Contraceptive method denial as downward contraceptive coercion: A mixed-methods mystery client study in Western Kenya.

ABSTRACT

OBJECTIVE: This study uses mixed methods to quantify the frequency of method denial in Western Kenya and describe how this barrier impacts contraceptive access. STUDY DESIGN: We estimate the frequency of method denial using data from mystery clients deployed to 57 randomly selected public-sector facilities located in Western Kenya. These quantitative data are triangulated with data from 8 focus group discussions, 19 key informant interviews, and 2 journey mapping workshops with contraception clients and providers. RESULTS: In 21% of mystery client visits, the client was denied their preferred contraceptive method. In 13% of visits, mystery clients were unable to procure any method. Method denial was primarily motivated by provider-imposed requirements for HIV or pregnancy testing, or by provider bias against young, unmarried, or nulliparous women. Method denial also occurred because of provider reluctance to offer certain methods. Focus group discussion participants and interviewees confirmed the frequency and reasons for method denial and identified this practice as a substantial barrier to reproductive autonomy. CONCLUSION: Method denial disrupts contraceptive access among women who have already overcome financial and logistical barriers to arrive at a health care facility. Further attention to this barrier is required to promote reproductive autonomy among women in Western Kenya. IMPLICATIONS Providers may impose unnecessary restrictions on contraceptive access that limit the ability of women to achieve their desired family size. Unwarranted method denial occurs in approximately one out of every 5 visits to public-sector facilities in Western Kenya and presents a major impediment to reproductive autonomy and justice.