Determinants of Intrauterine Contraceptive Devices Use and Decline among Family Planning Seekers in Nairobi, Kenya
The study focused on determining the factors that influenced the use and decline of intrauterine contraceptive devices (ruCD) among family planning (FP) services seekers in Nairobi. Kenya implements six types of contraceptives namely: steroid hormones, barrier devices, chemical products, surgical methods, natural family planning, lactation amenorrhea, and intrauterine devices (Il.K'Ds). The design was a descriptive, cross-sectional study with a sample size of 374 FP clients from six randomly selected health centers administered by the Nairobi Health Management Board. The health centers included were the following: Langata, Makadara, Mathare North, Riruta and Kariobangi. Multistage sampling was used to select the health centers and systematic sampling was used in selection of study respondents. Service providers were selected on randomly selected days. Data was collected using a structured interview guides for clients on exit, and in-depth interview schedules were used to collect data from service providers. A structured observational chart was used to obtain additional data on institutional infrastructure. Data was analyzed using computer Statistical Package for Social Sciences (SPSS) software. Data was presented through tables, percentages, frequencies, bar charts. Qualitative data was grouped into categories, themes developed and presented in text form. Information was collected on 374 women. The study demographic data showed that women age 36 to 40 years (34%) were the highest users of ruCDs while adolescents and youths (age 20 and below) 0.3% were the least users. There was a high significant relationship between education and ruCDs use. X2 = 30429 p value = 0.00012 indicating higher education influenced use of ruCDs positively. The occupation, income and family size also had significant relationship with the use of ruCDs. Results indicated that respondents who knew about ruCD had inaccurate information about the method. About 80% of the respondents had never used ruCDs as contraceptives, 8% were currently using and only 2% doubled as current and previous users. Among the non-users, lacks of counseling and psychosocial issues were cited as reasons for not demanding ruCDs. Results also indicated that there were health risks associated with ruCDs. Regarding providers' perspective, the study established that trained providers in ruCD provision were very few and they lacked updates in knowledge, counseling and skills necessary for ruCD insertion procedure. Facilities were grossly underutilized and poorly managed. The institutional infrastructure was poor and enabling environment for ruCDs service provision in terms of equipments and supplies was grossly lacking in all the study facilities. In conclusion, the study showed a low use of ruCD among the respondents due to lack of comprehensive oalanced counseling and psychosocial concerns related to this method. In addition service providers at .he study sites had inadequate Knowledge and counseling skills necessary for ruCD service provision. Lack of resources, equipment and expandable was observed in the study sites to affect ruCDs orovision. These factors underscore the need for the Government of Kenya to train health care iroviders on family planning especially ruCD counseling and insertion procedure.