Determinants of contraceptives use among women of Reproductive age in Nambale sub-county, Busia county, Kenya

Abstract

Use of contraceptives allow people to attain their desired number of children and determine the spacing of children. Contraceptives use and unmet need for contraceptives are key to understanding profound changes in fertility and to improving reproductive health. In Africa, 24.2% of women of reproductive age have an unmet need for modern contraception. Contraceptive prevalence according to WHO is the percentage of women who are currently using, or whose sexual partner is currently using, at least one method of contraception regardless of the method used, usually reported in married or in-union women aged 15-49. Nambale’s contraceptives prevalence rate is at 39% compared to 58% national average, despite continuous implementation of family planning campaigns by NGOs and the government of Kenya. The main objective of the study was to explore the determinants of contraceptives use among women of reproductive age (15-49 years) in Nambale Sub-County, Busia County, Kenya. The specific objectives included assessing the knowledge of women on contraceptives use, the social cultural factors affecting use of contraceptives among women of reproductive age, economic factors affecting use of contraceptives and the health systems factors affecting contraceptives use among women of reproductive age. A cross sectional study design was used. The study population comprised women of reproductive age (15-49 years) with a sample size of 371 women. Simple stratified sampling technique was used to obtain samples in each of the study sub-locations and households were sampled randomly where one woman of reproductive age was selected from each household. Quantitative data was collected using interviewer administered semi – structured questionnaires, whereas qualitative data was collected using Key informant interview and Focus Group Discussion guides. Data was analyzed using descriptive statistics for categorical data and median for continuous data. Pearson’s chi-square test was used to reveal significant associations between contraceptive use and the following variables; Education level, religion, age, ever given birth, spousal approval and regression models 95% confidence interval to calculate the odds of contraceptives usage. Qualitative data was analyzed through thematic analysis. Results revealed that women’s age, education level and total number of children were significant predictors of contraceptive use (X2(6) = 22.70, p<0.001). Older women were 0.95 times more likely to use contraceptives (95% C.I; 0.919-0.991, p-value = 0.015); women who had ever attended school were 0.10 times more likely to use contraceptives (95% C.I; 0.020-0.529, p-value = 0.006); and all the women who had at least one child were 0.35 times more likely to use contraceptives when compared to those who had none (95% C.I; 0.141- 0.875, p-value = 0.025). Additionally, health system related factors such as frequent stock outs, fear of side effects and health concerns, lack of privacy at the facility and harshness/ bad attitude among the health workers discouraged uptake of contraceptives and consequently, increase in discontinuation rates. Findings from this study may be used to advise policy review on promotion of male engagement in family planning, capacity building of health workers and addressing the gap in supply of family contraceptive commodities.