Factors Influencing Access to Contraceptives among Women of Reproductive Age in Public Primary Care Facilities in Kajiado Central Sub-County Kajiado County

Abstract

Strengthening health systems calls for attention on focus on the six health systems building blocks. The focus of this study was on medicines, vaccines and technologies, with an emphasis on access to contraceptives. In July 2013, the Kenyan government introduced the Free Maternal Service (FMS) policy. Implementing the FMS policy resulted in more usage of maternity services in Kenya however, personnel and physical resources were not enhanced to match the increasing demand. The challenges pointing to implementation of the FMS policy may be implied to lead to low access of maternal health services, including family planning services hence resulting in multiple health problems including unsafe abortions, unwanted births and unplanned pregnancies. Identifying the enabling and inhibiting elements before the execution of the interventions is likely to overcome these unmet needs. This study thus will seek to establish the factors influencing access to contraceptives by women of reproductive age within public health facilities in Kajiado County. The aim of the study was to determine how client factors, human resource factors, organizational factors and health communication influence access to contraceptives by women of reproductive age within Kajiado Central Sub-County, which has the highest average household size of 4.3 in Kajiado County. A cross-sectional descriptive research design was used in this study. The study targeted about 500 family planning clients visiting five public primary care health facilities in the sub-County. A sample of 217 drawn using systematic sampling. A structured questionnaire was used to collect data from 197 respondents. The majority of the respondents were between 25-35 years 112 (57%), were married 169 (86%), and majority 88 (45%) were on an injectable contraceptive method referred to as Depo Provera. The majority had one to four children 158 (80%), 93 (47%) had a college education, they were self-employed 81 (41%), and 61 (31%) were earning between KShs11,000-20,000. Results obtained from logistics regression analysis indicated that clients’ factors (p <0.001, OR=12.655, 95% CI [4.701-34.067]), and organizational factors (p <0.05, OR=2.541, 95% CI [1.079-5.985]), had a significant association with access to contraceptives. This study recommends that clients should be educated to demystify the cultural beliefs, myths and misconceptions surrounding contraceptive access. The county government should ensure the supply chain is well managed to ensure a constant supply of contraceptives, adopt automated systems and reduce human interventions. The county government should also improve the health provider infrastructure, as this is likely to lead to the delivery of quality services, client satisfaction and reduced maternal mortality. The health workers counsel clients before giving contraceptives, they also are friendly and listen to clients. This practice should continue being encouraged and natured, through in-service training.