Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya.
School of Public Health, University of Nairobi, Nairobi, Kenya.
BMC Public Health. 2021 Jul 5;21(1):1316. doi: 10.1186/s12889-021-11375-7.
Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya.
We used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as "the use of contraceptives without a partner's knowledge". We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions.
The prevalence of CCU was 12.2% (95% CI: 10.4-14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35-49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73-8.31), women with primary education (aOR 1.86, 95% CI 1.06-3.29) and those from the poorest (aOR 2.67, 95% CI 1.61-4.45), poorer (aOR 1.79, 95% CI 1.05-3.04), and middle (aOR 2.40, 95% CI 1.52-3.78) household wealth quintiles and were reduced among those with 2-3 (aOR 0.49, 95% CI 0.33-0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40-0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89-0.99) reduced the odds of CCU.
About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women's right to make independent choices.
计划生育（FP）是预防非计划怀孕、不安全堕胎和孕产妇死亡的关键干预措施。妇女及其伴侣的参与促进了避孕措施的接受、采用和持续使用、夫妻沟通和性别平等态度。伴侣参与是解决肯尼亚约 17.5%计划生育未满足需求的关键策略。本研究评估了肯尼亚隐性避孕（CCU）的流行情况和相关因素。
我们使用了绩效监测问责调查第六轮和第七轮的数据。我们将 CCU 定义为“在伴侣不知情的情况下使用避孕药具”。我们使用频率和百分比来描述样本特征和 CCU 的流行情况，并使用双变量和多变量逻辑回归评估相关因素。
CCU 的流行率为 12.2%（95%CI：10.4-14.2%）；在未受过教育的（22.3%）、最贫穷的（18.2%）和 35-49 岁的女性中最高。注射剂（53.3%）和植入物（34.6%）是 CCU 女性最常使用的方法。在单变量分析中，锡亚县、农村居民、教育、财富和性初潮年龄与 CCU 相关。在调整了混杂因素后，未受过教育的女性（aOR 3.79，95%CI 1.73-8.31）、接受过小学教育的女性（aOR 1.86，95%CI 1.06-3.29）和来自最贫穷（aOR 2.67，95%CI 1.61-4.45）、较贫穷（aOR 1.79，95%CI 1.05-3.04）和中等（aOR 2.40，95%CI 1.52-3.78）家庭财富五分位数的女性，以及生育 2-3 个（aOR 0.49，95%CI 0.33-0.72）和≥4 个孩子（aOR 0.62，95%CI 0.40-0.96）的女性，其 CCU 的几率降低。性初潮年龄（aOR 0.94，95%CI 0.89-0.99）降低了 CCU 的几率。
肯尼亚约十分之一的已婚女性隐性使用避孕药具，注射剂和植入物是首选方法。我们的研究突出了在计划生育伴侣参与方面的差距，并呼吁努力加强他们的参与，以增加肯尼亚的避孕措施使用，同时承认妇女做出独立选择的权利。
