A Qualitative Study Exploring How Family Planning Beliefs and Attitudes Contribute to Family Planning Behavior in Rural, Southeastern Kenya: Application of the Social Ecological Model

Published date01 December 2016
Date01 December 2016
A Qualitative Study Exploring How Family Planning
Beliefs and Attitudes Contribute to Family Planning
Behavior in Rural, Southeastern Kenya:
Application of the Social Ecological Model
Michele Coleman and Araceli Alonso
Overall, about 20 percent or 8.9 million women in Kenya have unmet family planning needs. The
total fertility rate as of 2014 was 3.9 births per woman, which did not meet the Kenya National
Population Policy for Sustainable Development target rate of 2.5, a rate that was set to help
improve the health of women and entire communities. Working with the staff from Nikumbuke-
Health by Motorbike (N-HbM), focus groups and in-depth interviews were conducted in June of
2013 in four rural villages of Southeastern Kenya to elucidate the determinants of reproductive
health, including the beliefs and attitudes surrounding family planning, and how these translate
into behaviors. The study results indicate that there is high knowledge of contraceptive methods
among the women in the communities, but this knowledge does not necessarily translate to behavior
or contraceptive use. Application of the Social Ecological Model identif‌ies mediators associated with
family planning behavior and suggests areas for interventions to meet the communities’ unmet
family planning needs at the intrapersonal, interpersonal, community, and societal levels. This
article outlines the specif‌ic recommendations given to N-HbM to translate family planning beliefs
and attitudes into behaviors, as well as discusses the global importance of designing family planning
programs that improve the health of women and their communities.
KEY WORDS: family planning, Kenya, Social Ecological Model
The use of family planning in sub-Saharan Africa varies by region and in
general lags behind the rest of the world, often failing to meet global
development standards. Family planning is def‌ined by the World Health
Organization (2016) as “allowing individuals and couples to anticipate and attain
their desired number of children and the spacing and timing of their births.” The
United Nations Sustainable Development Summit recently released the new
2030 sustainable development goals (SDGs) that build upon the millennium
development goals (MDGs); the need to increase family planning use is included
World Medical & Health Policy, Vol. 8, No. 4, 2016
1948-4682 #2016 Policy Studies Organization
Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA, and 9600 Garsington Road, Oxford, OX4 2DQ.
again as a much needed development goal. The MDGs made great progress
for women’s health, including declines in maternal, child, and infant death;
unfortunately, the global community did not accomplish universal access to
reproductive health, originally outlined in the MDGs and included again in the
SDGs (United Nations, 2015). An estimated 225 million women worldwide
want to prevent pregnancy but are not using an effective method (Singh, Darroch,
& Ashford, 2014). Specif‌ically in sub-Saharan Africa, the proportion of women
aged 15–49, married or in a union, who were using any method of contraception,
only moved from 13 percent to 28 percent from 1990 to 2015 (United Nations,
It is well established that the use of contraception and family planning
services reduces the number of unintended pregnancies; unsafe abortions; chronic
disease; and maternal, infant, and child deaths, all of which are of large concern
particularly in sub-Saharan Africa (United Nations, 2015). Yet, there still exist
prominent issues of translating this knowledge into family planning use. The
knowledge of at least one contraceptive method is almost omnipresent (99 percent)
among women in Kenya, but use is still at about 60 percent among married
women aged 15–49 and is lower in rural areas and in populations with less
education. Moreover, one out of every f‌ive women have an unmet family
planning need (Kenya National Bureau of Statistics et al., 2015). Kenya has seen a
decline in their total fertility rate in the past decade from 4.9 births in 2003 to 3.9
in 2014 (Kenya National Bureau of Statistics et al., 2015), but this did not reach
the Kenya National Population Policy for Sustainable Development target rate of
2.5 (Ettarh, 2011). Kenya had a population of 44.4 million in 2013, which is
expected to increase to 65.9 million in 2030, a rate that many consider to be
unsustainable (Population Reference Bureau, 2011). Much research has been
conducted to analyze why family planning uptake has increased at such a slow
rate, and numerous studies demonstrate the negative effects myths and false
information can have in a community as it relates to family planning use (Gueye,
Speizer, Corroon, & Okigbo, 2015; Kenya National Bureau of Statistics et al., 2015;
Mutombo, Bakibinga, Mukiira, & Kamande, 2014; Ochako et al., 2015; Rutenberg
& Watkins, 1997; Wambui, Ek, & Alehagen, 2009).
Many studies have attempted to quantify family planning knowledge and
reasons for low use. A multi-nation study reviewed demographic and health
surveys (DHS) from 51 countries, including Kenya, from 2006 to 2013 to
understand the reasons why women do not use contraceptives. The three main
reasons given by women were they are engaging in infrequent or no sex, they are
concerned by the side effects or health risks of the method, and their partner
expressed opposition of using a method (Sedgh & Hussain, 2014). The 2014
Kenya-specif‌ic DHS found that across all age groups, the perceived and actual
side effects of contraceptive methods were the primary barrier to use and most
common reason for method discontinuation (Kenya National Bureau of Statistics
et al., 2015). A quantitative study in rural, Western Kenya surveyed 923 women
for their levels of family planning knowledge and related factors. The researchers
found the women had low levels of knowledge regarding the benef‌its of family
Coleman/Alonso: Rural Kenya Family Planning Behavior 365

To continue reading

Request your trial

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT