Women’s and girls’ experiences of reproductive coercion and opportunities for intervention in family planning clinics in Nairobi, Kenya: a qualitative study

Abstract

Background: Reproductive coercion (RC), which includes contraceptive sabotage and pregnancy coercion, may help explain known associations between intimate partner violence (IPV) and poor reproductive health outcomes, such as unintended pregnancy. In Kenya, where 40% of ever-married women report IPV and 35% of ever-pregnant women report unintended pregnancy, these experiences are pervasive and co-occurring, yet little research exists on RC experiences among women and adolescent girls. This study seeks to qualitatively describe women's and girls' experiences of RC in Nairobi, Kenya and opportunities for clinical intervention. Methods: Qualitative data were collected as part of the formative research for the adaptation of an evidence-based intervention to address reproductive coercion and IPV in clinical family planning counselling and provision in Nairobi, Kenya in April 2017. Focus group discussions (n = 4, 30 total participants) and in-depth interviews (n = 10) with family planning clients (ages 15-49) were conducted to identify specific forms of reproductive coercion, other partner-specific barriers to successful contraception use, and perceived opportunities for family planning providers to address RC among women and girls seeking family planning services. Additionally, data were collected via semistructured interviews with family planning providers (n = 8) and clinic managers (n = 3) from family planning clinics. Data were coded according to structural and emergent themes, summarized, and illustrative quotes were identified to demonstrate sub-themes. Kenyan family planning providers and administrators informed interpretation. Results: The results of this study identified specific forms of pregnancy coercion and contraceptive sabotage to be common, and often severe, impeding the use of contraceptives among female family planning clients. This study offers important examples of women's strategies for preventing pregnancy despite experiencing reproductive coercion, as well as opportunities for family planning providers to support clients experiencing reproductive coercion in clinical settings.

Protocol for a matched-pair cluster control trial of ARCHES (Addressing Reproductive Coercion in Health Settings) among women and girls seeking contraceptive services from community-based clinics in Nairobi, Kenya

“…More than 1 in 3 (36%) women report currently using a modern form of contraception [31]. Although no previous quantitative studies of RC have been conducted in Kenya, our qualitative formative research among women and girls seeking contraceptive services suggested that RC and IPV are highly prevalent in this context, and that RC appears to pose a major barrier to successful contraceptive use [32].…”

“…Semi-structured interviews with contraceptive service providers and clinic managers were conducted to understand providers' experiences with patients reporting RC and IPV, and to identify further areas for adaptation and integration. Detailed methods and findings for this qualitative study are reported elsewhere [32].…”

Protocol for a Matched-Pair Cluster Control Trial of ARCHES (Addressing Reproductive Coercion in Health Settings) among Women and Girls Seeking Contraceptive Services from Community-Based Clinics in Nairobi, Kenya

“…Similar to many other LMIC contexts, unintended pregnancy is high in Kenya, with 25.4% of births being mistimed and 10.3% unwanted (25), and the more than 2 in 5 women reporting IPV in the country are at 70% increased odds of unintended pregnancy as compared to their same age peers (26). More than 1 in 3 (36%) women reporting currently usinga modern form of contraception (26).Although no previous quantitative studies of RC have been conducted in Kenya, our qualitative formative research among women and girls seeking contraceptiveservicessuggested that RC and IPV are highly prevalentin this context, and that RC appears to pose a major barrier to successful contraceptive use (27).…”

“…Semistructured interviews with contraceptive service providers and clinic managers were conducted to understand providers' experiences with patients reportingRC and IPV, and to identify further areas for adaptation and integration. Detailed methods and findings for this qualitative study are reported elsewhere (27).…”

“…In the ARCHES Kenya adaptation, all women and girls first receive comprehensive counseling and education on a broad range of contraceptive methods, and are asked about their pregnancy and contraception history and desires.Integrated within this otherwise standard contraceptive counseling is education on RC and contraceptive methods that may be used with a low risk of detection or interference from male partners or family members (i.e., contraceptive methods that may be used covertly,and strategies to reduce the likelihood of detection when using these methods) if they or someone that they know is facing RC.The specific strategies for reducing risk of detection included in ARCHES counseling are those that local women reported utilizing in the formative research (27).…”