Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?
Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?
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DOI：
10.1186/1475-9276-12-71
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发表时间：
2013-08-27
影响因子：
4.8
通讯作者：
Lumumba, Vane
中科院分区：
文献类型：
--
作者：
Fotso, Jean Christophe;Speizer, Ilene S.;Lumumba, Vane
简介：肯尼亚的特点是，在城市人口爆炸和城市贫困加剧的背景下，计划生育需求得不到满足和计划外怀孕率很高。在经历了一段时间的停滞不前之后，最近，计划生育和生殖健康指标有所改善。该文件的目的是：（a）说明肯尼亚城市在使用现代避孕药具方面的不平等现象、所用方法的类型以及避孕药具的主要来源;（B）审查穷人和富人之间在使用避孕药具方面的差异随着时间的推移扩大或缩小的程度;以及c）试图将这些调查结果与计划生育方案编制的背景联系起来，重点是这些服务是否越来越多地惠及城市穷人。我们使用1993年、1998年、2003年和2008/09年肯尼亚人口和健康调查的数据。双变量分析描述了现代避孕药具的使用模式以及所用方法的类型和来源，而多变量逻辑回归模型则评估了穷人和富人之间的差距如何随时间变化。对肯尼亚主要计划生育/生殖健康方案的审查补充了定量分析。2003年至2008/2009年期间，避孕药具的使用发生了巨大变化，导致2008/2009年穷人和富人之间几乎没有差距，与1993-1998年期间相比，避孕药具使用情况的改善并没有使城市穷人受益。事实上，1990年代后期，肯尼亚政府及其发展伙伴认识到，必须有意识地以穷人为目标，提供计划生育服务。大多数城市妇女使用短期和效果较差的方法，在审查期间，长效方法使用者的比例下降了一半。2003年至2008/09年，私营部门使用者的比例也有所下降。结论：最近，城市穷人和城市富人在使用现代避孕药具方面的差距缩小，这无疑是一个好消息，再加上对家庭计划背景的审查，表明计划生育计划可能越来越多地惠及城市穷人。
Introduction: Kenya is characterized by high unmet need for family planning (FP) and high unplanned pregnancy, in a context of urban population explosion and increased urban poverty. It witnessed an improvement of its FP and reproductive health (RH) indicators in the recent past, after a period of stalled progress. The objectives of the paper are to: a) describe inequities in modern contraceptive use, types of methods used, and the main sources of contraceptives in urban Kenya; b) examine the extent to which differences in contraceptive use between the poor and the rich widened or shrank over time; and c) attempt to relate these findings to the FP programming context, with a focus on whether the services are increasingly reaching the urban poor.Methods: We use data from the 1993, 1998, 2003 and 2008/09 Kenya demographic and health survey. Bivariate analyses describe the patterns of modern contraceptive use and the types and sources of methods used, while multivariate logistic regression models assess how the gap between the poor and the rich varied over time. The quantitative analysis is complemented by a review on the major FP/RH programs carried out in Kenya.Results: There was a dramatic change in contraceptive use between 2003 and 2008/09 that resulted in virtually no gap between the poor and the rich in 2008/09, by contrast to the period 1993-1998 during which the improvement in contraceptive use did not significantly benefit the urban poor. Indeed, the late 1990s marked the realization by the Government of Kenya and its development partners, of the need to deliberately target the poor with family planning services. Most urban women use short-term and less effective methods, with the proportion of long-acting method users dropping by half during the review period. The proportion of private sector users also declined between 2003 and 2008/09.Conclusion: The narrowing gap in the recent past between the urban poor and the urban rich in the use of modern contraception is undoubtedly good news, which, coupled with the review of the family program context, suggests that family planning programs may be increasingly reaching the urban poor.