Global Gag Rule Influence On Determinants Of Unmet Need For Family Planning At Family Health Options Kenya In Nairobi City County

This study was about the determinants of unmet need for family planning in the era of the global gag rule at Family Health Options Kenya in Nairobi City County. Problem statement: This policy creates inhibitions on family planning programs and results in loss of US funding for reproductive health NGOs that depend on donor funding for their reproductive health activities such as family planning. FHOK has had to close down the Kitengela and Mombasa clinics. Objectives: The objective of the study was to determine the unmet need for family planning among women who visited Family Health Options Kenya in Nairobi County by examining the association between unmet need and affordability of contraceptive services, accessibility of FHOK clinics and quality of FHOK services. Methods: Data was collected from clients using questionnaires for quantitative data and key informant interviews of service providers for qualitative data. The study design was a descriptive cross sectional study design.  Purposive sampling was used to select the clinics of the study and systematic random sampling was used to select the participants of the study. Data Analysis was done using Statistical Package for Social Sciences (SPSS). Chi square was used to test the significance of the association between the dependent and independent variables. Results: The most popular contraceptive selected at FHOK was implants. Unmet need was found to be 46.1%. Affordability of FHOK services was not found to have a significant association with unmet need for family planning. Accessibility and quality of FHOK services were also not found to have a significant association with unmet need. However, it was noted that the patients who used to visit the Kitengela clinic that was closed due to the global gag rule reported that the distance to the FHOK clinics in Nairobi County was too far. However, their numbers were not significant enough to show an association with unmet need for family planning. The key informant interviews revealed that the health providers had a meeting in the wake of this policy to strategize on how to mitigate it. They decided to focus on providing their clients with long term contraceptives as opposed to short term ones to reduce the frequency of the patient’s subsequent visits thus reducing the chances of stock outs of contraceptive commodities. Conclusion: Unmet need, at 46%, was higher than the national estimate of 18% (KDHS 2014) due to the fact that the study population was women who visited the clinic specifically for family planning services, not the general population of women in the community. None of the factors of affordability, accessibility nor quality of services were found to have a significant association with unmet need for family planning because the Global Gag Response project currently ongoing at FHOK has ensured replacement of the funding that was lost to the tune of USD 500,067 and this has ensured that despite the changes made by FHOK to adjust to the reduced funding, the affordability, accessibility and quality of patient care has not undergone a significantly noticeable change to the patients.