**Contraception Failure**

**Chapter 8**

**Provisional chapter**

**Contraceptive Failure among Women in Homa Bay**

Although the Kenya family planning program appears successful at the national level with contraceptive prevalence rate (CPR) in 2014 surpassing the 2015 target of 56% sub-national variations suggest the need to understand the patterns at the local levels to inform programs to either sustain or improve further the levels that the country has attained. This chapter examines the reasons for contraceptive failure among 166 women aged 15–39 years in three sub-counties of Homa Bay County in Kenya. The findings show that failure of methods such as injectables, pills and condoms was mostly because of challenges with client adherence and inconsistent use. Failure of long-acting and permanent methods such as implants and female sterilization was partly due to limited provider capacity to offer the methods and partly due to inability to afford the costs of resupplies of implants. These patterns were further exacerbated by limited access to adequate information on the part of users, which could enable them make informed contraceptive choices. The experiences of women regarding contraceptive failures—including highly effective long-acting and permanent methods—suggest the need for targeted interventions to address challenges that might hamper the success of the family planning pro-

**Contraceptive Failure among Women in Homa Bay** 

DOI: 10.5772/intechopen.72161

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution,

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

and reproduction in any medium, provided the original work is properly cited.

The potential benefits of family planning have informed efforts to increase investments in contraceptives especially in developing countries since the 1960s [1, 2]. Such benefits include

**Keywords:** contraceptive use, contraceptive failure, user and provider deficiency,

**County of Kenya: A Matter of User and Provider**

**County of Kenya: A Matter of User and Provider** 

Francis Obare, George Odwe and Wilson Liambila

Francis Obare, George Odwe and Wilson Liambila

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.72161

gram in such localized settings.

rural Kenya

**1. Introduction**

**Deficiencies**

**Abstract**

**Deficiencies**

**Provisional chapter**

#### **Contraceptive Failure among Women in Homa Bay County of Kenya: A Matter of User and Provider Deficiencies County of Kenya: A Matter of User and Provider Deficiencies**

**Contraceptive Failure among Women in Homa Bay** 

DOI: 10.5772/intechopen.72161

Francis Obare, George Odwe and Wilson Liambila Francis Obare, George Odwe and Wilson Liambila Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.72161

#### **Abstract**

Although the Kenya family planning program appears successful at the national level with contraceptive prevalence rate (CPR) in 2014 surpassing the 2015 target of 56% sub-national variations suggest the need to understand the patterns at the local levels to inform programs to either sustain or improve further the levels that the country has attained. This chapter examines the reasons for contraceptive failure among 166 women aged 15–39 years in three sub-counties of Homa Bay County in Kenya. The findings show that failure of methods such as injectables, pills and condoms was mostly because of challenges with client adherence and inconsistent use. Failure of long-acting and permanent methods such as implants and female sterilization was partly due to limited provider capacity to offer the methods and partly due to inability to afford the costs of resupplies of implants. These patterns were further exacerbated by limited access to adequate information on the part of users, which could enable them make informed contraceptive choices. The experiences of women regarding contraceptive failures—including highly effective long-acting and permanent methods—suggest the need for targeted interventions to address challenges that might hamper the success of the family planning program in such localized settings.

**Keywords:** contraceptive use, contraceptive failure, user and provider deficiency, rural Kenya

### **1. Introduction**

The potential benefits of family planning have informed efforts to increase investments in contraceptives especially in developing countries since the 1960s [1, 2]. Such benefits include

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

improvements in women's and children's health through appropriate spacing of births which in turn contribute to reductions in maternal and child mortality that could arise from having short birth intervals; enhanced educational and employment opportunities for women due to the ability to control their fertility; and environmental sustainability that results from creating a balance between population and available resources [3–7]. Although efforts to improve contraceptive uptake have led to increased use of modern family planning methods in some parts of the developing world, many countries are still characterized by high levels of unmet need for contraception and unintended pregnancies [8, 9]. It was, for instance, estimated that in 2012, 222 million women in developing countries had an unmet need for modern contraceptives, with the prevalence of unmet need being highest in most parts of sub-Saharan Africa [5]. In addition, 40% of 213 million pregnancies that occurred globally in 2012 were unintended, with Africa recording the highest rate of unintended pregnancies per 1000 women aged 15–44 years [10].

However, the success at the national level masked sub-national disparities in contraceptive use and reach of the family planning program in the country. Estimates from the 2014 KDHS, for instance, showed that CPR varied from a low of 2% in Mandera County in the former North Eastern Province to a high of 81% in Kirinyaga County in the former Central Province [17]. Among counties in the former Nyanza Province, Homa Bay County had the second lowest CPR (of 47%) among six counties in the region (with Nyamira County having the highest CPR of 68% in the region) [17]. The sub-national variations in contraceptive use suggest the need to understand the patterns at the local levels to inform programs to either sustain or improve further the contraceptive prevalence rates that the country has attained. This chapter examines the reasons for contraceptive failure among women in Homa Bay County. Contraceptive failure is likely to negatively affect the future of family planning programs not only in Homa Bay County, but Kenya as a whole and other similar contexts. Understanding the reasons for contraceptive failure is therefore important for informing strategies to further

Contraceptive Failure among Women in Homa Bay County of Kenya…

http://dx.doi.org/10.5772/intechopen.72161

157

From a global perspective, the 2012 London Summit on Family Planning set a goal of providing modern contraceptive methods to 120 million women with unmet need for contraception in 69 of the poorest countries by 2020 [19]. One strategy that has been proposed for achieving that goal is to support the women and girls who are already using contraception to continue using their current methods or to adopt other modern methods [12, 20]. The rationale for the strategy is that programmatically, it requires fewer resources to support those who have already overcome some of the barriers to contraceptive use than to address barriers related to non-use of contraception [12, 20]. Contraceptive discontinuation and failure are major contributors to unintended pregnancy among past and current users of contraception [12, 20, 21]. Understanding the reasons for contraceptive failure is therefore important for informing strategies to achieve the global goal of providing modern contraceptive methods to 120 mil-

Data are from a cross-sectional study that was conducted between November and December 2016 among currently married or cohabiting women aged 15–39 years in three rural subcounties of Homa Bay County, namely, Ndhiwa, Rachuonyo north and Rachuonyo south. The county, located along the shores of Lake Victoria in western Kenya region, was purposefully selected based on three factors. First, Homa Bay County is one of the counties with rapidly growing population. According to the 2009 Kenya population and housing census, the county was home to 963,794 people at the time of the census [22]. The population was projected to rise to about 1.2 million persons by 2017, of which, 564,843 were projected to be males while 612,338 females [23]. This growth is largely a result of high fertility, which is estimated at 5.2 children per woman, compared to a national average of 3.9 children per woman [17]. Second, the county continues to experience challenges with respect to reproductive

improve the performance of family planning programs in such settings.

lion women with unmet need for contraception by 2020.

**2. Data and methods**

**2.1. Data**

Unintended pregnancies result from non-use of contraception, use of ineffective methods, contraceptive discontinuation or switching for reasons other than wanting a pregnancy, and contraceptive failure [8, 9, 11]. With respect to contraceptive failure, which is the focus of this chapter, available estimates show that about a third of unintended pregnancies in developing countries result from method failure [12, 13]. Evidence further shows that contraceptive failure rate (number of failures per 100 episodes of use) within the first year of use is lowest for permanent methods such as female sterilization, followed by longer-acting methods such as implants, intrauterine devices (IUDs), and injectables while short-acting methods such as pills and male condoms have the second highest failure rates after traditional methods including withdrawal, periodic abstinence, and rhythm [12, 13]. Contraceptive failure may negatively affect the success of family planning programs especially in developing countries where uptake of modern methods is further hampered by limited method mix, weak service delivery systems, health concerns about possible side effects, as well as societal opposition to and misconceptions about contraception [6, 14, 15].

Consistent with global efforts to improve family planning uptake in developing countries, national estimates show that the contraceptive prevalence rate (CPR) in Kenya—the proportion of currently married women using any method of contraception—more than doubled from 27% in 1989 to 58% in 2014 [16, 17]. Use of modern methods nearly tripled over the same period from 18% in 1989 to 53% in 2014 [16, 17]. The 2014 CPR level raised excitement among the donor community, policy makers and program implementers since it surpassed the target of 56% that the country had set to achieve by 2015 as part of the Millennium Development Goals (MDGs). The achievement was attributed to a combination of factors, including deliberate efforts to reposition family planning after a decade of focus on HIV/AIDS; implementation of a national program on AIDS, Population and Health Integrated Assistance (APHIA) funded by the United States Agency for International Development (USAID) that focused on health systems strengthening; increased health sector funding for family planning; improvements in the capacity of healthcare workers to provide services; streamlining the procurement and distribution of commodities through the Kenya Medical Supplies Agency (KEMSA); and using innovative service delivery models such as mobile outreaches, in-reach/choice camps in facilities, community-based distribution, and integration of services [18].

However, the success at the national level masked sub-national disparities in contraceptive use and reach of the family planning program in the country. Estimates from the 2014 KDHS, for instance, showed that CPR varied from a low of 2% in Mandera County in the former North Eastern Province to a high of 81% in Kirinyaga County in the former Central Province [17]. Among counties in the former Nyanza Province, Homa Bay County had the second lowest CPR (of 47%) among six counties in the region (with Nyamira County having the highest CPR of 68% in the region) [17]. The sub-national variations in contraceptive use suggest the need to understand the patterns at the local levels to inform programs to either sustain or improve further the contraceptive prevalence rates that the country has attained. This chapter examines the reasons for contraceptive failure among women in Homa Bay County. Contraceptive failure is likely to negatively affect the future of family planning programs not only in Homa Bay County, but Kenya as a whole and other similar contexts. Understanding the reasons for contraceptive failure is therefore important for informing strategies to further improve the performance of family planning programs in such settings.

From a global perspective, the 2012 London Summit on Family Planning set a goal of providing modern contraceptive methods to 120 million women with unmet need for contraception in 69 of the poorest countries by 2020 [19]. One strategy that has been proposed for achieving that goal is to support the women and girls who are already using contraception to continue using their current methods or to adopt other modern methods [12, 20]. The rationale for the strategy is that programmatically, it requires fewer resources to support those who have already overcome some of the barriers to contraceptive use than to address barriers related to non-use of contraception [12, 20]. Contraceptive discontinuation and failure are major contributors to unintended pregnancy among past and current users of contraception [12, 20, 21]. Understanding the reasons for contraceptive failure is therefore important for informing strategies to achieve the global goal of providing modern contraceptive methods to 120 million women with unmet need for contraception by 2020.
