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Type Journal Article - International journal for equity in health
Title Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?
Volume 12
Issue 1
Publication (Day/Month/Year) 2013
Page numbers 71
URL http://www.biomedcentral.com/content/pdf/1475-9276-12-71.pdf
Introduction: 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.
Methods: 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.
Results: 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.
Conclusion: 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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