Reaching the hard to reach with family planning services: Introducing a culturally and religiously acceptable, modern FP method into Kenya

Cultural and religious resistance to modern family planning (FP) methods accounts for approximately one-third of method discontinuation and up to 40% of reasons for non-use of FP in Kenya. In North Eastern Province (NEP), the majority of the population is strongly influenced by Islamic religion and Somali cultural practices which have contributed to a modern contraceptive prevalence rate of 4% compared to 39 % nationwide. The Standard Days Method (SDM), a new, natural FP method, was introduced into FP services in seven health facilities in rural Ijara district in NEP by APHIA Project and Provincial Ministry of Health staff in close collaboration with local religious leaders who often act as gate keepers for use of MCH/FP services. Leaders were educated on the method and the concept of healthy birth spacing, approved the SDM given its compatibility with Islam, and then sensitized their communities on SDM and birth spacing benefits. From January-June 2009, providers offered SDM and recorded demographic information about new users. Among 254 acceptors, 95% were Muslim and 93% were new FP users. Providers reported in post-intervention interviews that the SDM was appealing to most clients, easy to use, culturally and religiously acceptable. Subsequent successful expansion into new districts in NEP and the research results led national stakeholders to recommend scale-up of the SDM into provincial FP services nationwide. A government task force will guide the process, and districts will involve religious and other community leaders in promoting healthy birth spacing, generally, and the new SDM option.