Academic journal article International Perspectives on Sexual and Reproductive Health

Longitudinal Evaluation of the Tupange Urban Family Planning Program in Kenya

Academic journal article International Perspectives on Sexual and Reproductive Health

Longitudinal Evaluation of the Tupange Urban Family Planning Program in Kenya

Article excerpt

CONTEXT: Levels of fertility and contraceptive use have long fluctuated in Kenya. The multicomponent Tupange program, part of the Urban Reproductive Health Initiative, was initiated in 2011 to increase use of modern family planning methods.

METHODS: Women aged 15-49 in the five Kenyan cities where Tupange was implemented were interviewed in 2010 and reinterviewed in 2014 to obtain information on their contraceptive use and exposure to components of the Tupange program. Fixed-effects models were estimated to identify associations between program exposure and use of modern family planning methods. Analyses were performed to determine the relative cost-effectiveness of program components.

RESULTS: During the four-year follow-up period, the proportion of women using modern contraceptives increased from 45% to 52%, and the proportion of users who were using long-acting or permanent methods rose from 6% to 19%. The fixed-effects model indicated that modern method use was associated with having heard Tupange-related local radio programming and marginally associated with having discussed family planning with a community health worker (CHW); among women who were unmarried or did not give birth during the study period, modern method use was associated with living near program facilities. Local radio programming was the most cost-effective program component, followed by proximity to Tupange facilities and discussions with CHWs.

CONCLUSIONS: Urban reproductive health programs seeking to increase use of modern family planning methods in Kenya and other Sub-Saharan African settings should consider multicomponent approaches that include CHW activities, local radio programming and improvements to the supply environment.

International Perspectives on Sexual and Reproductive Health, 2017, 43(2):75-87, https://doi.org/10.1363/43e4117

Kenya is a complex, challenging setting for family planning programming. In the late 1970s, the country's total fertility rate (TFR) was eight children per woman, one of the highest national rates observed at the time. (1-5) By 1989, Kenya's TFR had begun to decline in conjunction with increasing use of contraceptives, (4-6) eventually reaching an estimated 4.7 children per woman in the 1998 Demographic and Health Survey (DHS). (7) However, the 2003 DHS indicated that the contraceptive prevalence rate had plateaued (at 39% in both 1998 and 2003) and that the TFR had increased slightly, to 4.9. (8) On the basis of these findings, family planning advocates in Kenya pushed for the government to increase access to family planning and reproductive health services, particularly for poor and vulnerable populations. (9-11) By 2008, the TFR had declined to 4.6 and the contraceptive prevalence rate had increased to 46%, (12) suggesting that trends were again on track in the desired direction.

Use of long-acting and permanent methods (LAPMs) of family planning fluctuated during this period. In 1993, two-fifths of users of modern family planning methods were using a LAPM. By 2003, only one-quarter of modern method users were using a LAPM, and the 2008 DHS showed a continued decline in LAPM use. (9) This prompted a renewed focus on LAPMs by the Kenyan government, which expanded projects to train providers, ensure commodity security, partner with private-sector organizations and create demand for LAPMs. (13)

A complicating factor for meeting family planning needs in Kenya is the high rate of population growth in urban areas, fueled by both high fertility and rural-to-urban migration. In developing countries, many urban dwellers reside in informal settlements (also called slums) where they have tenuous or no property rights and poor living conditions. (14-16) In Nairobi, about half of the population lives in informal settlements. (17) Residents of slums have an elevated risk of mortality and morbidity from communicable diseases because of overcrowding, inadequate nutrition, and poor water, hygiene and sanitation. …

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