Improving provision of family planning among pastoralists in Kenya: Perspectives from health care providers, community and religious leaders

Abstract

There exist significant inequities in access to family planning (FP) in Kenya, particularly for nomadic and semi-nomadic pastoralists. Health care providers (HCP), are key in delivering FP services. Community leaders and religious leaders are also key influencers in women's decisions to use FP. We found limited research exploring the perspectives of both HCPs and these local leaders in this context. We conducted semistructured interviews with HCPs (n=4) working in facilities in Wajir and Mandera, and community leaders (n=4) and religious leaders (n=4) from the nomadic and semi-nomadic populations the facilities serve. We conducted deductive and inductive thematic analysis. Three overarching themes emerged: perception of FP as a health priority, explanations for low FP use, and recommendations to improve access. Four overlapping sub-themes explained low FP use: desire for large families, tension in FP decision-making, religion and culture, and fears about FP. Providers were from different socio-demographic backgrounds to the communities they served, who faced structural marginalisation from health and other services. Programmes to improve FP access should be delivered alongside interventions targeting the immediate health concerns of pastoralist communities, incorporating structural changes. HCPs that are aware of religious and cultural reasons for non-use, play a key role in improving access.

Effectiveness of Health Education Interventions Methods to Improve Contraceptive Knowledge, Attitude, and Uptake Among Women of Reproductive Age, Ethiopia: A Systematic Review and Meta-Analysis

“…24 Increased contraceptive knowledge is associated with a reduced risk of unplanned pregnancy, by more consistent use of highly effective contraceptives. 10,25,26 The findings of this study would provide evidence to FP program managers and service providers to design a targeted approach. Besides, it could be a contribution for achieving the growth transformation plan of the country and sustainable development goals.…”

Exploring the Influence of Sociocultural Factors on Non Utilization of Family Planning amongst Women in Ethiopia's Pastoralist Regions

“…If husbands oppose modern contraceptive use, women may face difficulties using FP methods. Women may conform to their husbands' beliefs or preferences due to societal norms or religious teachings, impacting their decision-making on using contraceptives [25].…”

“Everyone has their own problems and realities so the religious community cannot judge someone.” Contraception motivations and perceived consequences among young contraceptive users who practice a religion in Burkina Faso

“…Qualitative studies have also been undertaken to obtain a better understanding of how interpretations of religion in different contexts and communities are related to perceptions of contraceptive use and contraceptive decision-making. These studies have focused on women of reproductive age [ 26 – 30 ], men of reproductive age [ 26 , 28 – 30 ], providers [ 31 ], and religious leaders [ 28 , 31 – 35 ]. A notable gap in qualitative (and quantitative) studies on religion and its association with contraceptive use has been an examination of how religion and interpretations of religious doctrines by women, adolescents, and religious leaders are associated with young people’s (i.e., under age 25) and unmarried youth’s contraceptive decision-making and their access to and use of sexual and reproductive health (SRH) information and services.…”