Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study

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Study Justification:
This study aimed to assess the prevalence and factors associated with covert contraceptive use (CCU) in Kenya. The justification for this study is that family planning is crucial for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involving both women and their partners in family planning promotes contraceptive acceptance, uptake, and continuation, as well as couple communication and gender-equitable attitudes. Partner involvement is particularly important for addressing the unmet needs in family planning in Kenya.
Study Highlights:
The study found that the prevalence of CCU in Kenya was 12.2%. The highest rates of CCU were observed among uneducated women (22.3%), women from the poorest households (18.2%), and women aged 35-49 years (12.8%). The most commonly used methods of covert contraception were injectables (53.3%) and implants (34.6%). Factors associated with CCU included education level, wealth quintile, age at sexual debut, and number of children.
Study Recommendations:
Based on the findings, the study recommends efforts to strengthen partner involvement in family planning to increase contraceptive use in Kenya. It also emphasizes the importance of acknowledging women’s right to make independent choices regarding contraception. The study highlights the need for targeted interventions for uneducated women, those from the poorest households, and women in the 35-49 age group. Additionally, the study suggests addressing barriers related to education, wealth, and age at sexual debut to reduce CCU.
Key Role Players:
To address the recommendations, key role players may include policymakers, government agencies, non-governmental organizations (NGOs), healthcare providers, community leaders, and women’s rights advocates. Policymakers and government agencies can develop and implement policies that promote partner involvement in family planning and ensure access to a range of contraceptive methods. NGOs and healthcare providers can offer education, counseling, and contraceptive services to women and their partners. Community leaders and women’s rights advocates can raise awareness, challenge social norms, and advocate for gender-equitable attitudes.
Cost Items for Planning Recommendations:
While the actual costs will vary depending on the specific interventions and strategies implemented, some potential cost items to consider in planning the recommendations include:
1. Training and capacity building for healthcare providers: This may include training on family planning counseling, contraceptive methods, and partner involvement. Costs may include trainers’ fees, materials, and venue rental.
2. Contraceptive commodities: Ensuring a sufficient supply of contraceptives, including injectables and implants, may require budgeting for procurement, storage, and distribution.
3. Information, education, and communication (IEC) materials: Developing and disseminating IEC materials to raise awareness about family planning, partner involvement, and women’s rights may involve costs for design, printing, and distribution.
4. Community outreach and mobilization: Conducting community outreach activities, such as workshops, seminars, and awareness campaigns, may require budgeting for transportation, venue rental, and materials.
5. Monitoring and evaluation: Establishing a system to monitor and evaluate the impact of interventions on contraceptive use and partner involvement may involve costs for data collection, analysis, and reporting.
It is important to note that these cost items are estimates and may vary depending on the specific context and scale of the interventions.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the study design, data collection methods, and statistical analysis. However, it lacks information on the sample size and the representativeness of the sample. To improve the evidence, the abstract could include the sample size and information on how the sample was selected to ensure it is representative of the population. Additionally, providing information on the response rates and any potential biases in the data collection process would further strengthen the evidence.

Background: Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya. Methods: We used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as “the use of contraceptives without a partner’s knowledge”. We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions. Results: The prevalence of CCU was 12.2% (95% CI: 10.4–14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35–49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73–8.31), women with primary education (aOR 1.86, 95% CI 1.06–3.29) and those from the poorest (aOR 2.67, 95% CI 1.61–4.45), poorer (aOR 1.79, 95% CI 1.05–3.04), and middle (aOR 2.40, 95% CI 1.52–3.78) household wealth quintiles and were reduced among those with 2–3 (aOR 0.49, 95% CI 0.33–0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40–0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89–0.99) reduced the odds of CCU. Conclusion: About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women’s right to make independent choices.

We utilised data from sixth [35] and seventh [36] rounds of Kenya’s performance monitoring for accountability (PMA) surveys. The surveys used a multi-stage stratified cluster design that involved urban-rural and 11 counties (Nairobi, Bungoma, Kericho, Kiambu, Kilifi, Kitui, Nandi, Nyamira, Siaya, Kakamega and West Pokot) as strata, 151 enumeration areas (EA) sampled from the KNBS master sampling frame, 42 randomly selected households in each EA. All consenting females 15–49 years in the selected household were interviewed. Round 6 included 6106 households and 5876 females (99% response rate) while round 7 had 6097 households and 5671 females (99.1% response rate). Data were collected by trained interviewers using standardised questionnaires in November and December of 2017 and 2018 [35, 36]. CCU, the outcome variable, was defined as “the use of contraceptives without a male partner’s knowledge” [37]. It was measured based on the question: “Does your partner/husband know that you are using family planning?” among women currently using FP and in-a-union, for which they responded either ‘yes’ or ‘no’. The independent variables were selected based on a review of the literature on FP and the availability of the variables in the dataset. They included the county of residence, locality of residence, age in years, education levels, wealth quintiles, parity, desire for more children and age at sexual debut in years. The county of residence included the 11 counties sampled in the survey (Nairobi, Bungoma, Kericho, Kiambu, Kilifi, Kitui, Nandi, Nyamira, Siaya, Kakamega and West Pokot) while the locality of residence was either rural or urban, based on the classification by the KNBS master sampling framework [35, 36]. Respondents were asked how old they were on their last birthday and responses were categorized into 15–19, 20–34 and 35–49 years [27] and their highest level of education (no formal, primary, secondary and tertiary) [25, 27, 38]. Five wealth quintiles (poorest, poorer, middle, richer, richest) were computed based on wealth index generated using principal component analysis of the household assets, walls, flooring and roofing materials and type of water access and sanitation facilities [39]. Parity was assessed based on the question “How many times have you given birth?” and the response recoded as 0, 1, 2–3 and 4+ [25]. Women’s age at sexual debut was assessed based on the question “How old were you when you first had sexual intercourse?” and the response recorded in years [40]. Women were also asked whether they wanted more children, to which they responded with either ‘yes’, ‘no’ or ‘infertile’ [29]. We described the sample characteristics and the prevalence of CCU using frequencies and percentages. Factors associated with CCU were assessed using bivariate and multivariable logistic regressions. All variables in the bivariate analysis were included in the multivariable analysis. Stata 13.0 was used for analyses [41], which were adjusted for the sampling design and stratification using survey weight provided in the datasets. Statistical significance was set at p-value = 0.05.

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Based on the provided description, the study “Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study” aims to assess the prevalence and factors associated with covert contraceptive use (CCU) in Kenya. The study utilized data from the sixth and seventh rounds of Kenya’s performance monitoring for accountability (PMA) surveys, which involved a multi-stage stratified cluster design and interviews with females aged 15-49 years.

The study found that the prevalence of CCU in Kenya was 12.2%. Factors associated with CCU included education level, wealth quintiles, age at sexual debut, and parity. Uneducated women, women with primary education, and those from the poorest, poorer, and middle household wealth quintiles had increased odds of CCU. On the other hand, women with 2-3 children and those with 4 or more children had reduced odds of CCU. Age at sexual debut also influenced the odds of CCU.

To improve access to maternal health, based on the findings of this study, potential recommendations could include:

1. Education and awareness programs: Implement programs that focus on educating women and their partners about family planning methods, including the importance of open communication and joint decision-making. These programs should target both educated and uneducated individuals to address the higher prevalence of CCU among uneducated women.

2. Partner involvement: Promote the involvement of male partners in family planning discussions and decision-making. This can be achieved through targeted interventions that aim to increase male knowledge and engagement in contraceptive use.

3. Financial support: Provide financial support or subsidies for contraceptives, particularly for women from the poorest and poorer wealth quintiles. This can help reduce financial barriers and increase access to contraceptives.

4. Age-appropriate sexual education: Implement comprehensive sexual education programs that address the importance of delaying sexual debut and promote responsible sexual behavior. This can help reduce the odds of CCU by empowering women to make informed decisions about their reproductive health.

5. Tailored interventions: Develop interventions that are tailored to the specific needs and circumstances of different regions and communities within Kenya. This can help address the variations in CCU prevalence across different counties and localities.

It is important to note that these recommendations are based on the specific findings of the study and should be further evaluated and adapted to the local context before implementation.
AI Innovations Description
Based on the provided description, the recommendation to improve access to maternal health based on the study findings is to strengthen partner involvement in family planning (FP) in Kenya. This can be achieved through the following strategies:

1. Promote couple communication: Encourage open and honest communication between partners about family planning decisions. This can help increase acceptance, uptake, and continuation of contraceptives.

2. Increase awareness and education: Implement educational programs that target both women and men to raise awareness about the importance of family planning and the available contraceptive methods. This can help dispel myths and misconceptions and promote informed decision-making.

3. Address socio-economic factors: Target interventions towards uneducated women, those with primary education, and those from poorer households, as they were found to have higher rates of covert contraceptive use. Provide access to education and economic opportunities to empower women and improve their ability to make independent choices regarding family planning.

4. Tailor interventions to specific regions: Siaya county was associated with higher rates of covert contraceptive use. Develop targeted interventions for regions with higher prevalence to address the unique challenges and barriers faced by women in these areas.

5. Improve access to contraceptive methods: Ensure that a wide range of contraceptive methods, including injectables and implants, are readily available and accessible to women. This can be achieved through increased availability in healthcare facilities and community distribution programs.

6. Address cultural and social norms: Challenge gender norms and promote gender-equitable attitudes towards family planning. Engage community leaders, religious leaders, and influential individuals to advocate for partner involvement in family planning and support women’s right to make independent choices.

By implementing these recommendations, it is expected that partner involvement in family planning will increase, leading to improved access to maternal health services and a reduction in covert contraceptive use in Kenya.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase partner involvement in family planning: Promote and encourage the active participation of male partners in family planning decisions and discussions. This can be done through educational campaigns, counseling sessions, and community engagement programs.

2. Improve education and awareness: Implement comprehensive reproductive health education programs that target both men and women. These programs should provide accurate information about contraceptive methods, their benefits, and their proper usage.

3. Enhance access to contraceptives: Ensure that a wide range of contraceptive methods are readily available and accessible to women. This includes increasing the availability of contraceptives in rural areas, improving supply chain management, and reducing barriers such as cost and stigma.

4. Strengthen healthcare infrastructure: Invest in improving healthcare facilities, especially in underserved areas. This includes training healthcare providers in family planning counseling and services, equipping facilities with necessary equipment and supplies, and ensuring the availability of skilled birth attendants.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that reflect access to maternal health, such as contraceptive prevalence rate, antenatal care coverage, skilled birth attendance, and maternal mortality rate.

2. Collect baseline data: Gather data on the current status of these indicators in the target population. This can be done through surveys, interviews, and existing data sources.

3. Develop a simulation model: Create a mathematical or statistical model that incorporates the identified recommendations and their potential impact on the selected indicators. This model should consider factors such as population demographics, healthcare infrastructure, and socio-cultural context.

4. Input data and parameters: Input the baseline data and relevant parameters into the simulation model. This includes information on the prevalence of covert contraceptive use, partner involvement rates, education levels, wealth quintiles, and other relevant variables.

5. Run simulations: Use the simulation model to project the potential impact of the recommendations on the selected indicators. This can be done by adjusting the input parameters based on the expected changes resulting from the implementation of the recommendations.

6. Analyze results: Analyze the simulation results to assess the potential improvements in access to maternal health. This includes comparing the projected indicators before and after the implementation of the recommendations.

7. Refine and validate the model: Continuously refine and validate the simulation model based on new data and feedback. This ensures that the model accurately reflects the real-world context and provides reliable projections.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different recommendations on improving access to maternal health. This can inform decision-making and resource allocation for effective interventions.

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