Knowledge and experience of family planning
All the respondents in the study were familiar with modern methods of contraception. Among current and former users, most personal experiences were with the IUD (the coil), condoms, pills, injectables and implants. Most women were able to name several forms of contraception and to describe, in general, their mechanisms of action. However, knowledge of dual protection varied:
Many prefer the condom since it prevents in two ways, she (person using) won’t get pregnant, she also believes she won’t contract any diseases [User, Mombasa]
To prevent those, I mean early pregnancies, young girls, to the teenage they should use those coils, the contraceptives to prevent early pregnancy, STI and AIDS [Non-user, Kisumu]
In other cases, respondents were familiar with different methods, but not with how they were appropriately used.
The woman inserts it (pill in the vagina) so that she doesn’t get pregnant [Non-user, Kisumu]
Those things are harmful, I saw once, one have to be cut open somewhere here and they insert the coil then they stitch the area, I don’t know those are the coils and it last for I don’t know twenty years [Non-user, Kisumu]
In terms of their personal experience with family planning, it is interesting to note that not all participants correctly identified themselves as ‘users’ or ‘non-users’: those who used condoms described themselves as ’non-users’. This finding is based on the perception that condoms are not reliable for pregnancy prevention due to the potential for the method’s failure. The quote below illustrates this view:
I always thought that condoms were used to prevent diseases like HIV but not pregnancies because I was using the condoms but I still got pregnant. The day it burst is the day I conceived. So I would not say that a condom is a family planning method [Non-user, Mombasa]
Barriers to family planning use
Myths about contraceptives
Among the respondents, fear and concerns about family planning were a major barrier to use. Many of their fears were based on myths and misconceptions. The largest concern cited by participants was fear that a particular method would render them infertile; in many cases, this prevented them from using contraception.
I think the pills are not good and even my mum has warned me severally not to use pills because there will come a time when I might need to have a children and I might not be able to get one in future. You don't get pregnant (IF YOU USE PILLS) [Non-user, Mombasa]
If they put that (implants) on you when you remove it (implants) you cannot give birth again [User, Kisumu]
Some say that you, you might never give birth if you are used to taking the injections [Non-user, Kisumu]
While infertility was cited as a possible consequence of most methods, it was most strongly expressed around injectables. As a result, many young women believed that injectables were only recommended for women who already had children.
There are some who love the injection but they advise the ladies who are here that they should only go for the injection only if they have ever given birth before, that it’s not good to go if they’ve never given birth, they should go for the injection after [Non-user, Kisumu]
Participants also believed that it was possible that modern contraception methods could cause temporary infertility or reduce one’s childbearing capacity, limiting the number of children they were able to conceive in their lifetime.
I have little faith in pills…it (pills) affects me in that I cannot be able to give birth to many children [User, Mombasa]
She (mum) said it (pills) can cause infertility…can take long before conceiving [Non-user, Kisumu]
Another cited barrier to family planning use is the association of modern contraceptives with birth defects or abnormalities.
I think people like the injection more…Pills are very bad and I don’t like anything to do with them…if you take the pill for so long, you may give birth to a paralyzed child… [User, Mombasa]
You hear that someone was pregnant and they got pregnant while using the pills and then you start worrying if you will give birth to a normal child or you will give a child without hands [Non-user, Mombasa]
A number of participants expressed concerns about contraceptives as a foreign object that could disrupt the natural processes of the body and create harm. Failure to menstruate regularly, a common side effect from using certain contraceptive methods, was interpreted as causing the body to retain ‘dirty blood’ and leading to stomach aches.
Some fear that they will not receive their period when they use them (referring to contraceptives) and that blood is dirty and should come out [User, Kisumu]
Condoms were associated with discomfort and irritation from the lubricant, which they feared may cause an infection. Methods such as the coil or implant that were inserted were seen as having the potential to harm one’s internal organs.
A large number of respondents, especially those from Kisumu, also reported having heard or believing that the use of certain contraceptive methods, especially pills, led to cancer.
Many of them (community women) say that the pills are not good because they can accumulate under the abdomen and cause something like cancer; so many people don’t like those pills [Non-user, Kisumu]
Fear of side effects
In addition to the myths described above, many also mentioned real side effects as a barrier to use. The most common side effects expressed by the respondents were weight changes, bleeding, and lack of sexual desire. Headaches and blood pressure issues were also cited by a few.
All of the methods were associated with potential changes in weight, with some methods associated with weight gain (notably the injectable) and others with weight loss.
Injectable, I feel they are not good as they have side effects; they change your physical appearance, very fat, very many people get very fat [User, Mombasa]
I don’t know if its maybe I used them (pills) for a long time the first time and that’s why they (pills) are affecting me? They (pills) make me loose appetite and I start getting thin because I don’t eat [User, Mombasa]
Heavy bleeding was also associated with modern family planning methods.
The periods are so heavy till they feel like they are not menstruating, it’s like they are bleeding pure blood. [Non-user, Mombasa]
And others I heard that they receive their periods like the entire month when they are using these family planning methods. Like Norplant there is a friend who had periods throughout the month until she had it removed [Non-user, Mombasa]
Respondents also reported hearing that modern family planning reduces sexual desire.
All these family planning methods interfere with our feelings (libido) be it a coil, be it a tablet, (pills) be it what, I heard that it (modern family planning) reduces feelings [User, Mombasa]
Injectable I heard they make a woman “to be cold”. They lead to lack of sexual arousal just like the coil. There are some who have side effects by the way you “don’t have any feelings (sexual urge) [Non-user, Mombasa]
Sometimes they complain because of the way they (pills) make you feel tired, bring mood swings and sometimes you have a low libido. This will make him complain because he will start accusing you that you are being unfaithful to him [User, Mombasa]
Association with promiscuity and straying
There were notions that the use of modern contraceptive methods encouraged young women to become sexually promiscuous. Both users and non-users expressed the belief that the partners of young women who use contraceptives felt that they encouraged the women to be unfaithful. For instance, a non-user from Mombasa stated:
And so they (men) say that only promiscuous women use the pills and that is why they are against those pills [Non-user, Mombasa]
However, this seemed to be a belief held by the male partners and not the women themselves. Another respondent from Mombasa, this time a user, also stated that:
Sometimes they (men) accuse you of being unfaithful in the relationship [User, Mombasa]
The issue of modern contraceptives being associated with lack of trust was reported to have been discussed during youth meetings in the community, as mentioned by one of the respondents who said:
We have discussions at some youth meetings we go for, they say that using the condoms means that you don’t trust your girlfriend [Non-user, Kisumu]
Another respondent remarked that:
With the pills they (men) are very… much against it and they feel that with the pills their women can have extra marital affairs knowing that they will not get pregnant [Non-user, Mombasa]
Some young women thought that condoms were not a suitable method of contraception for couples in relationships because of their association with straying.
They (community members) don’t use condoms because they are married and you cannot use them with your husband when you are married. Maybe if you are having an affair, I don’t like condoms because, I have a husband that I live with so I don’t see why I should use condoms and I am not straying. [Non-user, Mombasa]
The role of others in influencing contraceptive use
As demonstrated by the repeated use of the third person pronouns (‘he’, ‘she’, ‘they’, ‘others’) in almost all of the above quotes, young women learn about both true side effects and myths from others in their community - peers, family or partners. Often these women received inaccurate information and were directly counselled by others not to engage with or use family planning methods.
They don’t like it (modern FP) at all, they tell me not to use pills, don’t use family planning, it will affect your fertility…when they hear that a girl has been taken to get an operation maybe she has an appendix…they will say that it has been caused by family planning [User, Mombasa]
I heard of a woman who got pregnant while using the coil. And she had some difficulties while giving birth, she had to go to the hospital and undergo an operation [Non-user, Mombasa]
If the advice I get from the community is good then there is no need to go to hospital, in my community we don’t use pills or the injection but we do it on our own and we are able to plan properly [Non-user, Mombasa]
I used to hear people say that they’re (modern FP methods) bad especially when I was a girl they’d say it would harm my body, like being unable to conceive [User, Kisumu]
Women also shared concerns raised by their spouses or partners on use of contraceptives, which echoed their own concerns about outcomes and side effects. Male partners raised concerns about family planning diminishing sexual urges, resulting in birth defects, or discomfort during sex.
There are some men who don’t want their women to use the planning methods, some men say that the medicines will result in messing up their reproductive organs [User, Thika]
They (men) say that when you get the injection you are no longer aroused, Some (men) say when they use the condom it affects that thing (penis), When he is through he feels a lot of pain the next day [User, Kisumu]
There was also a suggestion that men prevent women from using family planning to increase the number of their progeny.
Men do not like because they (men) want their wives to give birth to as many children as possible as they can [Non-user, Kisumu]