Abstract
Objective
This study uses mixed methods to quantify the frequency of method denial in Western
Kenya and describe how this barrier impacts contraceptive access.
Study design
We estimate the frequency of method denial using data from mystery clients deployed
to 57 randomly selected public-sector facilities located in Western Kenya. These quantitative
data are triangulated with data from 8 focus group discussions, 19 key informant interviews,
and 2 journey mapping workshops with contraception clients and providers.
Results
In 21% of mystery client visits, the client was denied their preferred contraceptive
method. In 13% of visits, mystery clients were unable to procure any method. Method
denial was primarily motivated by provider-imposed requirements for HIV or pregnancy
testing, or by provider bias against young, unmarried, or nulliparous women. Method
denial also occurred because of provider reluctance to offer certain methods. Focus
group discussion participants and interviewees confirmed the frequency and reasons
for method denial and identified this practice as a substantial barrier to reproductive
autonomy.
Conclusion
Method denial disrupts contraceptive access among women who have already overcome
financial and logistical barriers to arrive at a health care facility. Further attention
to this barrier is required to promote reproductive autonomy among women in Western
Kenya.
Implications
Providers may impose unnecessary restrictions on contraceptive access that limit the
ability of women to achieve their desired family size. Unwarranted method denial occurs
in approximately one out of every 5 visits to public-sector facilities in Western
Kenya and presents a major impediment to reproductive autonomy and justice.
Keywords
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Article info
Publication history
Published online: June 28, 2022
Accepted:
June 22,
2022
Received in revised form:
June 20,
2022
Received:
January 28,
2022
Footnotes
☆Conflicts of interest: The author declares no conflict of interest.
Funding: This work was supported by the National Institutes of Health (grant numbers R00 HD086270; P2C HD047879; T32 HD049302; P2C HD047873; T32 NR007969). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
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