Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?
Identifieur interne : 001418 ( Pmc/Curation ); précédent : 001417; suivant : 001419Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?
Auteurs : Jean Christophe Fotso [États-Unis, Kenya] ; Ilene S. Speizer [États-Unis] ; Carol Mukiira [Kenya] ; Paul Kizito [Kenya] ; Vane Lumumba [Kenya]Source :
- International Journal for Equity in Health [ 1475-9276 ] ; 2013.
Abstract
Kenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor.
We use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya.
There was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993–1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09.
The narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.
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DOI: 10.1186/1475-9276-12-71
PubMed: 23978064
PubMed Central: 3847584
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Speizer</name><affiliation wicri:level="1"><nlm:aff id="I3">Carolina Population Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, 27599, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Carolina Population Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, 27599</wicri:regionArea></affiliation></author><author><name sortKey="Mukiira, Carol" sort="Mukiira, Carol" uniqKey="Mukiira C" first="Carol" last="Mukiira">Carol Mukiira</name><affiliation wicri:level="1"><nlm:aff id="I4">African Population and Health Research Center (APHRC), P.O. Box 10787-00100, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>African Population and Health Research Center (APHRC), P.O. 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Speizer</name><affiliation wicri:level="1"><nlm:aff id="I3">Carolina Population Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, 27599, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Carolina Population Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, 27599</wicri:regionArea></affiliation></author><author><name sortKey="Mukiira, Carol" sort="Mukiira, Carol" uniqKey="Mukiira C" first="Carol" last="Mukiira">Carol Mukiira</name><affiliation wicri:level="1"><nlm:aff id="I4">African Population and Health Research Center (APHRC), P.O. Box 10787-00100, Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>African Population and Health Research Center (APHRC), P.O. Box 10787-00100, Nairobi</wicri:regionArea></affiliation></author><author><name sortKey="Kizito, Paul" sort="Kizito, Paul" uniqKey="Kizito P" first="Paul" last="Kizito">Paul Kizito</name><affiliation wicri:level="1"><nlm:aff id="I5">National Council for Population and Development (NCPD), Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>National Council for Population and Development (NCPD), Nairobi</wicri:regionArea></affiliation></author><author><name sortKey="Lumumba, Vane" sort="Lumumba, Vane" uniqKey="Lumumba V" first="Vane" last="Lumumba">Vane Lumumba</name><affiliation wicri:level="1"><nlm:aff id="I5">National Council for Population and Development (NCPD), Nairobi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>National Council for Population and Development (NCPD), Nairobi</wicri:regionArea></affiliation></author></analytic><series><title level="j">International Journal for Equity in Health</title><idno type="eISSN">1475-9276</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Kenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor.</p></sec><sec><title>Methods</title><p>We use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya.</p></sec><sec><title>Results</title><p>There was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993–1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09.</p></sec><sec><title>Conclusion</title><p>The narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Bongaarts, J" uniqKey="Bongaarts J">J Bongaarts</name></author><author><name sortKey="Cleland, J" uniqKey="Cleland J">J Cleland</name></author><author><name sortKey="Townsend, Jw" uniqKey="Townsend J">JW Townsend</name></author><author><name sortKey="Bertrand, Jt" uniqKey="Bertrand J">JT Bertrand</name></author><author><name sortKey="Das Gupta, M" uniqKey="Das Gupta M">M Das Gupta</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cleland, J" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Equity Health</journal-id><journal-id journal-id-type="iso-abbrev">Int J Equity Health</journal-id><journal-title-group><journal-title>International Journal for Equity in Health</journal-title></journal-title-group><issn pub-type="epub">1475-9276</issn><publisher><publisher-name>BioMed Central</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23978064</article-id><article-id pub-id-type="pmc">3847584</article-id><article-id pub-id-type="publisher-id">1475-9276-12-71</article-id><article-id pub-id-type="doi">10.1186/1475-9276-12-71</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes" id="A1"><name><surname>Fotso</surname><given-names>Jean Christophe</given-names></name><xref ref-type="aff" rid="I1">1</xref><xref ref-type="aff" rid="I2">2</xref><email>jeanchristophe.fotso@concern.net</email></contrib><contrib contrib-type="author" id="A2"><name><surname>Speizer</surname><given-names>Ilene S</given-names></name><xref ref-type="aff" rid="I3">3</xref><email>speizer@mail.unc.edu</email></contrib><contrib contrib-type="author" id="A3"><name><surname>Mukiira</surname><given-names>Carol</given-names></name><xref ref-type="aff" rid="I4">4</xref><email>cmukiira@aphrc.org</email></contrib><contrib contrib-type="author" id="A4"><name><surname>Kizito</surname><given-names>Paul</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>pkizito@ncpd-ke.org</email></contrib><contrib contrib-type="author" id="A5"><name><surname>Lumumba</surname><given-names>Vane</given-names></name><xref ref-type="aff" rid="I5">5</xref><email>vlumumba@ncpd-ke.org</email></contrib></contrib-group><aff id="I1"><label>1</label>Innovations for MNCH, Concern Worldwide US, New York, NY, 10017, USA</aff><aff id="I2"><label>2</label>Independent Consultant, Population & Reproductive Health, Nairobi, Kenya</aff><aff id="I3"><label>3</label>Carolina Population Center, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, 27599, USA</aff><aff id="I4"><label>4</label>African Population and Health Research Center (APHRC), P.O. Box 10787-00100, Nairobi, Kenya</aff><aff id="I5"><label>5</label>National Council for Population and Development (NCPD), Nairobi, Kenya</aff><pub-date pub-type="collection"><year>2013</year></pub-date><pub-date pub-type="epub"><day>27</day><month>8</month><year>2013</year></pub-date><volume>12</volume><fpage>71</fpage><lpage>71</lpage><history><date date-type="received"><day>5</day><month>7</month><year>2013</year></date><date date-type="accepted"><day>22</day><month>8</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2013 Fotso et al.; licensee BioMed Central Ltd.</copyright-statement><copyright-year>2013</copyright-year><copyright-holder>Fotso et al.; licensee BioMed Central Ltd.</copyright-holder><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.0"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><self-uri xlink:href="http://www.equityhealthj.com/content/12/1/71"></self-uri><abstract><sec><title>Introduction</title><p>Kenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor.</p></sec><sec><title>Methods</title><p>We use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya.</p></sec><sec><title>Results</title><p>There was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993–1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09.</p></sec><sec><title>Conclusion</title><p>The narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.</p></sec></abstract></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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