Contraceptive Switching among Homeless Women in Kenya

Purpose: The paper examines contraceptive-switching behaviors among homeless women in Nairobi, Kenya. High mortality and morbidity rates in Kenya are mainly a result of unplanned pregnancies, discontinuation of contraceptives, and switching of contraceptives. These incidences can be reduced through improved access to a wide variety of contraception and counseling services that allow homeless women to make informed decisions. Switching from one contraceptive to the other often lowers contraceptive preventive abilities putting women at risk of unplanned pregnancies Methodology: The study was carried out in Nairobi, Kenya. The study utilized primary data collected from a sample of 384 households in Nairobi. A Cluster case-control and observational study design was used to sample the population. Off slum settlements were randomly chosen and systematic random sampling was used to select female household members to be interviewed. The study sampled 8 groups of subjects per study area which are the CBD alleys and the off-slum settlements of Kibra, Korogocho, Mathare, Mukuru Kwa Reuben, Majengo, Kawangware, and Huruma Slums. Questionnaire responses were then extracted and analyzed using STATA software. Estimates were then regressed using logistic regression. Findings: The logistic estimates further reveal that as a homeless woman gets more educated, she will tend to switch contraception less often. The study found the predicted probability of educated women switching contraceptives to be 1.32%. The study also found that women who had lived in the streets had a 0.89% possibility of switching contraceptives. The study further noted that women who experienced miscarriages, stillbirths, or had aborted in the past 12 months were 4 times more likely to switch contraceptives than women who hadn't. Results derived from the regression show further show that immigrating from an urban area and having knowledge of Intra-uterine devices (IUDs), increases the chances that a homeless woman will switch contraceptives. Unique Contribution to Theory, Practice and Policy: There exists limited research on the reproductive health practices of homeless women in Kenya as more studies are focused on refugees, street children, and slum dwellers. This study therefore adds to knowledge on contraceptive utilization among homeless women. Over the years the government has initiated programs and policies to reduce the population in Kenya. However, these policies have had less impact on population control among street families in Kenya. The government in its efforts to control fertility, can utilize the findings of this study to come up with an optimal contraceptive mix, unique to the needs of homeless women in Kenya. The study is also critical in understanding the role of knowledge on contraceptive utilization among homeless women. Knowledge of contraceptives can also be improved through outdoor reproductive health campaigns and the establishment of mobile clinics to improve homeless women's accessibility to reproductive health services.