After a long period of slow progress, the recent uptake of contraceptive use in Kenya has been dramatic. This report describes adoption of a method and method switching and discontinuation among a cohort of married women aged 25-34 in two contrasting rural areas. A retrospective "fertility diary" completed by each woman provided information on spousal separation, reproductive status, and contraceptive use over a period of 46-48 months. Contraceptive prevalence rose rapidly over the period in both areas, with significant net adoption of injectables in both areas and of IUDs in one only. Method discontinuation was concentrated among users of pills, barrier methods, and "natural" methods, and only one-third of all discontinuations were voluntary. The wide differences between the two rural areas in contraceptive prevalence were not totally reflected in recent fertility levels, and the contribution of other proximate determinants of fertility, particularly postpartum amenorrhea and spousal separation, are discussed.
PIP:
In Kenya, researchers compared data on 377 25-34 year old women in rural Kisa with data on 338 such women in rural Ena to determine changes in contraceptive adoption, method switching, and method discontinuation and to examine the effects of contraceptive use of fertility in relation to other determinants of fertility. Contraceptive prevalence rose between 1987 and 1990 in both areas. It rose somewhat more quickly and was greater in Ena than Kisa (35-50% vs. 12-20%). Similarly more women had ever used a method in Ena than Kisa (76% vs. 35.5%). Women in Ena were more likely to use natural methods than those in Kisa (77 episodes vs. 11 episodes). Adoption of injectables was the contraceptive which showed the strongest net growth in both areas. In Ena, adoption of the IUD also grew considerably. The contraceptive mix in Ena was more balanced than it was in Kisa. In Ena, natural method users had fallen. The 3 main methods were oral contraceptives (OCs), injectables, and IUDs. Injectables and OCs predominated in Kisa. Few women used natural methods. Tubal ligation increased among high parity women. Few women in either area used condoms. OCs, barrier methods, and natural methods were used for short-term birth spacing. The major reasons for discontinuation were wanting another child (34.3%) and method failure/poor compliance (30.2%). Considerable male out-migration from Kisa (58% vs. 21% for Ena) and high infertility levels (untreated sexually transmitted diseases transferred to wives from husbands who had out-migrated) may have kept fertility levels relatively low. Most husbands had returned to Kisa during the Christmas holiday (80% of couples together) resulting in birth seasonality with peaks in September-October. Postpartum amenorrhea played a greater role in protecting women against pregnancy in Kisa than it did in Ena (51% vs. 35%). Women of Kisa had higher number of live births and age at 1st birth than women in Ena (4.4 vs. 3.6 and 18.6 vs. 19.8, respectively, p.001), especially simultaneous postpartum amenorrhea and separation (15% vs. 2%).