| Background: While Kenya's national fertility rate has declined, the urban poor still have high fertility rates and a great family planning (FP) need. This dissertation aims to study the impacts of married/cohabiting couples' characteristics and environmental factors on contraceptive use patterns among urban Kenyans.;Methods: Data came from baseline population-based surveys from the Measurement, Learning and Evaluation Project in three Kenyan cities: Nairobi, Mombasa and Kisumu.;For the first paper, women aged 15-49 were surveyed. The outcomes of interest were contraceptive use patterns (current/former/never user), and current user patterns (first method/switched from less to more effective/switched from more to less effective method). Multinomial logistic regression methods were used.;For the second paper, a total of 840 couples (unweighted=883) were identified. The outcomes of interest were current contraceptive use (currently using/not using) and intention to use contraception in the near future (wants to/doesn't want to use), among non-users. Logistic regression was used.;Results: The first paper shows that current contraceptive use and switching patterns, among current users, did not vary by neighborhood type (formal/informal). However, across household wealth, 62% of poor women were current users compared to 67% of the rich. Among current users, poor women were more likely to be using their first method than to have switched methods, suggesting reduced demand/limited access to contraception. Additional analyses to test a new slum variable (slum/intermediate/non-slum), based on a household's availability of electricity, water and toilet, showed similar results to household wealth.;The second paper shows that couples had greater odds of using contraceptives if the wife desired fewer children, or both partners admitted to discussing desired number of children/FP recently. Among non-users, intention to use contraception in the near future showed similar associations.;Conclusion: Since household wealth impacts contraceptive use, FP programs need to identify the urban poor across all urban neighborhoods. Local outreach workers can locate the urban poor and assist them in fulfilling their contraceptive needs. Furthermore, ideal family size and couple communication impact couples' contraceptive use. New strategies and interventions can increase men's engagement in FP and ensure that couples' fertility desires are met. |
