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Background: Understanding women’s contraceptive method choices is key to enhancing family planning services provision and programming. Currently however, very little research has addressed inter and intra-regional disparities in women’s contraceptive method choice. Using data from slum and non-slum contexts in Nairobi, Kenya, the current study investigates the prevalence of and factors associated with contraceptive method choice among women. Methods: Data were from a cross-sectional quantitative study conducted among a random sample of 1,873 women (aged 15-49 years) in two non-slum and two slum settlement areas in Nairobi, Kenya. The study locations were purposively sampled by virtue of being part of the Nairobi Urban Health and Demographic Surveillance System. Bivariate and multivariate logistic regression were used to explore the association between the outcome variable, contraceptive method choice, and explanatory variables. Results: The prevalence of contraceptive method choice was relatively similar across slum and non-slum settlements. 34.3 % of women in slum communities and 28.1 % of women in non-slum communities reported using short-term methods. Slightly more women living in the non-slum settlements reported use of long-term methods, 9.2 %, compared to 3.6 % in slum communities. Older women were less likely to use short-term methods than their younger counterparts but more likely to use long-term methods. Currently married women were more likely than never married women to use short-term and long-term methods. Compared to those with no children, women with three or more children were more likely to report using long term methods. Women working outside the home or those in formal employment also used modern methods of contraception more than those in self-employment or unemployed. Conclusion: Use of short-term and long-term methods is generally low among women living in slum and non-slum contexts in Nairobi. Investments in increasing women’s access to various contraceptive options are urgently needed to help increase contraceptive prevalence rate. Thus, interventions that focus on more disadvantaged segments of the population will accelerate contraceptive uptake and improve maternal and child health in Kenya.
The larger study, focused on women living in two non-slum settings (Harambee and Jericho) and two slum settlements (Korogocho and Viwandani) in Nairobi, Kenya. The settlements were purposively selected by virtue of being part of the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), a research platform of the African Population and Health Research Center (APHRC) [23]. All the four settlements are also recognized as distinct communities and have chiefs appointed by the government of Kenya. Though their residents are socially and economically heterogeneous, Korogocho and Viwandani are densely populated settlements occupied largely by economically disadvantaged people. The two settlements are also characterized by high unemployment and poverty levels, crime, poor sanitation and high prevalence of risky sexual behaviors and poor sexual and reproductive health outcomes, compared to Nairobi as a whole [24–26]. Health and other facilities in Korogocho and Viwandani are very poorly resourced and often lack basic essentials. Poverty also prevents a large number of people in both settlements from accessing better quality services in the city. Viwandani is located in Nairobi East District occupying an area measuring 5.7 km2. Viwandani has a total of 17,926 households [26, 27]. It is located within the industrial area part of Nairobi, about 7 km from Nairobi city center. The informal settlement is characterized by overcrowding, insecurity, poor housing and sanitary conditions, and inadequate social amenities [26, 28]. Korogocho is in Nairobi North District occupying an area of 0.9 km2, located within Kasarani Division. It is situated approximately 11 km from Nairobi’s central business district. The informal settlement has a total of 12,909 households [27]. Most residents operate small businesses to earn their living as wage employment is difficult to come by. The slum is characterized by high levels of insecurity, poor accessibility, inadequate housing, poor sanitation and water quality, and low access to basic services like health care and education. Jericho and Harambee, are also characterized by socio-economic diversity, but unlike the slums communities are predominantly middle-class settings, and enjoy better health, access to quality to services, and other indicators [29–31]. They were established during the pre-colonial period as predominantly African settlements. They have relatively better residential structures including accessible feeder roads, drainage and sewerage system [32]. This paper uses data from a cross-sectional quantitative research project conducted in 2009/10 in two non-slum settings (Harambee and Jericho) and two slum settlements (Korogocho and Viwandani) in Nairobi, Kenya. While these communities are not contiguous, they, form the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), a research platform of the African Population and Health Research Center (APHRC). All four settlements are also recognized as distinct communities and have chiefs appointed by the government of Kenya. Though their residents are socially and economically heterogeneous, Korogocho and Viwandani are densely populated settlements occupied largely by economically disadvantaged people. The two settlements are also characterized by high unemployment and poverty levels, crime, poor sanitation and high prevalence of risky sexual behaviors and poor sexual and reproductive health outcomes, compared to Nairobi as a whole [18, 19]. Health and other facilities in Korogocho and Viwandani are very poorly resourced and often lack basic essentials. Poverty also prevents a large number of people in both settlements from accessing better quality services in the city [20]. Jericho and Harambee are also characterized by socio-economic diversity, but unlike the slums communities studies are predominantly middle-class settings, and enjoy better health, access to quality to services, and other indicators [21–23]. The study was based on a sample of randomly-selected women aged 15–49 years, using a two-stage sampling procedure. In the first stage, 1,000 households from the two slum settlements and 1,000 households from the two non-slum settings were drawn from the NUHDSS. A second stage consisted of a random selection of one eligible woman (usual resident aged 15–49 years) in each of the sampled households [30, 31]. The sample size was based on the practice by the demographic and health surveys (DHS), which typically assume that to obtain reasonable precision for most indicators, at least 800 completed interviews of women 15–49 years are needed in each domain. Accounting for possible missing data and non-responses, the sample size was set to 1,000 per area. The questionnaire sought information on respondents’ social, economic, demographic, pregnancy and birth histories (including miscarriages and abortions, stillbirths, and neonatal deaths), the intendedness of all pregnancies mentioned by the respondent irrespective of their outcomes, current use of contraception and specific methods used. A total of 1,962 women were successfully interviewed, yielding a response rate of 98.1 %. This paper analyses data from 1873 women who reported being sexually active. We exclude from our analysis, 89 women who reported that they had never had sex or were pregnant at the time of the survey. The question that reported current contraceptive use among women was as follows: ‘Are you CURRENTLY doing anything to avoid getting pregnant?’ those who responded with a ‘yes’ were further asked to state the method they were currently using. The options listed included: female sterilization, male sterilization, pill, IUD (e.g., coil), injectables (e.g., Depo), implants, male condoms, female condoms, lactational amenorrhea method (LAM), rhythm method (safe days), withdrawal, emergency contraception (e.g., e-pill), diaphragm, spermicide (e.g., gel, form), and other methods not listed above for which they were required to specify. From these categories, the outcome variable, contraceptive method choice, was measured as a four outcome variable coded as: ‘no method’ for women who reported not doing anything to prevent pregnancy, ‘traditional method’ for women using withdrawal and the rhythm methods which are less effective in pregnancy prevention; short-term methods (for women who reported using female and male condoms, injectables, pills, emergency contraception); and long-term methods (for women who reported using female and male sterilization, implants and IUD). The dependent variable, household wealth was computed from reported household possessions, amenities and dwelling characteristics using principal component analysis and recoded into tertiles; poor, medium, and rich [33, 34]. Measurement of pregnancy wantedness is based on questions about the desirability of recent pregnancies reported. The question asked to women was as follows “At the time you became pregnant with (NAME), did you want to become pregnantthen, did you want to wait untillater, or did younot wantto have another (more) children at all?”, the response was classified into three categories; never pregnant, intended pregnancy (for women who reported they wanted the pregnancy at the time of conception), and unintended (for women who reported wanting no more children and wanting later the pregnancy later than at the time of conception). Employment status was defined as self-employed for those who were engaged in their own means of earning income, informal employment referred to those engaged in income that are partially or fully outside government regulation, formal employment were those under government taxation regulation while the unemployed were those not engaged in any income generating activities. Contraceptive method choice is influenced by several factors. In this study, we hypothesize that three sets of factors, socio-demographic, socio-economic and behavioural/attitudinal factors as the major influencers of contraceptive method choice. Socio-demographic factors include age, marital status, ethnicity, parity, and household size. The level of education, wealth, type of residence and employment status are considered as socio-economic factors. Pregnancy wantedness on the other hand is considered as a behavioural/attitudinal factor. This conceptual framework makes an assumption that all these factors directly influence the choice a woman makes on the contraceptive method. Level of education is coded as none, primary and secondary/higher while wealth index is recoded as tertiles and labelled poor, middle and rich. Using statistical software STATA version 14 for the analysis, descriptive statistics were used to provide sample characteristics. Secondly, bivariate analysis was used to assess individual relationship of each explanatory variable with contraceptive method choice while multivariate analysis was used to assess relationships controlling for other explanatory variables. The dependent variable, a four outcome variable coded as no method, traditional methods, short-term and long-term methods was fitted in a multinomial model to predict the determinants of contraceptive method choice among women living in slum and non-slum settlements. Three models were fitted, Model I assessed the determinants of contraceptive method choice while controlling for socio-demographic factors, Model II controlled for socio-economic factors while model III controlled for behavioural/attitudinal factor. The results of the regression analyses have been presented by odds ratio (OR) with 95 % confidence interval. All analyses were weighted using the svy command to account for differences in sampling probabilities.
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