Surprising success in Kenya's FP programme.

Abstract

Mrs. Margaret Gachara, Deputy Director of the Ministry's Family Health Division, explained that the strengths and weaknesses of the program have recently been examined using a new operations research approach, known as situation analysis. "If family planning was not working in Kenya, we had to know why in order to decide what to do about it. We began the study to find out where our weaknesses lay. To our surprise, we found that we were not weak, but moderately successful," she said. The Kenya Situation Analysis Study, conducted by the Health Ministry and the Population Council, revealed that contraceptive prevalence increased by 2%/year between 1984-89, from 17% to 27%. "That is quite acceptable by World Bank and WHO standards. Our total fertility rate has dropped from 7.9% to 6.7%, and in urban areas is down to 3.8%. We are now continuing with in-depth studies, but we expect to be able to say next year that our family planning program should have a moderately high rating, especially in terms of quality of care." Since the 1st results of the Analysis Study were published, family planning agencies in several other African, Asian and Latin American countries have requested similar studies. The Kenyan study showed that the Pill is the most popular method of contraception, used by about 80% of family planning acceptors. However, the use of injectable contraceptives has risen about 4-fold in recent years, from 0.5 to 1.8 million doses a year, Mrs. Gachara said. When the study was conducted, availability of injectable contraceptives was very poor and did not have strong logistical support. This has now been changed, and its use is going up very fast in rural areas. 1 of the reasons is that women who want to use contraception, but do not have support from their husbands, can have injection without their husbands knowing. Although the 3 monthly injectable initially had a very bad press and little Parliamentary support, research has shown that many of the fears were unfounded. Kenyan policy is to make the injectable available to women with 4 children and to those over 35. Guidelines have recently been changed, to require 1 live birth before injectables are offered, rather than 2. The government is also making efforts to promote the use of Noristerat, and a pilot program is currently underway to study implants. The situation analysis did reveal problems in a number of areas, and a list of recommendations has now been drawn up to improve the quality of care. The recommendations include improved supply of information on permanent contraceptive methods and on the side-effects of other contraceptives, a reduction in waiting times for family planning services and an increase in follow-up. "The future looks good for family planning in Kenya, but we have to match our services to contraceptive health benefits and to focus more on maternal health in its totality," Mrs. Gachara said.