PERFORMANCE MONITORING FOR ACTION PLANNING FAMILY PMA KENya (Kakamega) Results from Phase 1 baseline survey November–December 2019 overall key findings There has been 49% of the women reported to 45% of the 77% of the users consistent decrease in have received comprehensive pregnancies obtained their current modern contraception methods information during were modern method from a use since 2016 for all the FP visit. unintended. women. public health facility SECTION 1: CONTRACEPTIVE USE, DYNAMICS, AND DEMAND MODERN CONTRACEPTIVE PREVALENCE CONTRACEPTIVE PREVALENCE by Percent of women age 15-49 currently using modern contraception (mCPR) by method type marital status Percent of women age 15-49 currently using contraception by method type (PMA Phase 1 n=723) 100 100 90 90 80 80 74 70 70 68 66 70 60 57 62 60 49 50 53 50 51 47 40 45 40 36 29 28 30 30 26 25 20 20 24 23 23 22 10 10 1 1 1 2 0 0 Dec Dec Dec Dec Dec Dec Dec Dec 2016 2018 2019 2017 2016 2017 2018 2019 PMA2020 survey rounds PMA PMA2020 survey rounds PMA Phase Married women (PMA Phase 1 n=457) Short-acting methods Phase 1 Unmarried, sexually active women (PMA Phase 1 n=44) Long-acting methods 1 All women (PMA Phase 1 n=723) Traditional methods modern contraceptive Method Use, Unmet Need, and Demand prevalence by county Satisfied by a Modern Method Percent of women age 15-49 currently using modern contraception by Percent of women age 15-49 using contraception by method type, unmet need, Kenya county and demand satisfied by a modern method (PMA Phase 1 n=723) 100 Bungoma 50 90 83 81 79 80 Nyamira 49 80 Nandi 49 70 60 4 5 6 7 4 Kakamega 47 7 6 1 1 5 50 1 2 Nairobi 47 40 30 Kiambu 53 51 47 49 20 47 43 Kericho 10 Kitui 41 0 Dec Dec Dec Dec 2016 2017 2018 2019 Siaya 41 PMA2020 survey rounds PMA Phase Kilifi 35 1 Modern method Unmet need for limiting West Pokot 19 Traditional method Demand satisfied by modern method Unmet need for spacing 0 10 20 30 40 50 60 Demand satisfied by a modern method is use of modern contraceptive methods divided by the sum of unmet need plus total contraceptive use. TRENDS IN MODERN CONTRACEPTIVE MIX modern contraceptive method Percent distribution of modern contraceptive users age 15-49 by method and year (PMA Phase 1 n=340) mix Percent distribution of modern contraceptive users age 15-49 by method 1 2 6 36 41 6 45 46 30 Key for method mix charts: 30 3 Other modern methods 3 Emergency contraception 15 Male condom 33 Pill 30 28 39 Injectable (SC) Injectable (IM) 46 9 43 Implant 5 6 9 IUD 8 5 6 5 5 Female sterilization 6 5 4 5 ‘Other’ category includes 6 3 2 male sterilization, female 2 3 2 6 4 1 1 2 1 3 condoms, diaphragm, LAM, Dec Dec Dec Dec and standard days/cycle Married/in union Unmarried, beads. 2016 2017 2018 2019 women (n=280) sexually active PMA2020 survey rounds PMA women (n=30) Phase 1 Page 2 12-MONTH DISCONTINUATION RATE Among women who started an episode of contraceptive use within the two years preceding the survey, the percent of episodes discontinued within 12 months (n=378 episodes) 6% Reasons for discontinuation: Discontinued but discontinued to switched methods: become pregnant 3% 10% 12% experienced were concerned over had other fertility 22% 48% method failure side effects or health related reasons Switched discontinued for other reasons 4% 15% 4% other method- wanted a more other/don’t know related reasons effective method KEY FINDINGS for section 1: contraceptive use, Intention of Most Recent DYNAMICS, AND DEMAND Birth/Current Pregnancy Percent of women by intention of their most recent birth or • Implants is the most dominant method of current pregnancy (n=406) contraception among all, married and unmarried sexually 15%wanted no more children active women. • 54% of the time, methods were discontinued within one year of starting. 6% did so to become pregnant and 22% 30%wanted later switched to another method. • 45% of the pregnancies were unitended with 305 been mistimed and 15% not wanted at all 45% 55% of pregnancies were Intended unintended SECTION 2: QUALITY OF FP SERVICES AND COUNSELING Method information index plus (miI+) Percent of women who were told about side effects, what to do about side effects, of other methods, and the possibility of switching methods (n=336) When you obtained your method were Percent of women who responded “Yes” you told by the provider about side effects 34 66 to all four MII+ questions or problems you might have? Were you told what to do if you experienced side effects or problems? 9 92 Were you told by the provider about methods of FP other than the method you 28 72 received? 51% 49% Were you told that you could switch to a answered “No” answered “Yes” different method in the future? 25 75 to at least one to all four MII+ MII+ question questions No Yes Page 3 Discussed FP in the past year client exit interviews with provider/CHW Percent of female clients age 15-49 who said yes to the following questions (n=449) Percent of women who received FP information from a provider or community health worker (CHW), by age During today’s visit, did the provider tell 48% you the advantages/disadvantages of the 52% FP method? 1% 7% During today’s visit, did you obtain the method of FP you wanted? 92% 3% 40 29 Were you satisfied with FP services you 15 received today at this facility? 97% 15-19 20-24 25-49 (n=158) (n=128) (n=437) Yes No Neither (follow-up visit) Yes No Clients were interviewed immediately following their health facility visit to obtain FP counseling or services. KEY FINDINGS for section 2: QUALITY OF FP SERVICES AND COUNSELING • 97% of the clients reported satisfaction with FP services they received, however 48% reported that the provider did not discuss the advantages and disadvantages of the chosen method. • Adolescent girls are least likely to have discussed FP with their health provider or CHW in the past year. SECTION 3: PARTNER DYNAMICS partner involvement in FP Percent of women who are Percent of women who are not currently using FP and agree with currently using FP and agree with decisions the following statements (n=350) the following statements (n=331) Percent of women who are currently using modern, female controlled methods and agree with the following statements (n=336) Would you say Would you say that using FP is that not using Does your partner Before you started using this mainly your FP is mainly know that you are method had you discussed decision? your decision? using this method? the decision to delay or avoid pregnancy with your partner? 11% 49% 4% 15% 20% 29% 5% 40% 76% Yes <1% Joint decision 81% No 72% Mainly respondent Modern, female controlled methods Includes all modern methods except male Mainly partner sterilization and male condoms Other KEY FINDINGS for section 3: partner dynamics • Among women using a modern method that can be concealed, 20% report that their partner does not know that they are using contraception. • 11% of women who are using contraceptive method report that it is mainly their partner’s decision. • 15% of the decisions not to use and 49% of the decisions to use FP are jointly made. Page 4 SECTION 4: WOMEN AND GIRLS’ EMPOWERMENT agreement with family planning empowerment statements Percent of all women who strongly agree to strongly disagree with each statement Exercise of choice (self-efficacy, negotiation) for family planning (n=720) I feel confident telling my provider what is important when selecting an FP method. 10 4 2 15 69 I can decide to switch from one FP method to another if I want to. 12 4 2 14 68 Existence of choice (motivational autonomy) for family planning (n=713) If I use FP, my body may experience side effects that will disrupt relations with my partner. 52 11 4 14 20 If I use FP, my children may not be born normal. 72 9 2 7 9 There will be conflict in my relationship/marriage if I use FP. 64 14 3 7 13 If I use FP, I may have trouble getting pregnant the next time I want to. 62 12 3 8 15 If I use FP, my partner may seek another sexual partner. 69 14 2 6 9 Strongly disagree Disagree Neutral Agree Strongly agree Women's and Girls' Empowerment (WGE) Sub-Scale for Family Planning The Women's and Girls' Empowerment (WGE) Index examines existence of Mean WGE score, by education Mean WGE score, by age choice, exercise of choice, and achievement of choice domains across pregnancy, family planning, and sex Overall 4.1 Overall 4.1 outcomes. Presented results are only for the Tertiary 4.4 existence of choice and exercise of choice education 25-49 4.2 domains for family planning. Scores from the above family planning Secondary 4.2 20-24 4.0 empowerment statements were summed education and divided by number of items (7) for average WGE family planning score across both domains . None/ Primary 4.0 15-19 3.9 education Range for the combined WGE family planning score is 1-5, with a score of 5 21 3 54 21 3 54 indicating highest empowerment. Page 5 mCPR and intent to use contraception, mCPR and intent to use KEY FINDINGS for by categorical WGE score contraception, by employment section 4: Percent of women using a modern method of contraception Percent of women using a modern method of Women and girls’ and percent of women who intend to use contraception in contraception and percent of women who the next year by categorical WGE score (n=723) intend to use contraception in the next year by empowerment employment status (n=723) • Women who score 100 100 higher on the empowerment scale 80 80 are much more likely to be using a modern 12 60 60 11 contraceptive method 12 7 12 or intend to use in 40 15 40 Intent to use contraception the future.