**Acknowledgements**

controversies around the association between hormonal contraception and increased risk of

Previous studies showed that contraceptive failure was more prevalent among younger than older users, which could be an indication of incorrect use of methods among these sub-groups [29, 30]. The findings of this chapter, on the other hand, show that there were no significant variations in reporting contraceptive failure by age among participants in the study. This could largely be due to the study's focus on married or cohabiting women—one of its limitations—which might have left out many unmarried young women at risk of experiencing contraceptive failure. However, evidence on variations in contraceptive failure by level of education is mixed, with some studies finding higher failure rates among less educated than more educated users, while others found no difference between the two sub-groups [29–31]. The findings of this chapter are consistent with those of previous studies that did not find significant differences in contraceptive failure by levels of education. The significant differences in contraceptive failure between sub-counties included in the study are, on the other hand, consistent with those of other studies that found sub-national variations in method failure,

In spite of the consistency of the findings of this chapter with those of previous studies, they could be affected by the fact that information on contraceptive failure was based on women's self-reports, which could be subject to under- or over-reporting. In strict sense, contraceptive failure refers to the occurrence of a pregnancy during sexual intercourse when contraception is used. It is, however, unlikely that women may precisely determine that a pregnancy occurred during a particular sexual act when she or her partner was using contraception. Some women may also have become pregnant when they were not protected at all due to diminished efficacy of the methods they were using after failing to honor appointments for resupply. In addition, as previously mentioned, the exclusion of unmarried women from the study may result in under-reporting of episodes of contraceptive failure if young women who are likely to be unmarried were at higher risk of experiencing failure than their older married counterparts. Contraceptive failure also came out as an emerging issue during data collection and was not the primary objective of the study that provided data for this chapter. Consequently, some information that could further improve our understanding of the dynamics of contraceptive failure in such contexts was not captured, including the specific user and provider deficien-

which could be an indication of disparities in provision of quality care [29].

cies that contributed to failure and users' agency after experiencing failure.

Although the family planning program in Kenya appears to be doing well at the national level, experiences of women at sub-national levels suggest the need for targeted interventions to address challenges associated with contraceptive failure that might hamper the success of

HIV acquisition [18, 27, 28].

164 Family Planning

**5. Study limitations**

**6. Conclusion**

The study that provided data for this chapter was funded by UKaid from the Department for International Development (DfID) through STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) Research Programme Consortium. The opinions expressed in this chapter are, however, solely those of the authors and do not necessarily reflect the views of the funding agency or STEP UP partners.

### **Author details**

Francis Obare\*, George Odwe and Wilson Liambila

\*Address all correspondence to: fonyango@popcouncil.org

Population Council, Nairobi, Kenya
