Unmet Family Planning Demand: Evidence from Two Sites in Kenya.

A study was undertaken in Kenya to assess 1) the family planning (FP) needs of women in the perinatal period, 2) whether these needs are recognized by staff, 3) the postpartum demand for FP information and services, and 4) the barriers to addressing client needs. Data were collected from interviews with 400 prenatal clients, 200 postpartum women, 400 child welfare clinic attenders, and 69 staff members. More than a third of the clients desired no more children. A further 22%, 33%, and 28% of the three client groups, respectively, wished to delay their next pregnancy for more than four years. Over 88% of the prenatal, 93% of the postpartum, and 84% of the child welfare clients wanted to use FP. The staff was generally aware of the women's desire for information, but they underestimated the need for information in the immediate postpartum period. Information from the child welfare mothers indicated that by six months postpartum 75% of the women are at risk of pregnancy, and, by 12 months, 83% are at high risk of pregnancy. Therefore, women need FP services by six months postpartum. Even though most of the postpartum women wanted to receive a method before discharge from the maternity ward, very few received any FP services during their stay. The clients felt uncomfortable raising the issue with the maternity staff, and the staff felt constrained by a lack of knowledge although they recognized the need and wanted to be able to provide adequate services. Based on this study, it is recommended that 1) FP services be available in all parts of a hospital; 2) maternity ward staff, in particular, be trained to provide FP services; 3) a team approach to FP services be developed; 4) staff be more pro-active in identifying potential clients; and 5) maternal/child health and FP services be fully integrated to provide FP services in a private setting for all clinic attenders.