Women’s and girls’ experiences of reproductive coercion and opportunities for intervention in family planning clinics in Nairobi, Kenya: a qualitative study

Boyce et al. Reproductive Health (2020) 17:96 https://doi.org/10.1186/s12978-020-00942-7 RESEARCH Open Access Women’s and girls’ experiences of reproductive coercion and opportunities for intervention in family planning clinics in Nairobi, Kenya: a qualitative study Sabrina C. Boyce1* , Jasmine Uysal1, Stephanie M. DeLong1, Nicole Carter1, Chi-Chi Undie2, Wilson Liambila2, Seri Wendoh3 and Jay G. Silverman1 Abstract Background: Reproductive coercion (RC), which includes contraceptive sabotage and pregnancy coercion, may help explain known associations between intimate partner violence (IPV) and poor reproductive health outcomes, such as unintended pregnancy. In Kenya, where 40% of ever-married women report IPV and 35% of ever-pregnant women report unintended pregnancy, these experiences are pervasive and co-occurring, yet little research exists on RC experiences among women and adolescent girls. This study seeks to qualitatively describe women’s and girls’ experiences of RC in Nairobi, Kenya and opportunities for clinical intervention. Methods: Qualitative data were collected as part of the formative research for the adaptation of an evidence-based intervention to address reproductive coercion and IPV in clinical family planning counselling and provision in Nairobi, Kenya in April 2017. Focus group discussions (n = 4, 30 total participants) and in-depth interviews (n = 10) with family planning clients (ages 15–49) were conducted to identify specific forms of reproductive coercion, other partner-specific barriers to successful contraception use, and perceived opportunities for family planning providers to address RC among women and girls seeking family planning services. Additionally, data were collected via semistructured interviews with family planning providers (n = 8) and clinic managers (n = 3) from family planning clinics. Data were coded according to structural and emergent themes, summarized, and illustrative quotes were identified to demonstrate sub-themes. Kenyan family planning providers and administrators informed interpretation. Results: The results of this study identified specific forms of pregnancy coercion and contraceptive sabotage to be common, and often severe, impeding the use of contraceptives among female family planning clients. This study offers important examples of women’s strategies for preventing pregnancy despite experiencing reproductive coercion, as well as opportunities for family planning providers to support clients experiencing reproductive coercion in clinical settings. (Continued on next page) * Correspondence: 1 Center on Gender Equity and Health, School of Medicine, University of California – San Diego, 9500 Gilman Dr., La Jolla, CA 92093, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Boyce et al. Reproductive Health (2020) 17:96 Page 2 of 12 (Continued from previous page) Conclusions: Reproductive coercion is a critical barrier to modern contraceptive use in Kenya. Results from this study highlight opportunities for family planning providers to play a critical role in supporting women and girls in their use of contraception when reproductive coercion is present. Keywords: Reproductive health, Intimate partner violence, Sub-Saharan Africa, Family planning clinics, Reproductive coercion Plain English Summary Reproductive coercion (RC), which includes male partner behaviors that create barriers to women and girls’ efforts to prevent pregnancy, may help explain known associations between intimate partner violence (IPV) and poor reproductive health outcomes, such as unintended pregnancy. In Kenya, where 40% of ever-married women report IPV and 35% of ever-pregnant women report unintended pregnancy, these experiences are pervasive and co-occurring, yet little research exists on RC experiences among women and adolescent girls. Qualitative data were collected as part of research to inform the adaptation of an intervention to address reproductive coercion and intimate partner violence in clinical family planning services in Nairobi, Kenya in April 2017. Four focus group discussions and 10 interviews with family planning clients (ages 15–49) were conducted. Additionally, data were collected from 8 providers and 3 clinic managers from family planning clinics. Data were organized by themes (developed prior to and during analysis), summarized, and illustrative quotes were identified to demonstrate sub-themes, all of which were then reviewed by local family planning providers to inform interpretation. The results of this study identified specific forms of reproductive coercion to be common and sometimes severe, often impeding the use of contraceptives among female family planning clients. Reproductive coercion is a critical barrier to modern contraceptive use in Kenya. Results from this study highlight opportunities for family planning providers to play a critical role in supporting women and girls in their use of contraception when reproductive coercion is present. Introduction Globally, women who report experiencing intimate partner violence (IPV) are more likely to experience poor reproductive health outcomes, such as unintended pregnancy [1–3]. This issue is particularly relevant in Kenya, where, similar to many low and middle-income countries (LMICs), unintended pregnancy is pervasive, with 10% of all births reported as unwanted and 25% mistimed [4]. Unintended pregnancy is high among women experiencing physical or sexual violence from a male partner, an experience reported by nearly 40% of Kenyan ever-married women ages 15–49 years [4, 5]. IPV may be linked to unintended pregnancy via another form of gender-based violence, reproductive coercion (RC), which has been shown in the United States to be independently associated with risk for unintended pregnancy, above and beyond the risk associated with IPV [6]. Research in many global (...truncated)