Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study

Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions, and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors associated with covert contraceptive use (CCU) in Kenya.

We used data from the sixth and seventh rounds of the performance monitoring for accountability surveys. We defined CCU as "the use of contraceptives without a partner's knowledge". We used frequencies and percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors using bivariate and multivariable logistic regressions.

The prevalence of CCU was 12.2% (95% CI: 10.4-14.2%); highest among uneducated (22.3%) poorest (18.2%) and 35-49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education, wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were increased among uneducated women (aOR 3.79, 95% CI 1.73-8.31), women with primary education (aOR 1.86, 95% CI 1.06-3.29) and those from the poorest (aOR 2.67, 95% CI 1.61-4.45), poorer (aOR 1.79, 95% CI 1.05-3.04), and middle (aOR 2.40, 95% CI 1.52-3.78) household wealth quintiles and were reduced among those with 2-3 (aOR 0.49, 95% CI 0.33-0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40-0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89-0.99) reduced the odds of CCU.

About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to strengthen their involvement to increase contraceptive use in Kenya while acknowledging women's right to make independent choices.