1Population Council,Nairobi,Kenya.
2African Population and Health Research Center,Nairobi,Kenya.
J Biosoc Sci. 2019 Jul;51(4):491-504. doi: 10.1017/S0021932018000299. Epub 2018 Oct 12.
This study examines factors associated with satisfaction with oral pills and injectables among past users in Kenya based on a baseline survey for the 2-year prospective longitudinal study Improving Measurement of Unintended Pregnancy and Unmet Need for Family Planning conducted in 2016. Married women aged 15-39 years were interviewed using a structured questionnaire that captured information on reproduction, contraceptive knowledge and beliefs and attitudes towards contraception in general and towards specific methods. A multivariate logistic regression analysis was used to examine factors that influenced satisfaction with oral pills and injectables among past users in one urban site (Nairobi slums) and one predominantly rural site (Homa Bay in western Kenya). Results showed that dissatisfaction with pills and injectables is common among past users in both rural and urban Kenya (ranging from 39% to 56%). The distinctive contribution of the study lies in its ability to relate method-specific beliefs to overall satisfaction. Perception of effectiveness, ease of use and safety for long-term use had statistically significant influences on satisfaction with pills in both urban and rural sites while partner's approval was only important in Nairobi. For injectables, the perception of safety for long-term use was significant in the urban but not the rural site. Unlike pills, the belief that members of a woman's social network had used a method and found it satisfactory was a particularly powerful influence on satisfaction (AOR=2.8 in rural and 3.2 in urban). Perception of accessibility and fears about infertility were not found to be statistically associated with satisfaction for either pills or injectables. Surprisingly, the effects of all perceived contraceptive attributes were the same for major socio-demographic strata of the populations. The findings underscore the need for targeted counselling and community-based communication interventions to address negative and erroneous perceptions about family planning methods.
本研究基于 2016 年开展的为期两年的前瞻性纵向研究“改善意外怀孕和计划生育未满足需求的衡量”的基线调查，调查了肯尼亚过去使用口服避孕药和注射剂的人群中与满意度相关的因素。研究采用结构化问卷对 15-39 岁的已婚妇女进行了访谈，问卷内容涵盖了生殖、避孕知识以及对避孕的一般态度和对特定方法的态度。采用多变量逻辑回归分析，检验了在一个城市（内罗毕贫民窟）和一个主要农村地区（肯尼亚西部的霍马湾）过去使用口服避孕药和注射剂的人群中，影响满意度的因素。结果显示，农村和城市肯尼亚的过去使用者对避孕药和注射剂普遍不满意（范围为 39%至 56%）。本研究的独特贡献在于能够将特定方法的信念与总体满意度联系起来。在城市和农村地区，对有效性、易用性和长期使用安全性的认知对避孕药的满意度有统计学上的显著影响，而伴侣的认可仅在内罗毕重要。对于注射剂，长期使用的安全性认知在城市地区有统计学意义，但在农村地区则没有。与避孕药不同，女性社交网络成员使用过某种方法且感到满意的信念对满意度有特别大的影响（农村为 2.8，城市为 3.2）。对可及性的认知和对不孕的担忧，对于避孕药和注射剂的满意度都没有统计学上的关联。令人惊讶的是，所有认知到的避孕属性的影响在人群的主要社会人口阶层中是相同的。这些发现强调需要进行有针对性的咨询和社区为基础的沟通干预，以解决对计划生育方法的负面和错误认知。
