Gender and Contraception in Kenya: a Scoping Review.

backgroundAccess to the full range of contraceptive methods is a core component of sexual and reproductive health. While Kenya had one of the highest rates of contraceptive use compared to other countries on the African continent, studies since 2015 have shown prevalence of use has fallen; contraceptive usage rates are estimated at 38.7%, significantly lower than Kenya's target of 62% and in a context of high rates of unsafe abortions and high maternal mortality. This scoping review investigates the role of gender norms in determining patterns of contraceptive usage among women of childbearing age in Kenya.

methodsA PRISMA-ScR approach was employed, involving a keyword search of population, concept and context using ProQuest. The 307 search results were iteratively screened using specific eligibility criteria, and rigorous JBI checklist critical appraisal was conducted. Data relevant to the aim was extracted, synthesised and distilled, ensuring comprehensive, rigorous and reproducible scoping of a final 16 papers.

resultsStudies showed that heteronormative and gendered norms influenced contraceptive use, unmet need and discontinuation, at social, societal and structural levels. Heterosexual male partner preferences largely shaped women's contraceptive decisions, with disapproval or intimate/gender-based violence triggering covert usage facilitated by injectable methods. Networks, involving friends, kin and healthcare providers modulated perceived gender norms, and therefore contraceptive decisions. Stigmatisation against adolescents' and premarital sexuality was identified as an important barrier to contraceptive use, as well as perceived marital duties of coitus and childbearing. As expected, female education, employment and wealth were structural determinants shaping access and understanding of contraception. The evidence base was largely concentrated in Western Kenya.

conclusionsThis review presents a comprehensive account of the influence of gender norms on contraceptive usage patterns, though addressing sociocultural norms is complex. Public health interventions can improve contraceptive counselling by providers, involve males due to their decision-making dominance, and improve service accessibility by integrating HIV, contraceptive and domestic violence services. Wider structural factors surrounding education, employment and subsequent socioeconomic mobility for women will always shape the success of interventions. Further research could identify how this varies by region or demographic. Women's access to contraception is an important health issue. Kenya aims for 62% of reproductive-age women to use contraception and had high rates of contraceptive use compared to other African countries. However, since 2015, contraceptive use fell well below that target, while rates of unsafe abortions and maternal deaths remain high. This review summarises women's beliefs about what society expects and considers acceptable, and their impact on contraceptive use, particularly within Western Kenya. Women's decisions about contraception are affected by the opinions of their partners and others in their social circle (such as friends, family, and healthcare providers). In heterosexual romantic relationships, studies showed that in this context male partners often have more power than women, so their disapproval can cause women to avoid contraception or use it secretly. When people in a woman's social circle have disapproving or negative opinions about contraception, this can have a similar effect. Studies showed that both reproducing and satisfying male intimate partners were conceptualised as important, gendered duties, leading to the avoidance of contraception. Levels of education, financial security and employment led to greater decision-making agency in most studies, associated with greater access to information about contraception including from peers. Involving men in family planning discussions, training healthcare providers to discuss contraception non-judgementally and combining contraceptive services with other healthcare services to improve access could lead to increased contraceptive use.