Closing the poor-rich gap in contraceptive use in urban Kenya: are family planning programs increasingly reaching the urban poor?

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.

Exploring the connections between HIV serostatus and individual, household, and community socioeconomic resources: evidence from two population-based surveys in Kenya.

The positive association between health and socioeconomic status (SES) is well documented. However, available empirical evidence on the SES gradients of HIV serostatus is mixed, and few studies have explored the effects of community SES indicators on individual's HIV risk. Using nationally representative data of women and men from the 2003 Demographic and Health Survey and the 2007 AIDS Indicator Survey from Kenya, we assessed the associations between HIV serostatus and SES as measured by educational attainment and household wealth at the individual/household and community levels. Additionally, we explored changes in these associations between 2003 and 2007. Results from bivariate and cohort analyses showed that during this period, HIV burden shifted from higher to lower SES subgroups at both the individual/household and community levels, particularly among women aged 15-24 years. Results from multi-level logistic regression models showed that this shift was generally significant among women. In addition, communities' collective educational attainment, measured as the percentage of residents with some secondary schooling or higher, was a more significant predictor and protective factor for HIV risk than individual/household-level SES indicators for women in 2007 and men in both years. Our findings highlight the relevance of community-level SES to HIV dynamics in Kenya between 2003 and 2007.