Preferred Contraceptive Method Access in Public Facilities in Western Kenya: A Mixed-Methods Analysis of Reasons for Non-Preferred Method Use Using Mystery Client Data

Stephanie Chung, University of North Carolina, Gillings School of Global Public Health
Katherine Tumlinson, University of North Carolina, Chapel Hill
Dickens Onyango, Kisumu County Department of Health
Leigh G. Senderowicz, University of Wisconsin at Madison
Larissa Jennings Mayo-Wilson, University of North Carolina, Chapel Hill
Julie Daniels, University of North Carolina, Chapel Hill
Brian Pence, University of North Carolina at Chapel Hill
Sian Curtis, University of North Carolina at Chapel Hill
Amy Bryant, University of North Carolina, Chapel Hill

Introduction: Unmet need is a common family planning programmatic indicator. However, it assumes all contraceptive users have their needs met, as one can only have “unmet need” if they are not using contraception. Therefore, this widely used indicator does not recognize the needs of contraceptive users who would prefer to use a different method (non-preferred method users). Previous research has shown that inappropriate medical contraindications (IMCs) may contribute to non-preferred method use, but IMCs are difficult to measure. Methods: This mixed-methods study uses quantitative and qualitative data from mystery clients posing as family planning seekers in Kisumu County, Kenya to describe the frequency and nature of non-preferred method use, including understudied contributing factors such as IMCs. Results: Mystery clients were offered non-preferred methods in 22% of visits, but denied all methods in 43% of visits. Qualitative data shows IMCs often prevented mystery clients from accessing preferred methods. Structural factors, especially stockouts, greatly contributed to preferred method denial, but provider bias was rarer. Discussion: Inappropriate medical reasons for denial illustrated a need for improved understanding of contraindication criteria, including when to use pregnancy checklists. Additionally, method stockouts and lack of trained providers were significant barriers to preferred and all contraceptive access.

Keywords: Sexual and Reproductive Health and Rights, Mixed methods research, Family Planning and Contraception

See extended abstract.