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

• Author: Araceli Alonso,Michele Coleman
• DOI: http://doi.org/10.1002/wmh3.207
• Published date: 01 December 2016
• Date: 01 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

Introduction

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

364

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,

2015).

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