Factors influencing utilization of modern contraceptives among

women of reproductive age (15-49) years attending MCH /FP

clinic at Rachuonyo sub-county hospital, Homa-bay county

By

Moffat L. Wangeci

Index No. 2071080337

A dissertation submitted to:

Kenya National Examination Council in Partial Fulfillment of

Requirements for the Award of Diploma in Social Work

November 2018

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Declaration
I Moffat L. Wangeci declare that this research project entitled “Factors influencing utilization
of modern contraceptives among women of reproductive age 15-49 years” is my own work and
has not been submitted for any academic award.

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Certification

The undersigned certify that they have recommended that faculty of Health Records and
Information Technology acceptance of research entitled; A study on factors influencing
utilization of modern contraceptives among women of reproductive aged (15-49) years
attending MCH/ family planning clinic at Rachuonyo sub-county hospital, submitted by Moffat
L. Wangeci as a partial fulfillment for the award of Diploma in Health Records and Information
Technology.

Submitted by: Moffat L. Wangeci

Index No. 2071080337

Signature:……………………………..

ii
Dedication
This dissertation is dedicated to my dear mother; loving father and my siblings. I love you all
and God bless you.

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Release Authority
Author: Moffat L. Wangeci

Signature: ………………………….

Date ……………………………….

Title: A study to determine factors influencing utilization of modern contraceptives among

women of reproductive age (15-49) years attending MCH/FP clinic at Rachuonyo sub-
county, Homa-Bay county.

Credential for: Award of Diploma in Social Work.

Year of presentation: 2018

Authority: Permission is granted to Thika School of Medical and Health Sciences library to
produce copies of this dissertation for research purpose only. No other copy may be reproduced
in any form without prior permission of the author.

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Acknowledgement
First and foremost, my gratitude goes to the almighty God for special grace, strength, wisdom
and divine provision throughout the study period. I am also very grateful to those who provided
me with professional assistance during the writing of my project. Above all they deserve my
appreciation for their encouragement, moral and technical support. As a matter of fact, they
have improved and shaped my academic knowledge.

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Abbreviations

WHO: World Health Organization.

CPR: Contraceptive Prevalence Rate.

TFR: Total Fertility Rate.

FP: Family Planning.

KDHS: Kenya Demographic and Health Survey.

RHS: Reproductive Health Services.

DHS: Demographic and Health Survey.

RH: Reproductive Health.

NALEP: National Agriculture and Livestock Extension Programs.

WAFN: Women’s Action Forum Network.

HIV: Human Immunodeficiency Virus.

AIDS: Acquired Immunodeficiency Syndrome.

KMTC: Kenya Medical Training College.

WRA: Women of Reproductive Age.

SDA: Seventh Day Adventist.

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Operational Definition of Variables

Contraception: The practice of utilizing methods intended to prevent or

space future pregnancy

Contraceptive: It’s an agent used to prevent conception.

Contraceptive method choice: Contraceptive methods which a woman report using at

the time of the collection of data.

Contraceptive prevalence rate: Refers to the proportion of women of reproductive age

who will report using or having used modern
contraceptive method.

Traditional contraceptive methods: These consist of periodic abstinence and withdrawal.

Knowledge: Is in terms of awareness of contraceptives, importance

and side effects.
Socio-demographic factors: Are defined in terms of age, sex, marital status gender,
level of education, religion and place of residence.
Parity: Number of surviving children.

Family planning: A reproductive strategy that individuals or couples

employ to meet their goals and prevent unwanted
pregnancies.
Walk-in patient: Any client who has come for the service/contraceptives
but does not belong to that clinic.
Confidentiality: Keeping the information about the client secrete.
Unmet family planning: Percentage of women who do not want to get pregnant
but are not using any method of modern contraceptives.
They want to wait two or more years for their next birth.

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Table of Contents
Declaration .............................................................................................................................. i
Certification ...........................................................................................................................ii
Dedication ............................................................................................................................ iii
Acknowledgement ................................................................................................................. v
Abbreviations ........................................................................................................................ vi
Operational Definition of Variables.....................................................................................vii
List of figures ......................................................................................................................... x
Abstract ................................................................................................................................. xi
CHAPTER ONE .................................................................................................................... 1
1.2 Problem statement ....................................................................................................... 5
1.3 Purpose of the study .................................................................................................... 6
1.4 Broad Objective........................................................................................................... 7
1.7 Justification of the study ........................................................................................... 11
CHAPTER TWO ................................................................................................................. 13
2.0 Literature Review........................................................................................................... 13
CHAPTER THREE ............................................................................................................. 24
3.0 Methodology .................................................................................................................. 24
Population and sample ......................................................................................................... 25
Sample size determination ................................................................................................... 25
Data analysis techniques ...................................................................................................... 26
Selection criteria .................................................................................................................. 26
Ethical consideration ............................................................................................................ 27
CHAPTER FOUR ................................................................................................................ 27
4.0 Data analysis and interpretation ..................................................................................... 27
CHAPTER FIVE ................................................................................................................. 37
5.0 Discussion ...................................................................................................................... 37
CHAPTER SIX .................................................................................................................... 40
2.0 Conclusions and Recommendations .............................................................................. 40
APPENDICES ..................................................................................................................... 42
Appendix I: References........................................................................................................ 42
Appendix II: Questionnaire.................................................................................................. 45
Appendix III: Work Plan .................................................................................................... 50
Apendix IV: Research Budget ........................................................................................... 51
Appendix v: MAP OF HOMA BAY COUNTY.................................................................. 53
Appendix VI: MAP OF KENYA ........................................................................................ 54

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List of tables
Table 1: Area and population density by division .................................................................... 3

Table 2: Respondents .............................................................................................................. 28

Table 3: Marital status of the respondents .............................................................................. 28

Table 4: Have you heard of modern contraceptives? .............................................................. 31

Table 5: Why do you use modern contraceptives? ................................................................. 32

Table 6: Dislikes on modern contraceptives ........................................................................... 33

Table 7: Distance from the respondents’ home to the health facility ..................................... 34

Table 8: Respondents waiting time ......................................................................................... 35

Table 9: Reassurance of confidentiality .................................................................................. 35

Table 10: Respondents’ discussing with their partners on utilization of contraceptives ........ 36

Table 11: Respondents’ partners’ approval of contraceptives ................................................ 37

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List of figures

Figure 1: Age distribution of the respondents ........................................................................ 28

Figure 2: Level of education of respondents .......................................................................... 29

Figure 3: Religious denomination of respondents .................................................................. 29

Figure 4: Occupation of respondents ...................................................................................... 30

Figure 5: Have you used any contraceptive? .......................................................................... 31

Figure 6: How did you learn about modern contraceptives? .................................................. 31

Figure 7: Which contraceptive do you use?............................................................................ 32

Figure 8: Where do you get your contraceptives? .................................................................. 34

Figure 9: Did the health provider treat you in a friendly manner? ......................................... 34

Figure 10: Does your culture allow the use of contraceptives? .............................................. 36

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Abstract
The study seeks to identify factors influencing utilization of modern contraceptives among
women of reproductive age (15-49) attending MCH/FP clinic at Rachuonyo sub-county
hospital in Homa-bay county.

A quantitative, cross-sectional, descriptive study design was adopted and applied in the field.
The general objective of the study was to contribute to a better understanding of the factors
influencing utilization of modern contraceptives among women of reproductive age in the
study area. Specific objectives include: socio-demographic characteristics of women of
reproductive age, level of knowledge of women on utilization of modern contraceptives, health
facility practices influencing utilization of modern contraceptives, cultural practices that affects
utilization of modern contraceptives and the attitude of women towards utilization of modern
contraceptives.

Data was collected by use of structured questionnaires. Sample size constituted 100
respondents with a response rate of 100%. Simple random sampling method was used to select
the respondents from the target population. Data was analyzed using Ms Excel, Ms Word,
calculator and presented in tables, graphs and charts.

The studies found out that majority, (80%) of the respondents were using modern
contraceptives while 20% were not using any form of modern contraceptives. It also found out
that the 69 respondents who discussed with their partners on utilization of modern
contraceptives, 30 of them were given approval while 39 were not given approval by their
partners. Factors found to be significantly associated with utilization of modern contraceptives
were: education level, occupation, cultural practices, support from partners, access to
information and religion.

It is recommended that the health management team should develop interventions that will
enable women to understand the importance of utilizing modern contraceptive methods. Since
this study did not involve men, further studies are needed to determine the extent of utilization
of modern contraceptives among men and associated factors.

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CHAPTER ONE
Introduction
According to oxford dictionary, contraceptive is an agent used to prevent conception. Its uses
have been increasing steadily since 1970 and are currently widespread throughout the world.
However, the progress has been uneven across geographical areas and great challenges remain
in terms of both increasing the level of contraceptive use to satisfy existing needs in certain
regions and in terms of making available and adequate variety of contraceptive methods to
increase the ability of youths wishing to use contraception to do so in a consistent and efficient
manner. Modern contraceptives are easily classified and include oral contraceptives,
intrauterine contraceptive devises (IUDs), female and male condoms and diaphragm.

In the year 2000 and 2025, it is estimated that overall contraceptive prevalence at the world
level needs to increase from 63% to 67% in order to make possible the reduction of total fertility
from 2.8 children per woman to 2.3 children per woman as projected in the medium variant of
the 2000 revision of the United Nation population (United Nation, 2002).

Several researchers (Migadde et al, 1995) have indicated that sexually active young women
need access to family planning (FP) information and services to prevent unwanted pregnancies.
They also argued that sexually active young women need support and encouragement from
their peers, adults and the media to use contraceptives effectively and consistently. However,
improving contraceptives by sexually active young women requires the expanding and the
enhancing existing services as they often do meet the demand of a growing population of
sexually active young women.

Government support for method of contraception in Ghana has been rising steadily since 1975.
A lot of efforts have been made to support FP programs and the distribution of contraceptives
either directly or through government facilities by the ministry of health (MOH), or indirectly
through support of the non-governmental organizations (NGOs) such as Family Planning
Associations (FPA) This has resulted in a general increase on the use of contraceptives over
the last two decades. There have also been dropouts of fertility rate from 6.4 percent in 1970s
to 4.4 percent in 2005 (UNDP, 2008).
Kenya as a country has been slowly trying to increase its contraceptive prevalence rate
(CPR)with a population estimated to be 37.8 million, current growth rate of 2.9% per annum

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and this is considered to be high (NRHS,2009-2015). To date, CPR stands at 46% with
indictable, pills and male condom being the commonly used methods (KSPA, 2010).

Rachuonyo sub-county in the southern region of Nyanza province have tried in various ways
to adhere to the policies and programs of the ministry of health (MOH) and other agencies in
order to increase reproductive health services including FP and the use of contraceptives. Some
of the various ways include education and communication strategies coupled with service
counseling and outreach programs that are instituted in the district by the district health officer
and other stakeholders.

The particular problems which lead to this study has been acknowledged that unwanted child
births have been on an increase in Rachuonyo sub-county despite the efforts of the part of the
MOH and other stakeholders to provide quality of health and contraceptive services. This study
therefore wants to determine the health care practices that affect youth’s utilization of
contraceptives.

Background information

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Rachuonyo district is one of the 12 districts constituting Nyanza province. It is bordered by
Nyando south east, Kisii and Nyamira to the south and Homa-bay to the south east, Kericho to
the east and Lake Victoria to the north and west.

Administratively, the district is divided in to four divisions and forty locations all previously
part of the large South Nyanza district. Its capital Kosele, formally it was located in Oyugis.
The district has two constituencies: Kasipul Kabondo and Karachuonyo.

Table 1: Area and population density by division

Division Area(sq km) Population Population Location

density
Kasipul 365.5 129,854 355 7
Kabondo 141.5 49,934 353 11
East Karachuonyo 251.6 74,578 296 11
West Karachuonyo 186.6 52,754 283 11
Total 945.2 307,120 325 40

Source: District statistics office-Kosele-2001

Health
The district has 36 health centers with 4 hospitals. The average distance to the health centers is
5km and 60% of the households have access to the health facilities. The most prevalent diseases
are malaria and pneumonia. Life expectancy is 47 years with infant mortality of 87 deaths per
1000 live births and under-five mortality at 102 per 1000 population. HIV prevalence rate is
30%.

Education
There are 399 primary schools with an enrollment rate for males at 94% and females at 106%,
58 secondary schools with an enrollment rate for males at 28% and 15% females.

Socio-economic activities

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Rachuonyo district is an Agricultural district with 80% of the labor force involved in
agricultural activities. Agriculture contributes 70% to the district Gross Domestic Product.
Some of the raw materials produced for industry include; fish, coffee, cotton and sugarcane.
These provide inputs for agro based industries leading to increased incomes and poverty
reduction.

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1.2 Problem statement
The problem of unwanted pregnancies among youths and married women is most grievous
aspect of the complex of the negative factors associated with underdevelopment .Although the
problem of unwanted pregnancy among youths exist in industrialized countries as well, the
incidence is much higher in the third world . In industrialized countries, modern contraceptives
are widely available, public awareness is high and legal abortion may be an option in the event
of contraceptive failure or non us. The situation seems different in the third world since there
is lack of access to contraceptive information and service. Research from a variety of sources
suggests that being unwanted and unloved can have lasting effects on the child’s development.
The incidences of unwanted children among youths can be drastically reduced by effective
family planning services and access to modern contraceptives.

Rachuonyo sub-county has not been exception of this problem. The ability of a woman to
control her own fertility is one of the basic and important rights .A better regulated sexuality
and fertility life affects positively the status of the woman socially and economically. The
researcher therefore ought to determine the factors affecting utilization of modern
contraceptives among WRA in Rachuonyo sub-county.

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1.3 Purpose of the study
The study targets to find out factors influencing utilization of modern contraceptives among
women of reproductive age (15-49) years attending MCH/ family planning clinic at Rachuonyo
sub-county hospital, Homa bay-county.

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1.4 Broad Objective
To determine factors influencing utilization of modern contraceptives among women of
reproductive age (15-49) years attending MCH /FP clinic at Rachuonyo sub-county hospital,
Homa-bay county.

Specific objectives
1. To determine socio-demographic characteristics of women of reproductive age
(15-49).
2. To determine the level of knowledge of women on utilization of modern
contraceptives.
3. To determine health facility practices that influence utilization of modern
contraceptives.
4. To determine the cultural practices that affect utilization of modern contraceptives
5. To determine the attitude of women’s towards utilization of modern contraceptives.

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Research questions
1. What are the socio-demographic characteristics of women of reproductive age (15-49)
attending MCH/ family planning clinic at Rachuonyo sub county hospital?
2. What level of knowledge does the woman have on modern contraceptives?

3. What are the health facility practices that influence women’s utilization of modern
contraceptives?

4. What are the cultural practices that affect utilization of modern contraceptives?

5. What is the attitude of women towards utilization of modern contraceptives?

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Theoretical framework
Utilization of modern contraceptives among women of reproductive age is believed by a
number of complex interaction of many factors individual, social and health service delivery
levels. Individually; age, parity, education and knowledge about contraception do influence
utilization of modern contraceptives.

Socially, cultural norms, marital status, partner/ family support, designated gender roles and
the demand for bigger families influence the individual’s contraception choices. In addition,
practice of fellow women, religious teachings and policies influence freedom of choice of
contraceptive method.

Reproductive health service delivery factors such as attitude and skills of the providers, specific
side effects, availability of different methods, ease of use and access of contraceptive methods
do act directly or indirectly to influence utilization of contraceptives.

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Conceptual frame work

Societal factors
Cultural norms
Gender roles
Partner support

Individual factors
 Demographi
c factors i.e. Acceptance
age, of
Continuation Contraceptives
of education,
marital
Contraceptiv status,
es knowledge
etc. Utilization of
 Socio- modern
cultural contraceptives
factors i.e. among women
decision of reproductive
making age (15-45)
power
 Socio-
economic
Continuation
factors e.g.
of
cost of
contraception
services

 Health service factors

 Provider’s attitude and
actions
 Choice of care e.g. public
health facility, private or
outreaches
 Design/organization of
services i.e. cost of services,
waiting time etc
 Method choice and
availability

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1.7 Justification of the study
The use of contraception was never as widely proclaimed and exhibited as it is now. The use
of modern contraception has become so common that it is now normal for even youths to use
contraceptives. Sex is highly practiced amongst unmarried individuals and the number is not
getting lower as time goes on (www.dreamessay .com).

With a lot of evidences associated with increasing unwanted and unplanned children among
youths and in the country which has a direct impact on the development of the child,
contraceptive use becomes an important issue in health care delivery and government policies
and programmers. The identification of factors that influence utilization of modern
contraceptives will provide knowledge for health care providers and clients as well. In
summary, the findings in this study would go a long way to help providers of contraceptives to
make informed decisions. It will also help the government in policies formulation and
implementation

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Significance of the study

The study identified challenges and opportunities in the current family planning service
delivery approaches in addressing the family planning needs of youths and therefore this
information is expected to inform family planning programming to improve contraceptive
service provision for young people in order to reduce unwanted pregnancies. The results of this
study also provide insights on youth’s sexuality and therefore informative protection programs
for human immunodeficiency virus (HIV).

Limitations
 There was unfavorable climatic condition.
 There was illiteracy among some women.
 There was lack of enough funds for the study.

Assumptions
All women of reproductive age who participated in the study were able to give information that
was true based on their knowledge.

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CHAPTER TWO

2.0 Literature Review

Introduction
This chapter discusses the literature related to factors influencing utilization of modern
contraceptives among women of reproductive age (WRA). It particularly focuses on the extent
to which socio-demographic characteristics of youths, level of knowledge, cultural practices,
and attitudes of women and health care practices that influence utilization of modern
contraceptives among youths.

2.1Overview of utilization of contraceptives

The prevalence of utilization of modern contraceptives had increased widely due to
development and introduction of modern contraceptives and the establishment of organized
family planning programs (D. Arcanques, 2002).

Family planning (FP) services offers various economic benefits to the household, country and
country at large. First, FP permits individuals to influence the timing and the timing and the
number of births, which is likely to save lives of children. Secondly, by reducing unwanted
pregnancies, injuries and deaths associated with child birth, abortion and sexually transmitted
infections (STI) including HIV/AIDS (Hawkins et al.1995). Further, FP contributes to
reduction of population, poverty reduction, preservation of environment as well as demand for
public goods and services (Shane et al, 1997).

Education also influences utilization of contraceptives. A study in Kenya by Lasee and

Beakur, (1997) revealed that if the husband lacked schooling but the wife had some higher
education, they were 4.3 times likely to use contraceptives compared to un educated couples.
The interpretation of this research was that, in case the woman than her husband, she must have
considerably more household decisions-making (Beakur.s., 1997). A study in Mexico by
Nazar-Beutelpacher indicated that non-utilization of was higher among the illiterate than
among those who had completed secondary schooling (49% Vs 31%).

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Highly effective methods of birth control have been available for several decades. In spite of
this, approximately one half of pregnancies in the United States are unplanned, approximately
36% of American women of child bearing age are not using contraceptives (Pliskow 2000).

According to john B. et al, (2002), contraceptive behavior in the developing world has changed
remarkably over t he last three decades. This revolution is driven by the behavior of desired
family size and socioeconomic changes. The proportion of women who had heard of at least
one method of contraception was high compared to that of women who had not heard any
method.

WHO (2011) reviewed trends in the use of short term and long term methods of contraception
in thirteen developing countries in Sub Sahara Africa and there was substantial increase in
contraception, short term methods primarily. These findings were related to the cause that most
women were using contraceptives to space rather than stop child bearing.

There is abundant information that contraceptive knowledge and awareness is high among the
population, but this awareness as not translated to increased contraceptive use, with the end
result being very low contraceptive prevalence. In Nigeria, the low contraceptive prevalence
correlates with high level of unplanned pregnancies and abortions, leading to increase in the
maternal mortality rates especially in the rural areas and in the Northern Nigeria.

The current prevalence rate for contraceptive use in Nigeria is approximately 11%-13%. This
rate is very low in spite of high rate of sexual activity and widespread awareness of various
contraceptive methods among Nigerian adolescents and youths. This seems to indicate large
unmet needs for contraceptive use (Monjoke et al, 2010).

Barriers to the use of contraception are many and diverse, but include shortcomings intrinsic
to contraceptive methods such as cost, inconvenience and unacceptable side effects. Several
new methods that are in development or that have recently become available may help improve
user acceptability and lower barriers to contraceptive use.

Contraception is least effectively practiced in those lower class families in which the husband
and wife have poor communication and are characterized by a segregated relationship in which
‘they go their separate ways’ scattered and inconclusive attempts have been made to relate

14
contraceptive behavior to other variables such as relative dominance of husband and wife,
degree of personality, similarity between husband and wife and personality of the wife
(Rainwalter, 1965).

The socio-cultural, religious family and male dominant factors impending contraceptive use in
African countries have all been identified but what is lacking is generation of political priority
for FP and safe motherhood as well as political will, and commitment make this change on a
large scale as occurred in Indonesia (Averalo, 2004 and Nikula, 2010). According to Republic
of Kenya (20080), the Kenyan government has put in place various strategies and policies to
facilitate the use of FP services as a step towards reducing the fertility rates, increasing
contraceptive prevalence rate (CPR) and reducing the unmet family planning needs. Despite
these policy measures, total fertility rate (TFR) still remain high at 4.6% while CPR for all
methods is at 24%.

The low CPR, unmet needs of FP services, low death rate estimated at 14.02 deaths per 1000
women, high birth rate estimated at39.73 per 1000 population and low infant mortality
estimated at 59.26 per 1000 live births, contribute towards high population growth.

Standard of living tends to worsen when the rate of population growth exceeds the rate of
economic growth (Feyisetan et al. 998). At the facility level, the HFR may be contributing
towards depletion of productive resources in the society, raising the cost of living, ill health,
poor nutrition and limited educational opportunities and untimely trapping women in a poverty
cycle.

Components of successful FP programs include improvement of geographical and public-

private sectors, access to broad mix of contraceptive methods availability of competent health
care providers, promotion of active behavioral change through communication intervention
(WHO, 2011). Delivering FP services that address clients’ needs can effectively increase the
use of contraceptives. Success of the programs will depend upon how well their services are
tailored to unique needs of specific groups.

According to Moustaf .K. (2009), age, access to TV, NGO membership, working status,
number of living children and child mortality and wealth index are important determinants of

15
contraceptive use and method choice. There is need to establish and develop mass media
programs and giving information on available contraceptive methods.

Young women and partners should be a centre of focus for improving awareness of the benefits
of modern contraceptive methods with the ultimate goal of helping young women makes
informed and responsible choice about their contraceptive use. Community programs also play
a major role in expansion of family planning methods in rural set up.

Socio-demographic factors associated with modern contraceptives

The socio-demographic factors such as age, gender, level of education, residence, number of
living children and desire for additional children play an important role in determining the use
of contraception. In addition, ethnicity and marital status all shape clients experiences with
family planning and reproductive health (RH) services.

In some culture, women may be unwilling to receive care from male providers or their husbands
may object to have their wives see male providers hence shortage of female providers may
limit women’s access to services (www.fhl.org).

Education also influences utilization of contraceptives. A study in Kenya by Lasee and

Beakur, (1997) revealed that if the husband lacked schooling but the wife had some higher
education, they were 4.3 times likely to use contraceptives compared to un educated couples
The interpretation of this research was that, in case the woman than her husband, she must have
considerably more household decisions-making (Beakur.s., 1997). A study in Mexico by
Nazar-Beutelpacher indicated that non-utilization of was higher among the illiterate than
among those who had completed secondary schooling (49% Vs 31%).

Age is a demographic factor that affects utilization of health services. Report from KDHS
(2008/09) revealed an increased utilization of FP services among youths age 20-24 years as
compared to age 15-19 years. The youth hardly perceive the seriousness of health needs and
this is a major impediment to the youth in accessing and utilizing FP services.

A study by Senderowitz, et al, (2003) on rapid assessment of reproductive health services

concluded that youths are unwilling to seek care due to the national laws and policies restricting

16
care based on age or marital status, poor understanding of their changing bodies and insufficient
awareness of risks associated with early sexual debuts, STI/HIV and pregnancy.

Majority of women who are adopting any of the FP methods belong to age group 25-35 years
(Roumi.D, 2010). This means that the comparatively younger population is now adopting any
of the contraceptive methods. Use of FP was found to be highest among women aged between
20-29 years compared those below 20 years and above 39 years. Whereas 49% of the women
that were using contraceptives were aged 20-29 years, 41%were aged between 30-35 years
while no woman aged 50 years and above was found to be using any form of family planning
services. On the other hand, 4% and 6% of the women who were using family planning services
were less than 20 years and 40-49 years of age respectively (A.Leyland 1994)

Use of contraceptives was found to vary across marital status with married women using the
service most compared to single women due to high incidences of sexual activities compared
to single women. In this case, it was revealed that use of contraceptives was aimed at helping
to space children and prevent unwanted pregnancies (Meharab et al 1996).

According to Feldman and Maposhere (2003), women with more children were using FP
services more compared to those with fewer children. Out of the women that were using FP
services,36% had3-4 children followed by those with between 1-3 children at 30% .On the
other hand, 17% of those respondents using FP services had between 7-9 living children while
15% had no living children. Women in Zimbabwe who had several children wanted to avoid
further pregnancies. This revealed that the higher the number of children, the more the desire
to use FP services. This is because those with more children have already been satisfied with
children. The desire for more children was attributed to many factors including cultural
perception that more children signified a source of wealth (Teresa C.2005)

On the other hand, socio-economic factors have been shown to be of greater importance in
influencing the use of health services. In fact fees for transportation, services and supplies can
be a major barrier to contraceptives for many young people. Cost is a significant obstacle for
adolescents as young people frequently lack their own source of income or control over their
finances to be able to afford contraceptives (http://reproductiverights.org). This means that
persons of low socio-economic status can have difficulty in affording the costs associated with

17
utilization of health care hence making utilization unlikely unless they are provided with
subsidized costs (Taylor, 2003).

Poverty has led to some youths to engage in premarital sex in exchange for gifts or economic
support, further exposing them to RH risks. User fee charged at the health facilities may hinder
the youths from utilizing family planning services (MOH, NCAPD, 2005).

Level of knowledge on modern contraceptive

According to Jejeebhoy, SJ et al, inadequate knowledge about contraception and how to obtain
health services is one of the reasons why many youths in developing countries are especially
vulnerable. Inadequate knowledge about contraception brings fear, rumors and myths about
contraception.

In one survey in Uganda, some participants gave reasons why they would fail to use
contraceptives especially the condoms. They believe that it was dangerous because it would
get stuck in the vagina where it would get rotten and cause damage. Likewise, there were
rumors that the pills would cause deformed babies, inability to get pregnant in the future as
well as cancer of the breast and cervix (Eva-Britta, et al, 2010). Rumors and myths about
family planning may raise potential clients concern about side effects, safety and effectiveness
of different methods (Nalwadda, G, et al, 2010)

A study on contraceptive use in women enrolled in preventive HIV vaccine trial reported
insufficient knowledge of certain methods to be among the reasons for not using contraceptives
and that misconceptions related to FP methods and their incorrect use might have led to
inconsistent use resulting to undesired pregnancies (Kibuuka et al, 2009).

Another survey conducted in 14 countries among 700 women between 14 - 40 years showed
that knowledge gap in FP methods restrict women’s contraceptive choices and use thus, women
fail to take advantage of new contraceptives due to lack of knowledge, and stay with familiar
options (Rossella.N. 2006) .In another study in to contraceptive use dynamic in Kenya, further
analysis of demographic and health survey (DHS) data by Calvenrton (2001), were the study
utilized data from three waves of KDHS conducted in 1989, 1993 and 1998 multilevel
modeling techniques was employed to deal with the hierarchal data structure. The study

18
revealed that contraceptive use remains higher in urban areas. Urban contraceptive users are
more likely to choose long term modern methods and less likely to choose traditional than their
rural counterparts.

Akyeah, (2007) in a study in Kwabre district revealed that most of the women have high level
of knowledge about contraceptives but this does not translate in to the use methods of
contraception, while 4.7% aware of seven to nine contraceptive methods, and 91% of the
respondents knew at least two contraceptive methods. It also came out that these women have
access to FP service but the quality of the services offered is quite low in terms of different
contraceptive method. The most common method available was contraceptive pills, injections
and the condoms.

Studies have revealed that the more educated youths are more likely to seek RH services as
they possess better understanding of their health needs (KDHS, 2008/09). A study done in
Burkina Faso, Ghana, Malawi and Uganda in 2004 showed that contraceptive, STI and VCT
are still underutilized by the youths due to lack of knowledge about the services (Biddlecom
et al, 2007).

Godia (2010) and Transgrud, (2001 ) also found out that lack of understanding of the
importance of sexual health care may discourage young people from using the services and
therefore health education is a major component in passing health information and which in
turn can increase utilization of health services.

Cultural practices
In many parts of the world, women do not have the decision making power, physical mobility
or access to material resources to seek FP services. Women’s use of contraceptives is often
strongly influenced by spousal or familial support of, or opposition of FP. Research in Northern
Ghana found that women who choose to practice contraception risked social ostracism or
familial conflict (Philip B., Adongo, 1979). In some areas, women need their husbands’
permission to visit a health facility or to or to travel unaccompanied, which may result in either
clandestine or limited use of contraceptives (Biddlecom A. 1998).

19
Additionally, stigma around young people’s sexuality may similarly deter young people from
seeking such services or may result in denials of reproductive health services even where
parental consent is not required. Many sexually active young women report fear,
embarrassment, and shyness about seeking FP services (Muthali A. et al 2007).

Individual factors that determine a person’s use of services such as family planning are
mediated by the characteristics of the community in which the individual lives. It is important
to look beyond individual factors when examining FP use or non use (Tsui & Stephinson,
2002). Cultural norms and expectations are varied and include among others; gender roles
designated society such as role of women in child bearing and the demand for bigger families
(Srikenthan & Rreid 2008).

Culture often shapes perception of the individuals belonging to that culture on matters of
fertility including contraceptive use. In a cross-sectional survey tosses use and identify condom
use barriers, result showed that condom use during the last occasional intercourse was only
36.8%of males and 47.5% of females. Failure to use condom was related to its perceived quality
and lack of efficacy (Sennen et al, 2005)

In some culture, women may be unwilling to receive care from male providers or their husbands
may object to have their wives see male providers hence shortage of female providers may
limit women’s access to services (www.fhl.org).

In a study to explore religious beliefs among men and their influence to the use of condom
showed that for religious reasons, most 63% of men avoid using condoms and were opposed
to women’s contraceptive use (Degni et al,2008)

Studies done among the Luo communities have identified some cultural rituals in which sex is
a component part. In a 2007 SIDA trip report, it was noted that according to NALEP, the
sexual rituals surrounding Agriculture was seen as having an impact on its programs, for
instance, the custom requiring the husband to have unprotected sex with his wife before the
first planting season. In the same report, WAFN based on its 2007 baseline survey of cultural
issues and how they relate to HIV/AIDS observed that “the ritual role of sex remains highly
important” among the Luos. It further observed that “unprotected sex constitute part of the
ritual for blessing as upon the marriage of one’s child, in the making of important events in the

20
family calendar, cleansing of widows upon the death of their husbands and the initiation of
activities such as establishment of homestead or the construction of a house (Jolly,2007).
Other studies done in Kenya have indicated a general low usage of contraceptives. Some of
these studies have identified traditional practices as the main factor behind this low usage of
contraceptives (Erulkar et al, 2004).

A study on contraceptive use among HIV positive women, Mutisoet et al, (2008) noted that
the use of contraception was low with only 44% of the women being on some form of
contraception methods and further observed that the long term usage dropped even further.
This clearly indicates that even with awareness of the fact that contraceptive use is important
in the prevention of the spread of HIV and re-infection, the bulk of the respondents still failed
to use contraceptives.

Studies in Sudan, an Islamic country in the developing world, very few women reported that
the use of contraceptive method was against religion or cultural beliefs (Ibnouf H et al, 2007).
Other factors included urban- rural residence, women’s work status, women’s status related to
men, religion, culture and taboos, economic status of household, exposure to mass media and
community development (Mishra VK, 2001).

Contraceptive methods information provided was seldom sufficiently adapted to local beliefs
and characteristics. Cultural barriers were especially noticeable when service providers’ were
from a dominant or relatively successful ethnic group or social class, and clients from a
relatively impoverished one. In highly stratified societies there is a tendency to underestimate
the ability of lower class women to think for themselves and thus to use of family planning
information to make informed decisions themselves. In addition communication difficulties
sometimes arise because of different languages or belief systems between providers and clients
(UNPF, 1994)

The Nigerian study concluded that determinants of reproductive health service use rest on the
individual, household, service and community levels, therefore when considering those
influential determinant of use of reproductive health service, the household and community in
which the individual lives as well as the characteristics of the health service available in the
community must be taken into consideration. Providers should note that women do live in a
context where they are not making unilateral decisions about their reproductive health. It is

21
also significant to note that husbands approval was also rated high as determinants of
contraceptive use and this is consistent with literature that men are usually dominant decision
makers when birth or fertility control issues are to be determined. One of the frequent reasons
women gives for not beginning or continuing to use contraceptives is their partners’ opinion
(Moronkola et al, 2006).

Health system factors that determines women’s utilization of modern

contraceptives

The health facility design

Research identifies several features in the design of services that may actively discourage
young women using the services. Design obstacles include, but not limited to cost, crowded
waiting rooms, counseling space that do not afford privacy, appointment time that do not afford
young people’s work and school schedules little or no accommodation for walk-in patients and
limited contraceptive supplies and options. Hearing about these obstacles may prevent people
from making a first visit. Encountering these obstacles may discourage them from returning to
the facility for the services.

Provision of good quality health Services to young women can be achieved through favorable
policy environment. Improved clinical and communication skills of providers and their
supportive attitude (WHO, 2004). The services should be in a place that is easily accessible,
have flexible working hours, offer privacy, affordable cost or free and friendly health service
providers (MOH, 2005).

Privacy and confidentiality

Clients feel comfortable if providers respect their privacy during counseling session,
examinations and procedures. Particularly those who services in secrete report higher
satisfaction with health providers who keep their needs and personal information confidential
(Whittaker, 1996).
Lack of privacy can violate a woman’s sense of modesty and make it more difficult for them
to participate actively in selecting a contraceptive method. In a few places, obtaining and using
contraceptive methods can be a difficult and risky decision that can lead to abandonment,

22
violence, ostracism or divorce. In such situation, women need assurance of absolute
confidentiality.

Health workers attitude and actions

Providers’ attitude, opinion and biases about contraceptives represent what providers truly
believe, including their support or opposition to provision and opinions potentially affecting
distribution practices. Research shows that some family planning providers still restrict access
to contraceptives based on age or marital status (Speizer IS et al, 2000).

Service providers sometimes deny access to family planning methods as a result of their
prejudices about the method or its delivery system. Provider bias which occur when service
provider believe that they are in a better position to choose the most appropriate method for the
client or are biased towards certain methods may preclude women from using a method
appropriate to their circumstances and needs (Costello M 2001). If clients do not receive their
preferred methods or services or are turned away without receiving satisfactory diagnoses, they
may stop seeking care.

Studies have shown that women are more likely to seek out and continue using FP services if
they receive respectful and friendly treatment (Williams TW, 2000). Research shows that the
health providers tone, manner and mode of speech are important to clients (Whittaker M. et
al, 1996).

In one study in Zaire, most women who were asked about the two best qualities for nurse first
mentioned qualities related to communication style such as respect and attentiveness and
secondly listed technical qualities (Haddads et al, 1995).

Another study in Ethiopia on health workers attitude towards sexual and reproductive like
contraception for unmarried youths concluded that some health workers were setting up penal
rules and regulations against premarital sex (Tilahun et al, 2010).

Affordability of services
Clients are generally more likely to use low cost services. In Kenya, clients said that low cost
and proximity of services were the two most important factors that attracted them to services

23
(John Ross, 2000). A study in Bangladesh indicated that families spend more money on health
care only in a crisis situation.

Contraceptives side effects and related problems are rarely seen as emergencies; so many
women in the study stopped using contraception and switched methods because they could not
justify the expense of dealing with side effects (Sidney, 2001). On the other hand, clients may
be willing to accept higher cost if they believe that services are of high quality.

Clients schedule and waiting time

Long waiting time and inconvenient clinic hours can prevent the clients from obtaining the
service they need. In both Malawi and Senegal, clients identified long waiting time as a
concern. A client said that waiting was a big problem and she sometimes skips her appointment
if she thinks about the hour of service (John Snow, 2000). Some clinics do not post their hour
of service or do not serve clients during certain hours when they are supposed to be open.

A study in Kenya found that although clinics were officially open from 8.00 am to 5.00 pm,
providers discourage clients from coming in the afternoon and often did not provide services
to women who were only able to attend in the afternoon (AORTP II 1995).

CHAPTER THREE

3.0 Methodology
Introduction.

24
This usually entails details regarding the procedures used in conducting the research study
which mainly includes the proposed research design , population and sample, study area, data
collection procedures, data analysis techniques, (Mugenda, 1999).
Research design
The research design was a descriptive cross-sectional design to examine factors influencing
utilization of modern contraceptive among women of reproductive age. Cross-sectional designs
were considered in the present time to examine what currently exists and they were
fundamentally characterized by the fact that all data were collected at one time. The purpose
of descriptive design was to observe, describe and document aspects of a situation as it naturally
occur in a given population.
Study area
The study was carried out at MCH/FP clinic at Rachuonyo sub-county hospital in Homa Bay
County.

Population and sample

All women of reproductive age (15-49) years, attending MCH/FP clinic at Rachuonyo sub-
county hospital.

Sample size determination

The desired sample size was determined using Fischer’s 1998 formula
n=z2pq
d2
n=desired sample size
z=standard normal deviation (1.96), which corresponds to 95% confidence interval
p=proportion of population estimated to have similar characteristics being measured
q=1-p
d=error margin to be tolerated
p=50%=0.5
z=1.96
q=1-0.5
d=0.05
Therefore n= (1.962) ×0.5×0.5
=384

25
The sample size was 384 but due to inadequate resources the researcher is only able to question
100 respondents for the study.
Sampling procedure

A random sample was selected to represent the above defined study population. A systematic
random sampling technique was used to select the sample unit.
Instrument

The study used questionnaire for data collection. The selection of this tool was guided by the
nature of data to be collected, the size and objectives of the study. Questionnaires increase the
chances of getting honest responses since they ensure anonymity of the respondents. The
questionnaires used both open ended and closed ended questions. The use of open ended
questions offered flexibility of the respondents to provide more details. Closed ended questions
allow for quantitative analysis.
Data collection procedure
Questionnaires was administered to the respondents to fill and the researcher was ever present
in case of any difficulty i.e. clarification or language interpretation

Data analysis techniques

Data analysis was start once all the data were captured. Since study ought to establish the extent
to which the independent variable influences the dependent variable, it was therefore suitable
to analyze data using descriptive analysis i.e. by use of pie charts, tables and graphs that
describes and summarizes the data.

Selection criteria
Inclusion criteria
The criteria included all women of reproductive age, married and unmarried who were utilizing
modern contraceptives and those that were not using any method of modern contraceptives,
willing to participate in the study and able to give informed consent; attending at the facility
during the study period. The criteria also included both married and unmarried women
Exclusion criteria
1. Those who were not residents of Rachuonyo sub-county and those who were below15 years
and those above 49 years.
2. Those who were unwilling to participate in the study.

26
3. Those women who had health/ mental conditions rendering it impossible to obtain
informed consent.

Ethical consideration
Authority to pursue study was granted by the K.M.T.C. and the medical superintendent of
health, Rachuonyo district. The respondents were provided with information on the research
and its intended purpose. They were also informed that the information they gave would be
purely for research purpose and each participant voluntarily signed an informed consent form.

The respondents were reassured that all the responses that were gotten from each of them were
to be treated with high confidentiality. Te study was also flexible to allow any respondent to
withdraw if any case she feels so. The researcher analyzed the data as it was collected from the
respondents and the findings were not manipulated.

CHAPTER FOUR

4.0 Data analysis and interpretation

Introduction
This chapter presents all the findings of the study. The study was analyzed using descriptive
statistics, scientific calculator and computer. The result was presented inform of tables, graphs
and charts.

27
Part A: Socio-demographic Information

Table 2: Respondents

Response Frequency Percentage

Questionnaire returned 100 100%
Questionnaire not returned 0 0%
Total 100 100

The table above shows the 100% response.

Figure 1: Age distribution of the respondents

The above graph shows that the majority of the respondents (31%) lie in age bracket of (20-
24) followed by 25% in age bracket of (15-19) while the least (2%) in age bracket of (40-44)
years. There were no respondents in age bracket of (45-59) years.

Table 3: Marital status of the respondents

Marital status Frequency Proportion (%)

Married 36 36%
Single 31 31%
Divorced 8 8%
Separated 15 15%
Widowed 10 10%

28
 Total 100 100%

Majority of the respondents (36%) were married, followed by 31% single, 15% separated, 10%
widowed and the least (8%) divorced.

Figure 2: Level of education of respondents

The above graph, majority of the respondents (47%) were in primary level followed by
secondary level at 25%, college level at 16% while the least (12%) were in university level.

Figure 3: Religious denomination of respondents

29
Majority of the respondents (51%) were from SDA denomination followed by the Catholic at
(38%) and the least were Islam.

Figure 4: Occupation of respondents

From the above findings, majority of the respondents (25%), were students followed by
housewives at 21% where as the least of the respondents (17%) were employees.

Part B: Level of Knowledge on Modern Contraceptives.

30
Table 4: Have you heard of modern contraceptives?

Response Frequency Proportion (%)

Yes 100 100%
No 0 0%
Total 100 100

The table above shows that 100% of the respondents have heard of modern contraceptives.

Figure 5: Have you used any contraceptive?

20%

Yes
No

80%

The chart above indicates that majority (80%) of the respondents are using modern
contraceptives while minority (20%) of the respondents are not using contraceptives. The 20%
who are not using modern contraceptives complain that the myths about the contraceptives
have discouraged them not to do so. Some also said that they fear the side effects of the
contraceptives and also that their culture does not allow the use of contraceptives.

Figure 6: How did you learn about modern contraceptives?

31
The above graph shows that majority (42%) learned about modern contraceptives from hospital
health workers followed by 35% from friends and relatives and the least (23%) from mass
media.

Figure 7: Which contraceptive do you use?

The graph above shows that condom is used by majority (36%) of the respondents followed by
emergency contraceptives at 25%,contraceptive pills and injectables at13%, implants at10%
and the least(4%) using natural family planning method.

Table 5: Why do you use modern contraceptives?

32
 Reasons Frequency Proportion (%)
Control number of births 31 39
Child spacing 13 16
Prevent unplanned pregnancy 17 21
Prevent STI 19 24
Enhance sexual performance 0 0
Total 80 100

The table above shows that majority (39%) of the respondents use contraceptives to control the
number of births followed by 24%, to prevent STI, 21% to prevent unplanned pregnancy while
16% for child spacing.

Table 6: Dislikes on modern contraceptives

Response Frequency Proportion (%)

Side effects 53 66
Regular refilling 25 31
Others 2 3
Total 80 100

The above table indicates that majority (66%) of the respondents dislike modern contraceptives
due to their side effects, 31% due to regular refilling and the least (3%) due to other reasons
such as myths about modern contraceptives.

Part C: Health Facility Factors

33
Table 7: Distance from the respondents’ home to the health facility

Distance Frequency Proportion (%)

Less than 1km 55 55
1 - 2km 32 32
3 -4km 11 11
5 -6km 2 2
Total 100 100

The table above shows that majority (55%) stays around the health facility that is less than 1km
away from the health facility followed by 32% in 1-2km, 11% in 3-4km and the least (2%) in
5-6km away from the health facility.

Figure 8: Where do you get your contraceptives?

The above graph indicates that majority (44%) of the respondents get their contraceptives from
drug shops, 34% from government health facility and the least (22%) get their contraceptives
from private clinics.

Figure 9: Did the health provider treat you in a friendly manner?

34
 19%

Yes
No

81%

The chart above shows that majority (81%) of the respondents feel that the health care providers
treated them in a friendly manner while 19% of them reported not treated in a friendly manner.

Table 8: Respondents waiting time

Response Frequency Proportion (%)

Too long 47 59
Just right 33 41
Total 80 100

The above table indicates that 59% of the respondents reported that their waiting time was too
long while 41% reported that the waiting time was just right.

Table 9: Reassurance of confidentiality

Response Frequency Proportion (%)

35
 Yes 45 56
No 35 44
Total 80 100

The above table shows that 56% of the respondents reported that they were reassured of
confidentiality by the health care providers while 44% reported that they were not assured of
confidentiality.

Section D: Cultural Factors

Figure 10: Does your culture allow the use of contraceptives?

The above graph shows that majority (52%) of the respondents reported that their culture
allows the use of contraceptives while 48% reported that their culture does not allow the use of
modern contraceptives.

Table 10: Respondents’ discussing with their partners on utilization of

contraceptives

36
 Response Frequency Proportion (%)
Yes 30 43
No 39 57
Total 69 100

The above table shows that 34% of the respondents reported that they have discussed with their
partners on utilization of modern contraceptives while majority (57%) have not.

Table 11: Respondents’ partners’ approval of contraceptives

Response Frequency Proportion (%)

Yes 19 63
No 11 56
Total 30 100

The above table shows that the 30 respondents who discussed with their partners on utilization
of modern contraceptives, majority (63%) reported that their partners approved it while 56%
reported that their partners did not approve the use of contraceptives.

CHAPTER FIVE
5.0 Discussion
Socio-demographic characteristics

37
The study revealed that majorities (31%) of the respondents were aged between 20-24 years
followed by 15-19 years at 25%, 25-29 years at 19% and there were no respondents aged 45-
49 years. It revealed that 36% of them were married, 31%n single, 15% separated and the least
(10%) widowed.

According to their level of education, majority (47%) of the respondents were in primary level
followed by secondary level at 25%, college level at 16% and the least (9%) in university level.
This indicates that most of the respondents rely on the advice given to them by health care
workers since they have little knowledge on.

The studies also showed that majority (80%) of these women of reproductive age were
currently using some form of modern contraceptives such as condom, pills injectables and
implants. The high rate of contraceptive use in this study could be because of the availability
of multiple contraceptive such as government health center, drug shops and private clinics.
However, 20% reported not using any modern contraceptive yet they have heard of
contraceptives. This should be of great public health concern.

In Homa-Bay County where there is high prevalence of HIV, high level of sexual activity and
unprotected sex are placing these women at risk of HIV infection as well as unwanted
pregnancy which may lead to unsafe abortions.

Occupationally, majority (25%) of the respondents were students 21% were housewives, 19%
farmers, 18% were in business while the least (17%) were employed.

Knowledge on modern contraceptives

The study revealed that 100% of the respondents have heard of the modern contraceptives.
Majority (42%) learned about contraceptives from hospital health workers, 35% from friends
and relatives and 23% learned from mass media. They also had the knowledge of different
types of modern contraceptives. Concerning these contraceptives that are used by the
respondents, the most commonly used was condoms at 36% followed by emergency
contraceptive pills at 25% contraceptive pills and injectables at 13% each and implants at 10%.
Only 4% of the respondents preferred the natural family planning methods.

38
Further still, this study showed women aged (15-19) and (20-24) use short term contraceptives
such as condoms and emergency contraceptive pills. This indicates knowledge gaps among
youths, limited access to comprehensive contraceptive information as well as full range of
contraceptive services. On the other hand, this could mean that young people are mainly
interested in condoms and emergency pills and therefore, an opportunity for promoting
condoms and emergency contraceptive pills’ use among young women since acceptability is
already demonstrated.

Health system factors

This study also showed that utilization of modern contraceptives was lower among unmarried
females below 20 years. This could be because the young women (youths) themselves and the
providers of contraceptives were a little reserved about use of contraceptives by the unmarried
and school going youths. The implication of this study is that family planning programs
targeting women should not aim at everybody but rather focus on specific sub groups.

The findings of this study further suggest that the quality of contraceptive services provided to
the young women aged (15-19) years is low. This low quality of services could be indicative
of the difficulties young women experience when receiving modern contraceptives and also
reason for the low utilization of contraceptives among young women. Receiving good quality
contraceptive services encourages acceptance or continuation of contraceptive use. Some of
the respondents also reported that their waiting time in the health facility was too long and this
sometimes discourages them to continue using contraceptives.

Cultural factors
The study revealed that 52% of the respondents reported that their culture allows the use of
contraceptives while 48% of the respondents reported that their culture does not allow the use
of contraceptives. This indicates that culture is a major barrier to utilization of contraceptives.
Majority of the respondents who reported not using contraceptives were from the Catholic
denomination thus, religion also affects utilization of modern contraceptives.

39
The study also revealed that minority (43%) of the respondents discussed with their partners
on utilization of modern contraceptives while majority (57%) did not. The 43% that is 30
respondents who discussed contraceptives with their partners, majority (63%) that is 19
respondents got approval while 37% that is 11 respondents did not get approval from their
partners.

CHAPTER SIX

2.0 Conclusions and Recommendations

Conclusion
In conclusion, the study showed that a big proportion of women were using any modern
contraceptive. It also showed uneven availability of contraceptive supplies and limited

40
information characterized the contraceptive services accessed by young women. In addition,
the providers had negative attitude towards dispensing contraceptives towards unmarried and
school-going young women. Therefore, to improve utilization of contraceptives among women
especially the youths; availability of contraceptive choices should not be compromised;
providers should; providers should trained on how to serve young people and dispensing
contraceptives should be accompanied by adequate information on how to use the
contraceptives and their side effects.

Recommendations
 The gaps in providers’ knowledge and competence need to be addressed immediately
in order to improve how providers serve young women so as to meet the individual
needs of different groups especially the youths.
 Young women should be well informed on contraceptives and have access to a variety
of contraceptives.
 There is also need for family planning programmers to harmonize family planning
training to women and their partners for knowledge uniformity across them.
 All family planning training should have a section on young women just as it is with
other vulnerable groups like people living with HIV/AIDS.
 Drug shops plays an important role in providing contraceptive services and their
potential to reach women in rural areas should not be overlooked and therefore,
interventions are needed to target drug shops operators for the safety of their clients.
 Clients’ waiting time should be reduced at the family planning clinics by providing
more health providers. The health providers should also be trained on client care
practices.
 Policies should be introduced that improve young people’s demand and access to
modern contraceptive methods e.g. lower the cost of contraceptives/ free
contraceptives, ensure confidentiality of services and introduction of alternative
distribution channels for modern contraceptives.
 Access of all young women (youths) to appropriate comprehensive sexual education in
and out of schools should be ensured.
 Existing health services should be youth friendly and comprehensive.

41
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16. Mutiso S.M., J. Kinuthia and Z. Qureshi, 2008. Contraceptive use among HIV infected
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September 2003 (page 2).
24. Sennen HH, Carabin H,and Handerson NJ,2005. Towards an understanding of barriers to
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25. Sidney Ruth Schuler: “The persistence of a service delivery ‘culture’: Findings from a
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26. Speizer IS., Hotchkiss DR.and Magnani RJ: Doservice providers in Tanzania unnecessarily
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28. Tilahun.M. Mengishe,B.,Egata G. and Reda A.A (2010): Health workers attitude towards
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Appendix II: Questionnaire

My name is Caroline Atieno Oloo, a second year student of Health Records and Information
Technology at Siaya Medical Training College.
I am carrying out a research on factors influencing utilization of modern contraceptives among
women of reproductive age (15-49) years attending MCH/FP clinic. The information obtained
will be confidential and therefore, you are required to provide the necessary information.

45
Instructions
 Read and understand the questions carefully before answering.
 Do not write your name(s) on the questionnaire.
 Use a pencil to place a tick in the brackets [ ] provided for the most correct answer
 Answer all the questions as possible as you can.

SECTION A: Socio-demographic data

1. Age
a) 15-19 [ ]
b) 20-24 [ ]
c) 25-29 [ ]
d) 30-34 [ ]
e) 35-39 [ ]
f) 40-44 [ ]
g) 45-49 [ ]

2. Marital status
a) Married [ ]
b) Single [ ]
c) Divorced [ ]
d) Separated [ ]
e) Widowed [ ]

3. Level of education
a) Primary [ ]
b) Secondary [ ]
c) College [ ]
d) University [ ]

4. Religious denomination

46
 a) SDA [ ]
b) Catholic [ ]
c) Islam [ ]
d) Hindu [ ]
e) Others [ ]

5. Occupation
a) Farmer [ ]
b) Housewife [ ]
c) Employed [ ]
d) Business [ ]
e) Student [ ]

PART B: Level of knowledge on modern contraceptives

1. Have you heard of modern contraceptives? Yes [ ] No [ ]

2. Where did you learn about contraceptives / family planning?

a) Friends / relatives [ ]
b) Mass media / radio [ ]
c) Hospital health workers [ ]
d) Others (specify) [ ]

3. Have you used any type of contraceptive? Yes [ ] No [ ]

4. If yes, which contraceptives / family planning method do you use?

a) Condoms [ ]
b) Emergency contraceptives [ ]
c) Contraceptive pills [ ]
d) Indictable [ ]
e) Implants [ ]
f) Natural family planning [ ]

47
5. Why do you use modern contraceptive?
a) Control number of births [ ]
b) Child spacing [ ]
c) Prevent unplanned / unwanted pregnancies [ ]
d) Prevent sexually transmitted infections [ ]
e) Enhance sexual performance [ ]

6. What don’t you like about contraceptives?

a) Side effects [ ]
b) Regular refilling [ ]
c) Others (specify) [ ]

PART C: Health facility factors

1. How long is your home to the health facility?
………………………………………………………………………….

2. Have you ever inquire contraceptives from the health providers?

a) Yes [ ]
b) No [ ]

3. Where do you get your contraceptives?

a) Drug shop
b) Private clinic
c) Government facility
e) None
4. What type of service did seek?
a) Family planning counseling
b) Condoms
c) Pills
d) Injectables

48
 e) Emergency pills
e) Others (specify)

5. Did you get the services you went for?

Yes [ ]
No [ ]
6. When you were receiving counseling, were other people present?
Yes [ ]
No [ ]
7. Did the provider reassure you that any information concerning your personal situation and
the service you received will remain confidential?
Yes [ ]
No [ ]
8. Did you feel that the time you spent with the provider was enough?
a) Too long
b) Just right
c) Too short
9. Do you think the environment you were given the service was comfortable?
Yes [ ]
No [ ]
10. (a) Did the health provider treat you in a friendly manner?
Yes [ ]
No [ ]
(b) If no, explain. ………………………………………………………………

11. Have you been informed about the following?

(a) When to return for your visit
No [ ]
Yes [ ]
(b) That you can return at any time if you have questions or problems
Yes [ ]
No [ ]

49
SECTION D: Cultural factors.
1. Does your culture allow the use of modern contraceptives?
Yes [ ]
No [ ]

2. (a) Have you discussed with your partner about the use of contraception at any time?
Yes [ ]
No [ ]
(b) If yes, does he approve of contraceptive /family planning methods?

Yes [ ]
No [ ]

Thank you for your time and cooperation.

Appendix III: Work Plan

Month 2014 2015

Activities Sep Oct Nov Dec Jan Feb Mar Apr May Jun
Problem
identification
Contact with
supervisors

50
Literature
review
Proposal
writing
Proposal
presentation
Data
collection
Report
writing
Submission
of
dissertation

Apendix IV: Research Budget

Item/ Activity Quantity Price per unit Total

Biros 5 25/= 125/=
Pencil 6 5/= 30/=
Full scups 2 reams 350/= 700/=
Printing papers 2 reams 500/= 1000/=

51
Eraser 2 20/= 40/=
Stapler 1 350 350/=
Stapler pins 1 packet 30/= 30/=
Spring file 1 75/= 75/=
Internet services 2hrs for 10 days 30/= per hr 600/=
Printing 60 pages 5per page 300/=
Proposal binding 3 copies 380 per copy 1140/=
Travelling to the external supervisors 4 trips 200 per trip 800/=
Questionnaire printing 100 copies 21 per copy 2100/=
Data collection 31 days 150 per day 4650/=
Final dissertation binding 3 copies 500 per copy 1500/=
Flash disk 2 GB 700 100/=
Grand total 31540/=

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Appendix v: Map Of Homa Bay County

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Appendix VI: MAP OF KENYA

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