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Original research
Mixed-methods study on pharmacies as contraception providers to Kenyan young people: who uses them and why?
  1. Lianne Gonsalves1,2,3,
  2. Kaspar Wyss2,3,
  3. Jenny A Cresswell1,
  4. Michael Waithaka4,
  5. Peter Gichangi4,5,6,
  6. Adriane Martin Hilber2,3
  1. 1Department of Sexual and Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
  2. 2Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
  3. 3University of Basel, Basel, Switzerland
  4. 4International Centre for Reproductive Health Kenya, Mombasa, Kenya
  5. 5Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
  6. 6Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  1. Correspondence to Lianne Gonsalves; gonsalvesl{at}who.int

Abstract

Objectives This study sought to answer two questions: (1) what are the characteristics of young Kenyans aged 18–24 who use contraception obtained at pharmacies, and (2) why are pharmacies appealing sources of contraception?

Design and setting This was a mixed-methods study in one peri-urban part of Kwale County, Kenya. Methods included cross-sectional survey (n=740), six focus group discussions, 18 in-depth interviews and 25 key-informant interviews. Quantitative data analysis identified factors pushing young people to pharmacies for modern contraception versus other sources. Qualitative data analysis identified reasons pharmacies were perceived to be appealing to young clients.

Participants Participants were (1) young people aged 18–24 from the study area, including a subset who had recently purchased contraception from a pharmacy; or (2) pharmacy personnel and pharmacy stakeholders.

Results Among surveyed participants who had ever had sexual intercourse and had used modern contraception at last sexual intercourse, 59% obtained it from a pharmacy. In multivariable analysis, participants who used a condom or emergency contraception as well as those living alone were significantly more likely to get contraception from pharmacies. Pharmacies were valued for their convenience, privacy, non-judgmental and personable staff, service speed, as well as predictable and affordable prices.

Conclusions Our findings indicate a high percentage of young people in Coastal Kenya use pharmacies for contraception. Our inclusion of emergency contraception users partially explains this. Pharmacies were perceived to be everything that health facilities are not: fast, private and non-limiting. Policy-makers should recognise the role of pharmacies as contraception providers and look for opportunities to link pharmacies to the public health system. This would create a network of accessible and appealing contraception services for young people.

  • reproductive medicine
  • community child health
  • public health
  • qualitative research

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Footnotes

  • Contributors LG conceived of the study and developed the protocol with substantive input from KW and AMH. PG was Principal Investigator of the ARMADILLO study and thereby supported LG in setting up this study’s infrastructure in Kenya. LG trained and supervised data collectors, with guidance from PG. JAC and MW developed the statistical analysis plan. LG led the manuscript writing with substantive input from KW and AMH. All authors reviewed and edited drafts.

  • Funding This work was partially supported by the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP).

  • Disclaimer LG and JAC are staff members of the World Health Organization. The named authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study received ethics approval from the Ethikkommission Nordwest- und Zentralschweiz (EKNZ) (Req-2017-00389) in Basel, Switzerland, as well as the University of Nairobi/Kenyatta National Hospital in Nairobi, Kenya (P274/05/2017). The ARMADILLO RCT also received ethics approval from WHO (Protocol WHO A65892) and is registered with the ISRCTN Registry (ISRCTN85156148).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The full deidentified quantitative dataset can be made available on request to the corresponding author. Qualitative data cannot be shared publicly, as consent procedures for participants did not include making full interview and focus group discussion transcripts publicly available. However, transcript excerpts are available to researchers on request to the corresponding author and following approval from the University of Nairobi/Kenyatta National Hospital Ethics Committee (contact via uonknh_erc@uonbi.ac.ke).

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