Age matters: differential impact of service quality on contraceptive uptake among post-abortion clients in Kenya.
This paper analyses the impact of high quality, user-friendly, comprehensive sliding-scale post-abortion services on clients' uptake of contraception in a Kenyan town. Data were drawn from detailed physician records in a private clinic that served 1080 post-abortion clients in 2006. All clients received confidential family planning counselling and were offered a complete range of contraceptives at no additional cost. One quarter of clients were below age 19. Prior to the abortion, no client aged 10-18 years reported having used contraception, as compared to 60% of clients aged 27-46 years. After the abortion and family planning counselling session, only 6% of clients aged 10-18 chose a method, as compared to 96% of clients aged 27-46, even though contraception was free, the provider strongly promoted family planning to everyone and all clients had just experienced an unwanted pregnancy. Significant predictors of contraceptive uptake post-abortion were: having a child, a previous termination, prior contraceptive use and being older than 21. These findings suggest that availability, affordability and youth-friendliness are not sufficient to overcome psycho-social barriers to contraceptive use for sexually-active young people in Kenya. To reduce unwanted pregnancies, more attention may be needed to developing youth-friendly communities that support responsible sexuality among adolescents.
Department of Community Health Sciences, School of Public Health, University of California, Los Angeles, USA. ptavrow@ucla.edu
Paula
P
Tavrow
Mellissa
M
Withers
Kara
K
McMullen
D000028:Abortion, Induced / Q000706:statistics & numerical data; D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration*; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003376:Counseling / Q000458:organization & administration; D005193:Family Planning Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007630:Kenya; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D014932:Women's Health Services / Q000458:organization & administration*; D055815:Young Adult