Individual, partner, and community variables associated with method-specific contraceptive beliefs in urban and rural Kenya

Caila Brander; Kathryn Risher; George Odwe; Yohannes Dibaba Wado; Francis Obare; John Cleland; Kazuyo Machiyama

doi:10.1016/j.contraception.2024.110470

Individual, partner, and community variables associated with method-specific contraceptive beliefs in urban and rural Kenya

Contraception. 2024 Apr 17:110470. doi: 10.1016/j.contraception.2024.110470. Online ahead of print.

Authors

Caila Brander¹, Kathryn Risher², George Odwe³, Yohannes Dibaba Wado⁴, Francis Obare³, John Cleland⁵, Kazuyo Machiyama⁵

Affiliations

¹ Research Division of Ibis Reproductive Health, Cambridge, MA, United States. Electronic address: cbrander@ibisreproductivehealth.org.
² Division of Epidemiology, Penn State College of Medicine, Hershey, PA, United States.
³ Reproductive Health Program, Population Council, Nairobi, Kenya.
⁴ Sexual, Reproductive Maternal, Newborn Child and Adolescent Health Unit, African Population and Health Research Center, Nairobi, Kenya.
⁵ Population and Studies Group, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.

PMID: 38641156
DOI: 10.1016/j.contraception.2024.110470

Abstract

Objectives: Global unmet need for contraception remains high. Contraceptive health-related beliefs are a barrier to contraceptive use but are poorly understood. This study examined quantitative differences in two health-related beliefs between pills, injectables, and implants.

Study design: We used cross-sectional baseline data collected between August and December 2016 from Nairobi (urban) and Homa Bay (rural) Kenya among women aged 15 to 39 years (N = 5081). Dichotomous outcome variables were constructed for two health-related beliefs (infertility and serious health problems) for the three methods. Using a socioecological framework, possible risk factors at individual, relationship, and community levels were identified a priori. We used logistic regression to identify factors associated with method-specific beliefs.

Results: Roughly a quarter of participants believed the methods caused serious health problems, while a smaller overall proportion believed the methods caused infertility. Risk factors patterned similarly across methods but differed between beliefs. In adjusted models, perceived partner approval of a method was associated with lower odds of believing it caused infertility or serious health problems. Unsatisfactory or mixed social network experiences predicted serious health problems but not infertility beliefs. Current use was associated with lower odds of believing all three methods caused serious health problems, but only implant users were more likely to believe they caused infertility. Past use was associated with higher odds of serious health problems but not infertility beliefs.

Conclusions: Across three methods, negative community and perceived partner attitudes toward specific contraceptive methods were associated with higher individual-level odds of contraceptive health beliefs in Kenya.

Implications: Efforts to support women who want to use contraception should focus on providing information on contraceptive health and fertility concerns, ideally targeting partners and women of all ages in addition to potential contraceptive users. It is reasonable to address these concerns broadly across commonly used contraceptive methods.

Keywords: Contraception; Contraceptive behaviors; Contraceptive beliefs; Family planning; Misconception; Unmet need for contraception.