Access to Reproductive Health Services among Women of Reproductive Age 15–49 Years Living in the Informal Settlements of Mathare, Nairobi City County, Kenya
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Date
2025-10
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Kenyatta University
Abstract
Informal settlements in Nairobi, such as Mathare informal settlements, house an estimated 60% to 80% of the city's population. These areas are marked by inadequate sanitation, overcrowding, poor housing, and limited public health services. Women living in these communities face severe reproductive health challenges due to poor service availability, insufficient information, and socio-economic constraints. The primary objective of this study was to assess the accessibility of reproductive health services (RHS) among women of reproductive age (15–49 years) residing in Mathare informal settlements, Nairobi City County. Specific objectives were to determine the level of knowledge on RHS; assess women’s attitudes toward RHS; identify the types of RHS services accessed; and evaluate the health system factors influencing accessibility. A cross-sectional descriptive study was conducted in four villages within Mathare: Mathare 3B, Mathare 4A, Kosovo, and Mathare Village 2. Data were collected using structured questionnaires from 384 women, achieving a 78.1% response rate. Quantitative analysis using SPSS Version 26 involved univariate statistics, chi-square tests for bivariate associations, and logistic regression to identify determinants of RHS accessibility. Most respondents were aged 18–29 years (48.7%), had primary education (61.7%), were married (58.7%), and unemployed (69.3%). While 67% of women rated RHS as acceptable, family planning, fertility intention, and pregnancy planning services were underutilized. Knowledge gaps (66.7%) and negative attitudes (64%) were significant barriers. Key determinants of RHS accessibility included age (p < 0.001), education, marital and employment status, with older women more likely to access services (OR = 8.686). High accessibility was associated with spousal involvement, positive views on education, and open partner discussions. Barriers included long travel distances, high transportation costs, service unavailability, and social myths. The study concluded that Women in Mathare informal settlements face significant barriers to accessing quality reproductive health services, particularly in family planning. Limited knowledge, negative perceptions, and structural challenges continue to limit access. Strategic and targeted interventions are urgently needed to improve uptake and service delivery. To improve reproductive health service accessibility among women in Mathare informal settlements , the study recommends implementing targeted reproductive health education programs to bridge knowledge gaps, conducting community sensitization initiatives to address negative attitudes and misconceptions, expanding the availability of underutilized services, particularly family planning in public health facilities, addressing structural barriers such as long distances, transportation costs, and inconsistent medical supplies, and undertaking further research to explore male partner involvement and assess the effectiveness of community-based and digital interventions.
Description
A Research Thesis Submitted in Partial Fulfilment of the Requirements for the Award of the Degree of Master of Public Health (Monitoring and Evaluation) in the School of Health Sciences of Kenyatta University, October 2025.
Supervisors
1. Justus O.S Osero
2. Eliphas Gitonga