IUD Re-introduction in Kenya 

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Background:  The IUD has virtually disappeared from the national mix of modern family planning methods in Kenya over the past 15 years, despite its proven safety, effectiveness, acceptability, and low cost. While the percentage of Kenyan women using any modern contraceptive has more than tripled since 1984, the proportion of contraceptive users choosing the IUD decreased from 31 to eight percent between 1984 and 2003.[i] Despite the increased use of contraceptive methods, as more Kenyans enter reproductive age, unmet need continues to grow. Limited donor resources and a skewed method mix toward short-term (and more costly) methods compound this unmet need.

The Kenya Ministry of Health (MOH) is committed to providing a range of contraceptive options and a more balanced and sustainable method mix to Kenyans. The MOH has thus led the process of rehabilitating the IUD in Kenya.

Recognizing that the barriers to IUD provision are multifold, the initiative focuses on four areas: consensus-building and advocacy, building capacity and improving service delivery, demand creation, and monitoring and evaluation.

Consensus-building and Advocacy:  From the onset, the MOH undertook several activities to cultivate ownership and consensus among various groups, including researchers, trainers, program managers,  service providers, professional associations, funding agencies, and clients. Global and local research on IUDs was disseminated and discussed during a series of panels and stakeholder meetings (2001).

Subsequently, a task force[ii] was established to develop a strategy for IUD reintroduction, based on a qualitative assessment of IUD service delivery in Kenya (February 2002).[iii] FHI was requested to coordinate the activities of the task force. The MOH and its partners developed a joint work plan, upon which the initiative was launched (February 2003).

The advocacy component included a review of MOH policies and the development of various communication efforts to raise awareness among providers, clients, and the general public. As of March 2004, over 2,600 advocacy briefs had been distributed, 400 program managers and family planning service providers were sensitized in meetings in all eight provinces in Kenya, and hundreds of others have been encouraged to take a new look at the IUD during radio programs and presentations at regional reproductive health conferences.

Building Capacity and Improving Service Delivery:  Through the Ministry of Health AMKENI Project, a USAID-supported service delivery project, the initiative will also improve the supply of quality IUD services by establishing a training system for IUD services, creating a cadre of trainers to reach IUD providers in both the public and private sectors, enhancing supervision capacities within the existing MOH structure, ensuring the provision of equipment and expendable supplies to AMKENI-supported clinics,  improving facilities' infrastructure, and addressing infection-prevention techniques in clinics. The AMKENI project is working with the MOH's Decentralised Reproductive Health Training and Supervision teams to implement these capacity-building activities.

Demand Creation:  Clients' awareness of the existence and advantages of the IUD are major determinants of demand. Often clients are not aware of the IUD as a contraceptive option, or they have misconceptions about the method. To raise awareness, the initiative developed information, education, and communication (IEC) materials and initiated public education campaigns through the AMKENI project's extensive network of field agents. As of March 2004, nearly 12,000 community members were reached through educational sessions on the IUD.

Monitoring and Evaluation:  Partners are collecting data for monitoring and evaluating the initiative's progress and success. Specifically, this information will assist in refining and improving the program's functioning and in documenting program outputs and outcomes and eventually its impact on IUD use. For example, a midterm review of the initiative found that IUD provision has more than doubled in participating facilities since the launch of reintroduction. Operations research will also be conducted to determine the effectiveness of using "detailers"[iv] to change provider attitudes toward the IUD. This information will also be useful when determining appropriate scale-up or replication of such a strategy.

Lessons Learned:  Although this initiative to reintroduce the IUD is still in its third year, and monitoring efforts are just beginning, there are already several lessons learned about consensus-building, partnership, and advocacy. Significant success factors thus far include:

• High-level political commitment: Leadership by the MOH ensures a commitment by all involved to undertake necessary policy and programmatic changes and aids with direction and momentum.
• Use of champions: Credible spokes people are important advocates in that they can help bridge the worlds of research, policy, and programs.
• Synthesis and incorporation of valid  research findings to inform action: Succinct and accessible evidence makes busy policy-makers, program managers, and providers take notice.
• Review of existing policy and guidelines: Thorough review of current policies provides the context for identifying barriers to and opportunities for IUD reintroduction.
• Partnership with key stakeholders: Collaboration leads to ownership and more effective project implementation.
• Collaboration and leveraging of resources by implementing agencies: Organizations can effectively cooperate and contribute resources when they share common goals, are well coordinated, and bring a variety of skills to the project.

This work was supported by the U.S. Agency for International Development (USAID). The contents do not necessarily reflect USAID views and policy.

For more information, contact FHI's Research to Practice initiative at rtop@fhi.org or FHI Nairobi at iucdbriefs@fhi.or.ke.

This document is also available as a PDF (216 KB) in English, a PDF (217 KB) in Spanish (196 KB), and a PDF (111 KB) in French.

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[i] Central Bureau of Statistics, Ministry of Planning and National Development. Kenya Contraceptive Prevalence Survey 1984. Nairobi, Kenya: Central Bureau of Statistics, Ministry of Planning and National Development, 1984; National Council for Population and Development, Central Bureau of Statistics, and Macro International Inc. Kenya Demographic and Health Survey 2003 preliminary results [Online]. Available: http://www.cbs.go.ke/pdf

[ii] Taskforce members include the AMKENI Project; United Kingdom Department for International Development (DFID) Deutsche Gesellschaft fur Technische Zusammenarbeit (GTZ); GmbH/MOH; Family Planning Association (FPAK); Johns Hopkins Program for International Education in Reproductive Health (JHPIEGO); Division of Reproductive Health, Kenya MOH; Population Council; PRIME/IntraHealth; and the U.S. Agency for International Development (USAID). FHI acts as secretariat.

[iii] This strategy is based on global and local evidence, including an FHI 1995 qualitative assessment of IUD service delivery in Kenya, which outlined five inter-related factors that were influencing this decline: poor quality of care, fear of HIV transmission, provider bias, poor product image, and shifting client preferences.

[iv] The term "detailing" describes an intervention wherein a role model or "champion" makes outreach visits to service delivery points to educate and motivate audiences in order to achieve a desired outcome (in this case, increased promotion of the IUD).