social exclusion and marginalization of homeless people: a clarion social work call for the spirit of ubuntu to reign. Social Work, 57(4), 455-471. http://dx.doi.org/10.15270/52-2-970
Modey, E. J., Aryeetey, R. & Adanu, R. (2014). Contraceptive discontinuation and switching among Ghanaian women: evidence from the Ghana Demographic and Health Survey, 2008. African journal of reproductive health, 18(1), 84-92. https://pubmed.ncbi.nlm.nih.gov/24796172/
Mumah, J. N., Machiyama, K., Mutua, M., Kabiru, C. W. & Cleland, J. (2015). Contraceptive Adoption, Discontinuation, and Switching among Postpartum Women in Nairobi's Urban Slums. Studies in Family Planning, 46(4), 369-386. doi:10.1111/j.1728-4465.2015. 00038.x
Roe, A.H., McAllister, A., Sammel, M.D. and Schreiber, C.A. (2020). Pregnancy intentions and contraceptive uptake after miscarriage. Contraception, 101(6), 427-431. https://doi.org/10.1016/j.contraception.2020.03.002
Rogers, E. M. & Kincaid, D. L. (1981). Communications Networks. Towards a New Paradigm for Research. Free Press. New York.
Rogers, E. M. (1962). Diffusion of innovations (1st ed.). New York: Free Press of Glencoe
Rosero-Bixby, L. and Casterline, J.B. (1993). Modelling diffusion effects in fertility transition. Population studies, 47(1), 147-167. https://www.jstor.org/stable/2175231
Ross, John, A., William, L. & Winfrey. (2001). Contraceptive use, intention to use and unmet need during the extended postpartum period. International Family Planning Perspectives 27(1): 20-27
Simmons, R. G., Sanders, J. N., Geist, C., Gawron, L., Myers, K. & Turok, D. K. (2019). Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants. American journal of obstetrics and gynecology, 220(4), 376. https://doi.org/10.1016/j.ajog.2018.12.022
Steele, F. & Curtis, S. (2003). Appropriate methods for analyzing the effect of method choice on contraceptive discontinuation. Demography 40(1): 1-22. https://doi.org/10.1353/dem.2003.0009
Steele, F. & Diamond, I. (1999). Contraceptive switching in Bangladesh. Studies in Family Planning 30(4): 315-28. https://doi.org/10.1111/j.1728-4465.1999.t01-3-.x
United Nations. (2015). Transforming our world by 2030: A new agenda for global action Zero. Draft of the outcome document for the UN Summit to adopt the Post-2015 Development Agenda. New York: United Nation
Waldorf, B. and Franklin, R. (2002). Spatial dimensions of the Easterlin hypothesis: Fertility variations in Italy. Journal of Regional Science, 42(3), 549-578. doi: 10.1111/1467-9787.00272
WHO. (2010). Global Recommendations on Physical Activity for Health. Geneva: WHO.
Wiegratz, I., Stahlberg, S. & Manthey, T. (2011). Effect of extended-cycle regimen with an oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest on bleeding patterns, safety, acceptance and contraceptive efficacy. Contraception ,84, 133-43. https://doi.org/10.1016/j.contraception.2011.01.002
Zewude, B., Biru, D. and Tesfaye, A. (2019). Pregnancy and Child Bearing Practices outside the Home Setting: The Case of on-street Women in Shashemene Town, West Arsi Zone, Ethiopia. Sci JWomens Health Care. 2019;3(1): 001-007.
Zimmerman, L. A., Sarnak, D. O., Karp, C., Wood, S. N., Ahmed, S., Makumbi, F. & Kibira, S. P. (2021). Association between experience of specific side-effects and contraceptive switching and discontinuation in Uganda: results from a longitudinal study. Reproductive health, 18(1), 239. https://doi.org/10.1186/s12978-021-01287-5
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Copyright (c) 2023 Pkaremba Lydia Cheruto , Dr. Martine Oleche Odhiambo (PhD), Dr. Elizabeth Owiti (PhD)
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