Evidence suggests that socio-cultural barriers that limit the ability of women in sub-Saharan Africa to make decisions regarding contraceptive use and childbearing contribute to the slow uptake of contraception in this region. This paper explores factors influencing women’s decisions regarding contraceptive uptake, switching and discontinuation, and the implications of those decisions for family planning programmes. Data were from in-depth interviews that were conducted in 2018 with 42 women who participated in a longitudinal research project implemented in Homa Bay County of Kenya. Participants comprised women who were aged 15–39 years at the time of recruitment into the study and who discontinued using injectables or implants between the first and second rounds of data collection. Data were analysed using an exploratory inductive content analytic approach. The findings show that uptake of contraception was largely driven by concerns about the negative consequences of frequent childbirth on individual health and household socioeconomic well-being. Most women discontinued methods because of dissatisfaction but, instead of abandoning contraception altogether, switched to alternative methods, albeit sometimes less-effective ones. However, some women had difficulties in identifying an appropriate new method after experiencing side-effects, contraceptive failure or stock-out of their current method. Securing the cooperation of sexual partners was an additional problem especially for women whose partners did not support contraception. The findings suggest that concerns about the negative consequences of frequent childbirth outweigh challenges associated with contraceptive use. This presents an opportunity for family planning programmes to improve contraceptive uptake and continuation by addressing the health system challenges related to commodity stock-out and poor quality of care, as well as the concerns of men.

中文翻译：

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影响肯尼亚农村地区妇女计划生育决定的因素及其对计划生育项目的影响

有证据表明，限制撒哈拉以南非洲妇女决定使用避孕药具和生育的能力的社会文化障碍导致该地区避孕药具的采用缓慢。本文探讨了影响女性在避孕、转换和停药方面的决定的因素，以及这些决定对计划生育项目的影响。数据来自 2018 年对 42 名参与在肯尼亚霍马湾县实施的纵向研究项目的女性进行的深度访谈。参与者包括在研究招募时年龄在 15-39 岁之间并且在第一轮和第二轮数据收集之间停止使用注射剂或植入物的女性。使用探索性归纳内容分析方法分析数据。研究结果表明，采取避孕措施主要是出于对频繁分娩对个人健康和家庭社会经济福祉的负面影响的担忧。大多数女性因为不满意而停止使用避孕方法，但并没有完全放弃避孕，而是改用替代方法，尽管有时效果较差。然而，一些女性在经历副作用、避孕失败或当前方法缺货后，难以确定合适的新方法。确保性伴侣的合作是一个额外的问题，特别是对于伴侣不支持避孕的女性而言。研究结果表明，对频繁分娩的负面后果的担忧超过了与避孕药具使用相关的挑战。这为计划生育项目提供了一个机会，通过解决与商品缺货和护理质量差相关的卫生系统挑战以及男性的担忧来提高避孕药具的使用和持续使用率。