Fertility intentions and the adoption of long-acting and permanent contraception (LAPM) among women: evidence from Western Kenya.

BACKGROUND: The use of long-acting and permanent method (LAPM) for family planning (FP) is of importance to the FP movement. A better understanding of how fertility-related intentions shape the usage of LAPM is important for programming. This paper explored the interaction of fertility intentions with LAPM use in rural western Kenya.

METHODS: We draw on monitoring data from 28,515 women aged 15-49 years who received FP services between 2013 and 2015 as part of a community-based FP project. We assessed the association between the use of LAPM and fertility intentions, adjusting for age, parity, education, service delivery model, FP counseling and year of data collection.

RESULTS: Of the 28,515 women who accessed FP services during the period (2013-2015), about two-thirds (57%) reported using LAPM, much higher than the national rates, and around 46% wanted another child within or after two years. In a multivariable regression model, women who desired no more children tended to use LAPM more than those wanting a child within or after some years as well as those uncertain about their future intentions.

CONCLUSION: The significant rates of utilization of LAPM between both women who desired no more children and the fair proportion of use among women spacing births underscore the benefits of sustained community level interventions that address both the demand and supply barriers of contraceptive adoption and use.