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    • Jacques VallinJacques Vallin
      Emeritus Research Director at INED, Paris; Honorary President of IUSSP
      Massimo livi BacciMassimo livi Bacci
      Emeritus Professor of Demography, University of Florence, Italy
      Alaka BasuAlaka Basu
      Professor, Dept of Development Sociology, Cornell University, Ithaca, NY, USA and Senior Fellow, United Nations Foundation, Washington DC, USA
      Bruno MasquelierBruno Masquelier
      Professor of Demography, University of Louvain, Belgium
      Gustavo De SantisGustavo De Santis
      Professor of Demography, University of Florence, Italy
      Ernestina CoastErnestina Coast
      Associate Professor of Population Studies, London School of Economics
      Roberto ImpicciatoreRoberto Impicciatore
      Assistant Professor of Demography, University of Milan, Italy
      Salvatore StrozzaSalvatore Strozza
      Professor of Demography, University Federico II, Naples (Italy)
      Cinzia ContiCinzia Conti
      Researcher at Istat, Head of Unit on Foreign Presence and Social Dynamics
      Alessandro RosinaAlessandro Rosina
      Professor of Demography and Director, Center for Applied Statistics in Business and Economics, Università Cattolica del Sacro Cuore
      Letizia MencariniLetizia Mencarini
      Associate professor of Demography, Bocconi University - Dondena Centre for Research on Social Dynamics and Public Policy & Collegio Carlo Alberto; P.I. ERC P.I. ERC project n. 313617 (2013-2018) SWELLFER http://swellfer.wordpress.com
      Feng WangFeng Wang
      Professor of Sociology at the University of California, Irvine, USA, and Professor at Fudan University, Shanghai, China
      Corrado BonifaziCorrado Bonifazi
      Director of the Institute for Research on Population and Social Policies, National Research Council, Rome Italy
      John KnodelJohn Knodel
      Research Professor Emeritus, Population Studies Center, Institute for Social Research, University of Michigan (USA) and International staff, College of Populations Studies, Chulalongkorn University (Thailand)
      Gilles PisonGilles Pison
      Professor at Museum National d'Histoire Naturelle and Director of Research at the French National Institute for Demographic Studies (INED) (Paris)
      Andrea BrandoliniAndrea Brandolini
      Head of Statistical Analysis Directorate, Bank of Italy
      Peter McDonaldPeter McDonald
      Professor of Demography in the Australian National University. Honorary President of IUSSP and winner of the Irene B. Taeuber Award
      Monica Das GuptaMonica Das Gupta
      Research Professor of Sociology, University of Maryland, USA
      Stefano MolinaStefano Molina
      Senior Program Officer, Giovanni Agnelli Foundation, Italy
      Cheikh MbackéCheikh Mbacké
      Associate Professor, Sociology department, Laval University
      Letizia TanturriLetizia Tanturri
      Associate Professor of Demography, University of Padova, Italy
      Francesco BillariFrancesco Billari
      Professor of Sociology and Demography, University of Oxford
      Paula Miranda-RibeiroPaula Miranda-Ribeiro
      Professor, Demography Department and Cedeplar, Universidade Federal de Minas Gerais, Brazil.
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  • N-IUSSP
    • N-IUSSP is a new IUSSP news magazine, which will disseminate scientific findings from demographic research carried out all over the world. The practical implications of current trends, the risks and potentialities of emerging situations, the pros and cons of specific laws are discussed in rigorous but plain language.

      You are invited to contribute to this new publication: please check our guidelines and submit your 1000 word contribution to contact@niussp.org

Family planning in the slums of Nairobi, Kenya
Planning familial dans les bidonvilles de Nairobi, Kenya

Donatien Beguy, Alex C. Ezeh, Blessing U. Mberu, Jacques B.O. Emina
children in Nairobi

In Kenya, rapid population growth has occurred amidst poor urban governance and limited employment opportunities, leading to widespread urban poverty that is concentrated in informal settlements or slums. In Nairobi, the capital city, it is estimated that between 60 and 70% of the residents live in slums or slum-like conditions (APHRC 2014). Slum-dwellers have limited access to health and reproductive health services and they have comparatively poor sexual and reproductive health outcomes (Zulu et al. 2008). Within urban areas in Kenya, unmet need for contraception is greater among the poorest women, and their childbearing is often mistimed or unwanted (Ezeh et al. 2010). However, it is suggested that the gap between poor and rich in the use of modern contraception in urban Kenya is narrowing, and that family planning (FP) services may be increasingly reaching the urban poor (Fotso et al. 2013).

Using data collected from representative samples of the slum population in Nairobi in 2000 and 2012, we recently examined changes in the use of modern contraception in Nairobi slums over the period (Beguy et al 2017).

Our findings

Overall, there was a dramatic 19-percentage-point increase in the use of modern contraception among married women between 2000 (35%) and 2012 (54%), with a substantial improvement among hitherto disadvantaged groups, i.e. poor urban women. This is consistent with the substantial increase in modern contraceptive prevalence rate (CPR) over the last decade in Kenya, from 32% in 2003 to 53% in 2014, with the public sector being the major provider of contraceptive methods. While in 2000 there were significant differentials in the CPR by various socio-demographic and socioeconomic characteristics, these associations had nearly disappeared in 2012. For example, in 2000, women with secondary or higher education were much more likely to be using modern methods than those with no education (43% vs. 13%). By 2012, usage had increased in both groups, and the differences had considerably shrunk (54% and 33%, respectively; see Table 1).

TabellaNiusspOverall, data suggests that the observed increase in modern CPR among women of reproductive age in Nairobi slums between 2000 and 2012 was overwhelmingly due to a change in their reproductive behavior with respect to use of modern contraception. This is consistent with findings from a recent study which demonstrated that changes in behavior explained much of the increase in modern CPR in 27 countries in sub-Saharan Africa, including Kenya (Emina et al. 2014).

Family planning programs apparently work

The change observed in Nairobi’s slums was probably due to the revival of family planning (or FP) programs in Kenya over the past few years. To address the significant disparities in contraceptive use and unmet need for FP in the country, the government of Kenya sought to eliminate stockouts of contraceptive commodities and remove financial barriers to family planning services by introducing, in 2006, a budget line for contraceptive commodities in the Ministry of Health’s annual budget. This has significantly narrowed most of the gaps in CPR since 2008–09. Other programs were set up to expand the reach and quality of FP programs among disadvantaged groups, including women from urban slums. For example, the Gates Foundation–funded Kenya Urban Reproductive Health Initiative (Tupange) was implemented between 2009 and 2015 to raise the CPR by at least 20 percentage points in poor urban settlements in five cities: Nairobi, Kisumu, Mombasa, Kakamega, and Machako.

Our analysis shows that more effective meeting of fertility preferences, particularly among women who want to cease childbearing, has contributed to much of the increase in use of modern contraception among women in Nairobi slums. Those who want no more children have the highest levels of contraceptive use: over 60% in 2012, reflecting a 56% increase over the period 2000-2012.

In addition, compositional change also plays a role in increasing CPR in Nairobi slums. For instance, the increase from 34% to 46% in the proportion of women with at least secondary education and the fact that these women also have the highest levels of contraceptive use explains much of the change in modern contraceptive use between 2000 and 2012. This finding corroborates previous evidence showing women’s education to be a key determinant of modern contraceptive use, and suggests that, even in slum settlements, education may have a powerful effect in bringing about social change.

Data also show that as child survival has improved over time, the demand for contraception to space or limit childbearing has increased among women in Nairobi slums.

Although we were unable to assess changes in the quality of reproductive health services, the proportion of women reporting that they were informed about FP when they visited a health facility increased considerably between 2000 and 2012. Our analysis also shows significant behavioral effects, suggesting that programs may be adopting strategies to ensure that women attending health facilities are provided with appropriate information to assist those who wish to adopt FP methods. For example, Tupange activities include training health care providers, FP orientation for all facility staff, and integration of FP services with other maternal and child health and HIV/AIDS services (Speizer et al. 2013). Also, the program’s social franchising of private providers has helped expand provision of FP services, in conjunction with its advocacy for increased resources for FP to improve commodity security and create a conducive policy environment. Other activities include working with community health workers to promote and distribute FP methods; community awareness and educational activities with local leaders, women, and youth.

Conclusion

This research suggests that in Nairobi slums, the largest gains in FP uptake between 2000 and 2012 were made among previously disadvantaged groups. Much higher increases among previously deprived groups have reduced inequity in access to contraceptive methods, constituting the main force behind the increase in overall contraceptive use. This may be the result of efforts by the government of Kenya and its development partners to reduce the disparities in uptake and use of FP services by targeting the poorest segments of the Kenyan population, such as those living in urban slums. This success is also an indication that such programs need to be sustained and scaled-up across the country.

References

APHRC – African Population and Health Research Center (2014). Population and Health Dynamics in Nairobi’s Informal Settlements: Report of the Nairobi Cross-sectional Slums Survey (NCSS) 2012. Nairobi: African Population and Health Research Center.

Beguy D., Ezeh A.C., Mberu B.U., Emina J.B.O. (2017) Changes in Use of Family Planning among the Urban Poor: Evidence from Nairobi Slums. Population and Development Review, supplement chapter. DOI: 10.1111/padr.12038.

Ezeh AC, Kodzi I, Emina J (2010). Reaching the Urban Poor with Family Planning Services. Studies in Family Planning. 41(2):109-116.

Fotso J, Speizer I, Mukiira C, Kizito P, Lumumba V. 2013. Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor? International Journal for Equity in Health. 12(1):71.

Emina JBO, Chirwa T, Kandala N-B (2014). Trend in the use of modern contraception in sub-Saharan Africa: does women’s education matter? Contraception.90(2):154-161.

Speizer IS, Corroon M, Calhoun L, et al. (2014). Demand generation activities and modern contraceptive use in urban areas of four countries: a longitudinal evaluation. Global health, science and practice. 2(4):410-426.

Zulu EM, Dodoo FN-A, Ezeh AC (2002). Sexual risk-taking in the slums of Nairobi, Kenya, 1993-98. Population Studies. 56(3):311-323.

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