Patterns of fertility preferences and contraceptive behaviour over time: change and continuities among the urban poor in Nairobi, Kenya

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Study Justification:
– The study aims to investigate the association between fertility preferences and contraceptive use among women living in informal settlements in Nairobi, Kenya.
– It addresses the need to understand the patterns of fertility preferences and contraceptive behavior among the urban poor population.
– The findings have major implications for family planning programs in informal settlements where access to and knowledge about contraception may be limited.
Highlights:
– The study found that there is regularity and stability in reported fertility preferences among women living in the informal settlements.
– Younger women (15-24 years) are more likely to change their preferences over time, transitioning from wanting to limit childbearing to wanting additional children.
– Women aged 35-49 are more likely to change their preferences from desiring more children to wanting to limit their childbearing.
– The desire to limit childbearing is strongly associated with the use of modern and long-acting contraceptive methods.
Recommendations for Lay Reader:
– Family planning programs in informal settlements should focus on providing access to modern and long-acting contraceptive methods.
– Efforts should be made to educate and raise awareness among women, particularly younger women, about the importance of family planning and the available contraceptive options.
– The findings highlight the need for targeted interventions to address the changing fertility preferences among different age groups of women.
Recommendations for Policy Maker:
– Allocate resources to improve access to modern and long-acting contraceptive methods in informal settlements.
– Invest in comprehensive reproductive health education programs targeting women in informal settlements, with a focus on younger women.
– Collaborate with local community organizations and healthcare providers to ensure the effective implementation of family planning programs in informal settlements.
Key Role Players:
– Ministry of Health, Kenya
– Local community organizations
– Healthcare providers
– Non-governmental organizations (NGOs) working in reproductive health
Cost Items for Planning Recommendations:
– Training and capacity building for healthcare providers
– Procurement and distribution of modern and long-acting contraceptive methods
– Development and dissemination of educational materials
– Community outreach and awareness campaigns
– Monitoring and evaluation of family planning programs in informal settlements

The main objective of this paper is to investigate the association between fertility preferences and contraceptive use among 15–49-year-old women living in Korogocho and Viwandani, informal settlements in Nairobi, Kenya. We draw on longitudinal data collected under the Maternal and Child Health project conducted between 2006 and 2010 in the two settlements. There is substantial regularity and stability but also unusual instability in reported fertility preferences over time among women living in these settings. Younger women, aged 15–24 years, are likely to change their preferences over time, passing from limiting to wanting additional children. But women aged 35–49 are likely to change their preferences from desiring more children to limiting their childbearing. The desire to limit childbearing is strongly associated with the use of modern and long-acting contraceptive methods. Findings have major implications for the success of family planning programmes in informal settlements where access to and knowledge about contraception may be limited.

Based on the description provided, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or SMS-based platforms to provide information and reminders about contraceptive methods, family planning, and maternal health services. This can help overcome barriers related to limited access to information and knowledge about contraception.

2. Community Health Workers (CHWs): Train and deploy CHWs in informal settlements to provide education, counseling, and support on family planning and maternal health. CHWs can bridge the gap between healthcare facilities and the community, ensuring that women have access to accurate information and services.

3. Task-Shifting: Explore the possibility of task-shifting certain maternal health services to lower-level healthcare providers, such as nurses and midwives. This can help increase the availability of services and reduce the burden on doctors, especially in resource-constrained settings.

4. Integrated Services: Integrate family planning services with other maternal and child health services, such as antenatal care and postnatal care. This can ensure that women receive comprehensive care throughout their reproductive journey, making it easier for them to access contraception and other necessary services.

5. Public-Private Partnerships: Foster collaborations between public and private sectors to improve access to maternal health services. This can involve leveraging private healthcare providers and facilities to expand service coverage and reach underserved populations in informal settlements.

6. Supply Chain Innovations: Develop innovative supply chain solutions to ensure a consistent availability of contraceptive methods in informal settlements. This can involve exploring alternative distribution channels, improving stock management systems, and addressing logistical challenges.

7. Financial Incentives: Explore the use of financial incentives, such as conditional cash transfers or vouchers, to encourage women to seek maternal health services and adopt contraceptive methods. This can help overcome financial barriers and increase utilization rates.

8. Community Engagement and Empowerment: Implement community-based interventions that empower women and communities to make informed decisions about their reproductive health. This can involve community dialogues, peer education programs, and women’s support groups.

It is important to note that the specific context and needs of the target population should be considered when implementing these innovations.
AI Innovations Description
Based on the description provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Recommendation: Develop targeted family planning programs in informal settlements to address the changing fertility preferences and contraceptive behavior among women.

Explanation: The findings of the study highlight the importance of addressing the unique challenges faced by women living in informal settlements, such as limited access to and knowledge about contraception. To improve access to maternal health, it is crucial to develop targeted family planning programs that specifically cater to the needs of women in these settings. These programs should focus on:

1. Education and awareness: Provide comprehensive information about different contraceptive methods, their effectiveness, and their availability. This can be done through community-based workshops, health campaigns, and the use of local influencers.

2. Accessibility: Ensure that modern and long-acting contraceptive methods are readily available in informal settlements. This can be achieved by establishing clinics or mobile health units that offer a range of contraceptive options and are easily accessible to women in these areas.

3. Affordability: Address the financial barriers that may prevent women from accessing contraceptives. This can be done by subsidizing the cost of contraceptives or providing them free of charge through government-funded programs.

4. Tailored interventions: Recognize the different fertility preferences and contraceptive needs of women in different age groups. Develop interventions that specifically target younger women who may change their preferences over time and older women who may transition from desiring more children to limiting their childbearing.

By implementing these recommendations, it is possible to improve access to maternal health by addressing the association between fertility preferences and contraceptive use among women in informal settlements. This will contribute to the success of family planning programs and ultimately lead to better maternal health outcomes in these communities.
AI Innovations Methodology
To improve access to maternal health in informal settlements like Korogocho and Viwandani in Nairobi, Kenya, the following innovations and recommendations can be considered:

1. Mobile Health (mHealth) Solutions: Utilize mobile technology to provide maternal health information, reminders for prenatal and postnatal care appointments, and access to telemedicine consultations. This can help overcome barriers such as limited access to healthcare facilities and lack of awareness about maternal health services.

2. Community Health Workers (CHWs): Train and deploy CHWs within the informal settlements to provide education, counseling, and support for maternal health. CHWs can conduct home visits, distribute contraceptives, and refer women to healthcare facilities when necessary.

3. Maternal Health Vouchers: Implement a voucher system that provides subsidized or free maternal health services to women in informal settlements. This can help reduce financial barriers and increase utilization of antenatal care, skilled birth attendance, and postnatal care services.

4. Public-Private Partnerships: Collaborate with private healthcare providers to improve access to quality maternal health services in informal settlements. This can involve establishing satellite clinics or mobile clinics within the settlements, ensuring availability of skilled healthcare professionals, and improving the quality of care provided.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve the following steps:

1. Data Collection: Gather baseline data on key indicators such as maternal mortality rates, antenatal care coverage, contraceptive prevalence, and healthcare utilization in the target settlements.

2. Modeling: Develop a simulation model that incorporates the innovations and recommendations mentioned above. This model should consider factors such as population demographics, healthcare infrastructure, availability of resources, and potential uptake of the interventions.

3. Parameter Estimation: Estimate the parameters required for the simulation model based on available data, expert opinions, and literature review. This may include factors such as the number of CHWs needed, the cost of implementing the voucher system, and the potential increase in healthcare utilization due to mHealth solutions.

4. Simulation Runs: Run the simulation model multiple times, varying the input parameters to assess different scenarios and their potential impact on improving access to maternal health. This can help identify the most effective combination of interventions and estimate the expected outcomes.

5. Evaluation: Analyze the simulation results to evaluate the potential impact of the recommendations on improving access to maternal health. This can involve assessing changes in key indicators such as maternal mortality rates, contraceptive use, and healthcare utilization rates.

6. Policy Recommendations: Based on the simulation findings, provide evidence-based policy recommendations to stakeholders, including government agencies, non-governmental organizations, and healthcare providers. These recommendations should focus on implementing the most effective interventions identified through the simulation process to improve access to maternal health in informal settlements.

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