Evaluation of Dynamics of Contraceptive Use, Discontinuation and Method Switching in Migori and Kitui Counties, Kenya
Condition: Family Planning; Contraception
Study type: Observational

Summary: 
      Kenya has made tremendous strides in improving contraceptive prevalence rate for the last 20
      years, however the rate of contraceptive discontinuation as remained almost constant at 1 out
      of 3 women using a family planning method. Contraceptive discontinuation increases unmet need
      of family planning. Hence understanding the underlying reasons for discontinuation helps in
      designing programs that improve method satisfaction.

      The primary goal of the study is to understand the factors leading to contraceptive
      discontinuation and switching among women of reproductive age (15 - 49 years) in Migori and
      Kitui counties, Kenya. The secondary goal is to assess whether a client-centered intervention
      focusing on contraceptive counseling can reduce modern contraceptive discontinuation and
      increase client satisfaction with use of modern contraceptive methods among women of
      reproductive age in the two counties.

      The specific objectives are to:

        1. To assess the quality of family planning services offered in health facilities in Migori
           and Kitui counties, Kenya

        2. To explore describe barriers and facilitators of modern contraceptive discontinuation
           and method switch among women of reproductive age in Migori and Kitui counties.

        3. To assess the client-centered intervention focusing on contraceptive counseling in
           reducing contraceptive discontinuation among women of reproductive age in Migori and
           Kitui counties, Kenya
    

Detailed description: 
      The 24 month prospective cohort study will seek to understand reasons for contraceptive
      discontinuation among women of reproductive age including adolescents in Kitui and Migori
      Counties, Kenya. The study will be implemented to assess determinants of contraceptive
      discontinuation after the barrier of lack of adequate counseling is removed. The barrier will
      be addressed by implementing an intervention focusing on a client-centered counseling
      approach in reducing contraceptive discontinuation among women accepting a contraceptive
      method. Ten health facilities with a high family planning caseload will be enrolled into the
      study. Counseling sessions will be conducted at the facilities using three channels:

        1. Counseling by Community Health Volunteers (CHVs) The proposed intervention will identify
           CHVs and build their capacity on contraception with an aim of having them providing FP
           counseling and services in high volume facilities - thus providing additional human
           resources. Their current training on family planning focuses on general information for
           each contraceptive method but lacks adequate content on counseling for family planning.
           The CHV training package will be enhanced with additional content on contraceptive
           methods that will equip them with the necessary skills on counseling. They will also be
           trained on adolescent focused counseling as well. Once trained, the CHVs will offer
           counseling for family planning at facility level. Following the counseling, CHVs will
           provide a method including pills and injectables to women and girls who have come for a
           revisit, unless they request for contact with the health care worker. This is in line
           with the Kenya's Ministry of Health task sharing policy and family planning guidelines
           that allows CHVs to conduct community distribution of pills, condoms and injectables.

        2. Individualized Counseling by Health Care Workers Once counseling has been done by the
           CHVs, the heath care workers will attend to the women in need for additional counseling
           and a method that the CHVs were unable to provide, for instance LARCs. The current
           counseling method used by the health care worker is the Balanced Counseling Strategy,
           which is cumbersome as it has a lot of information that overwhelms the providers and
           clients. The study proposes to adopt the counseling for continuation materials that will
           used to develop a simplified job aid for use by heath care workers to provide
           individualized counseling.

        3. Partner Counseling by Health Care Workers (HCWs) CHVs will mobilize potential couples to
           jointly attend contraceptive counseling sessions by the health care workers. The health
           care workers will be trained on how to conduct couple counseling. Existing couples
           counseling materials will be adapted based on the information gathered from the
           formative assessment. The facility will identify a package of additional
           non-contraceptive related services for the men who will have accompanied their spouses
           for family planning services.

      The investigators will enroll 1016 women of reproductive age in the following sub groups;
      Implant, IUD, Injectables and Pill users. Follow up interviews at 3, 6, and 12 months will be
      done to establish contraceptive use, discontinuation and method switching among women.
    

Intervention name(s): Enhancing contraceptive counseling on method continuation and switching
Intervention type(s): Behavioral
Intervention description(s): Health care workers and Community Health Volunteers will be trained on a contraceptive counseling package that enhances information on method continuation and switching. This will be done in the ten intervention facilities prior to enrollment of clients into the cohort study.
Intervention MeSH terms: Contraceptive Agents
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Women of reproductive age 15-49 years receiving a contraceptive method in the intervention
        facilities as new users to either the method or family planning