Innovations for MNCH, Concern Worldwide US, New York, NY, 10017, USA.
Int J Equity Health. 2013 Aug 27;12:71. doi: 10.1186/1475-9276-12-71.
Kenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor.
We use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya.
There was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993-1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09.
The narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.
肯尼亚的计划生育（FP）需求未得到满足，且非意愿妊娠率高，城市人口迅速膨胀，城市贫困问题加剧。该国 FP 和生殖健康（RH）指标在经历了一段时间的停滞不前之后，最近有所改善。本文的目的是：a）描述肯尼亚城市地区现代避孕方法使用率、方法类型和避孕药具主要来源的不平等现象；b）检验贫困和富裕人群之间避孕方法使用的差异随时间扩大还是缩小；c）尝试将这些发现与 FP 规划背景联系起来，重点关注服务是否越来越惠及城市贫困人口。
我们使用了 1993 年、1998 年、2003 年和 2008/09 年肯尼亚人口与健康调查的数据。通过描述性分析，我们描述了现代避孕方法的使用模式以及方法类型和来源，而多元逻辑回归模型则评估了贫困和富裕人群之间的差距随时间的变化情况。定量分析补充了对肯尼亚主要 FP/RH 项目的回顾。
2003 年至 2008/09 年期间，避孕方法的使用情况发生了巨大变化，2008/09 年贫困和富裕人群之间几乎没有差距，而 1993 年至 1998 年期间，避孕方法的改善并没有显著惠及城市贫困人口。事实上，上世纪 90 年代末，肯尼亚政府及其发展伙伴意识到，需要有针对性地向计划生育服务的贫困人群提供服务。大多数城市妇女使用短期和效果较差的方法，在审查期间，长效方法使用者的比例下降了一半。2003 年至 2008/09 年期间，私营部门用户的比例也有所下降。
在最近一段时间，城市贫困和富裕人群在现代避孕方法使用方面的差距缩小，这无疑是个好消息。结合对家庭项目背景的审查，这表明计划生育项目可能正在越来越多地惠及城市贫困人口。
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