Factors influencing contraceptive uptake among women of reproductive age in Kenya

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n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); Skip to content Gates Open Research file_upload Submit via VeriXiv search clear search menu close clear Search Browse Gateways & Collections How to Publish Submit via VeriXiv My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Publication Charges Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Contact Blog My Account Submissions Content and Tracking Alerts My Details Sign In Submit via VeriXiv { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://gatesopenresearch.org/articles/8-32" }, "headline": "Factors influencing contraceptive uptake among women of reproductive age in Kenya", "datePublished": "2024-04-24T11:23:43", "dateModified": "2024-08-19T10:48:32", "author": [ { "@type": "Person", "name": "Jane Bitutu Nyakundi" }, { "@type": "Person", "name": "Shadrack Yonge" }, { "@type": "Person", "name": "Samuel Kiiru" }, { "@type": "Person", "name": "Peter Gichangi" } ], "publisher": { "@type": "Organization", "name": "Gates Open Research", "logo": { "@type": "ImageObject", "url": "https://gatesopenresearch.org/img/AMP/Gates_image.png", "height": 600, "width": 47 } }, "image": { "@type": "ImageObject", "url": "https://gatesopenresearch.org/img/AMP/Gates_image.png", "height": 1200, "width": 94 }, "description": " Background Modern Contraceptive Methods (MCM) use is among the interventions preventing unplanned pregnancies and unsafe abortions globally. Nevertheless, MCM uptake is still low. We aimed at determining factors influencing contraceptive uptake among women of reproductive age 15 to 49 years, in Kenya. Methods We used secondary data collected by Performance Monitoring for Action (PMA). PMA used cross sectional multi-stage cluster survey design and collected the data between November and December 2019. The study was approved by NACOSTI/202974 and KNERC KNH/ERC/R/192. Results The study obtained a sample size of 9477 women of reproductive age (WRA) from 11 counties in Kenya. Both descriptive and inferential statistical analysis with a P value of 0.05 was done using Stata 16.1. The prevalence of modern contraceptives uptake was 43.2% uptake was 43.2% among all WRA. The prevalence was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55). More than half (53.4%) of the married women were using a modern contraceptive, while only about two in every 10 of the unmarried were using a modern contraceptive. Women affiliated with the Islam religion were less likely to use modern contraceptive (aPOR 0.6, 95% CI 0.42, 0.89 p=0.010) as compared to the Catholics. Family planning (FP) services were found to be lower (aPOR 0.535(95% CI 0.29,0.98 p=0.043) in National Hospital Insurance Fund (NHIF)-covered facilities than in non-NHIF-covered ones. Adolescent FP service provision and prescription was 4 times higher (aPOR 4.0 95% CI; 1.05,15.41, p=0.42) as compared to either the prescribed or provided. Conclusion Low uptake for MCM is influenced by sociodemographic factors and Health system factors. Efforts to increase MCM uptake should focus on rural residents, unmarried women, Islamic religion women and accreditation of NHIF services in all facilities. 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Gates Open Res 2024, 8 :32 ( https://doi.org/10.12688/gatesopenres.15283.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] Jane Bitutu Nyakundi https://orcid.org/0009-0002-7166-1968 1,2 , Shadrack Yonge 1 , Samuel Kiiru https://orcid.org/0009-0004-7416-059X 3 , Peter Gichangi 3-5 Jane Bitutu Nyakundi https://orcid.org/0009-0002-7166-1968 1,2 , Shadrack Yonge 1 , Samuel Kiiru https://orcid.org/0009-0004-7416-059X 3 , Peter Gichangi 3-5 PUBLISHED 19 Aug 2024 Author details Author details 1 Department of Environmental and Health Sciences, Technical University of Mombasa, Mombasa, Mombasa County, Kenya 2 Ministry of Health, Kilifi County Government, Kilifi, Kilifi, Kenya 3 Research, Monitoring and Evaluation, International Centre for Reproductive Health Kenya, Mombasa, Mombasa County, Kenya 4 Technical University of Mombasa, Mombasa, Mombasa County, Kenya 5 Department of Primary Health Care, Ghent University, Ghent, Flanders, Belgium Jane Bitutu Nyakundi Roles: Conceptualization, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Shadrack Yonge Roles: Supervision, Validation, Writing – Review & Editing Samuel Kiiru Roles: Data Curation, Formal Analysis, Methodology, Writing – Review & Editing Peter Gichangi Roles: Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Modern Contraceptive Methods (MCM) use is among the interventions preventing unplanned pregnancies and unsafe abortions globally. Nevertheless, MCM uptake is still low. We aimed at determining factors influencing contraceptive uptake among women of reproductive age 15 to 49 years, in Kenya. Methods We used secondary data collected by Performance Monitoring for Action (PMA). PMA used cross sectional multi-stage cluster survey design and collected the data between November and December 2019. The study was approved by NACOSTI/202974 and KNERC KNH/ERC/R/192. Results The study obtained a sample size of 9477 women of reproductive age (WRA) from 11 counties in Kenya. Both descriptive and inferential statistical analysis with a P value of 0.05 was done using Stata 16.1. The prevalence of modern contraceptives uptake was 43.2% uptake was 43.2% among all WRA. The prevalence was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55). More than half (53.4%) of the married women were using a modern contraceptive, while only about two in every 10 of the unmarried were using a modern contraceptive. Women affiliated with the Islam religion were less likely to use modern contraceptive (aPOR 0.6, 95% CI 0.42, 0.89 p=0.010) as compared to the Catholics. Family planning (FP) services were found to be lower (aPOR 0.535(95% CI 0.29,0.98 p=0.043) in National Hospital Insurance Fund (NHIF)-covered facilities than in non-NHIF-covered ones. Adolescent FP service provision and prescription was 4 times higher (aPOR 4.0 95% CI; 1.05,15.41, p=0.42) as compared to either the prescribed or provided. Conclusion Low uptake for MCM is influenced by sociodemographic factors and Health system factors. Efforts to increase MCM uptake should focus on rural residents, unmarried women, Islamic religion women and accreditation of NHIF services in all facilities. READ ALL READ LESS Keywords contraceptive methods, women of reproductive age, cross sectional study survey, 11 counties in Kenya Corresponding Author(s) Jane Bitutu Nyakundi ( [email protected] ) Close Corresponding author: Jane Bitutu Nyakundi Competing interests: No competing interests were disclosed. Grant information: This work was supported by the Gates Foundation [OPP1198333]. The funders had no role in the study design, collection, analysis, and interpretation of data, in writing of the report, or in the decision to submit for publication. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Nyakundi JB et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Nyakundi JB, Yonge S, Kiiru S and Gichangi P. Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.12688/gatesopenres.15283.2 ) First published: 24 Apr 2024, 8 :32 ( https://doi.org/10.12688/gatesopenres.15283.1 ) Latest published: 19 Aug 2024, 8 :32 ( https://doi.org/10.12688/gatesopenres.15283.2 ) Revised Amendments from Version 1 The following changes have been in the new version of the article: We have revised some grammatical errors that existed. There are a few sentences that have been revised, with no change in the statistics provided previously. We have made some changes in the discussion that are not affecting the article majorly. The following changes have been in the new version of the article: We have revised some grammatical errors that existed. There are a few sentences that have been revised, with no change in the statistics provided previously. We have made some changes in the discussion that are not affecting the article majorly. To read any peer review reports and author responses for this article, follow the "read" links in the Open Peer Review table. READ REVIEWER RESPONSES Introduction A modern contraceptive method is defined as a product or medical procedure that interferes with reproduction from acts of sexual intercourse 1 . Modern contraceptive methods (MCM) are in line with addressing reproductive health needs as reflected in Sustainable Development Goal 3.7 2 which calls for universal access to family planning by 2030 2 . Birth spacing and limitation by utilizing current family planning (FP) methods have the potential to prevent 1.5 million maternal deaths and almost two million children deaths each year, as well as contribute to overall economic growth and development. Unmet FP demand on the other side contributes to unintended pregnancies and unsafe abortions 3 , 4 . Of the 1.11 billion women of reproductive age who needed family planning services in 2019 only 842 million got them, leaving 270 million women around the world with unmet demands. The unmet need for family planning services is significantly worse in the low and middle income countries where more than 232 million women cannot receive MCM when necessary 5 . Every year, approximately 14 million unintended pregnancies occur in sub-Saharan Africa alone 6 with teenager girls and women between the ages of 15 and 24 being the most vulnerable. For example, in Benin, adolescence is seen as the start of the continuity of medical care for reproductive newborn, maternal, and pediatric health. During this time poor access to and utilization of contraception are likely to have a negative impact on health outcomes overall 7 . Modern contraceptives are so effective that they reduce maternal death by more than 20% and newborn mortality by 17% 8 . Contraceptive prevalence rates (CPR) are often lower in areas with high fertility rates and the sub-Saharan Africa (SSA) region is not an exception 9 , 10 . The majority of underdeveloped countries including Kenya, however, utilize few contraceptive methods hence they have a lot of unmet needs 11 . According to the UN's 2017 World Family Planning highlight levels of unmet family planning need greater than 20% are considered high, and those less than 10% are deemed low 12 . Studies have shown that, in some countries in Africa, 38% of contraceptive users stopped using them after the first year 13 , 14 . Kenya is not exempt from this - 31% of users of contraceptives discontinued use within a year of beginning use 15 . Even though Kenya has made a sizable effort in raising knowledge about the methods and encouraging the use of contraceptives, some women with unmet need for family planning were previous contraceptive users. Modern contraceptive prevalence rates among married women are 57.0% and among sexually active unmarried women aged 15–49 years, 59%. which is still a low contraceptive prevalence rate 15 by Kenyan survey. The availability of high-quality healthcare facilities such as hospitals and health centers have an impact on one's selection of contraception and the unmet need for FP 16 . In addition, insufficient stocks and restricted usage of available methods create conditions that ultimately restrict women’s choices and use and are likely contributing factors to the prevalence of contraceptive discontinuations 17 . To ensure that individuals and couples can select their chosen contraceptive method and meet their fertility objectives, it is crucial to have an appropriate choice of methods at various tiers of the health care system 18 . Healthcare financing of reproductive health is critical that promotes equitable access due to affordability of services. The Kenyan health sector is financed from public, private, and donor sources accounting for 37%, 39.6%, and 23.4% of total health expenditure. Out-of-pocket (OOP) costs for households make up a sizable amount (26.1%) of all medical expenses 19 . It is the State’s fundamental duty to respect, protect, promote and fulfil the right to the highest attainable standard of reproductive health care by ensuring the provision of a health service package at all levels of the health care system including FP services 20 . In this context, this study will examine the factors influencing the uptake of modern contraception among Kenyan women of reproductive age and fill this gap using the most up-to-date Performance, monitoring for Action (PMA) survey data available in Kenya which may help decision-makers, stakeholders and planners develop efficient tactics to reduce the terrible consequences of unintended pregnancy while also raising the level of socioeconomic status across the country and geographical area 8 . Finally, we shall come up with solid recommendations on how to improve contraceptive uptake and usage with the ultimate goal of accelerating the country's growth and development. This study's specific objectives were to describe the socio-demographic factors associated with contraceptive uptake among women of reproductive age, to describe the prevalence of MCM uptake among women of reproductive age and to determine the effects of health system factors on contraceptive use among Kenyan women of reproductive age. Methods Ethical clearance Ethical approval was given by the Kenyatta National Ethics and Research Committee (KNH-UON ERC) Ref No KNH/ERC/R/192 and administrative approval by the National Council for Science, Technology, and Innovation (NACOSTI) Ref No 202974 and by all participating counties, on 1 st October 2019 for the original collection of the data. All the consent obtained from the study participants were verbally read to the participants, and they were also given the hard copies for them to sign after reading. Two copies were signed, and they retained a copy, while the other copy was archived by the project. All participants above 18 years gave written informed consent, while for the minors, the study obtained both assent and their parent/guardian’s written informed consent. Study design This study used secondary data from the PMA cross-sectional survey conducted in November and December of 2019. Study setting The research was conducted in Kenya, one of the countries where Performance Monitoring is done. Kenya is one of the East African countries, a lower-middle-income country with current fertility rate 3.3 births per woman, with a population of approximately 52 million people. The study was carried out in 11 of the 47 counties Nairobi, Kiambu, Kericho, Kitui, Kilifi, Bungoma, Siaya, Nyamira Nandi, Kakamega, and West Pokot. Inclusion criteria and exclusion criteria The inclusion criteria were 15 to 49-year-old women who lived in the 35 households randomly selected in each of the 308 EAs within the 11 counties, and all service delivery points serving the EAs for the public facilities and a maximum of three private facilities within the enumeration area (EA). The PMA study excluded all men and women who were younger than 15 years and those older than 49 years, those who never consented for the interviews, those who were mentally challenged beyond the point of responding to the interviews and those outside the study areas. Study variables Modern contraceptive uptake among women of reproductive age was our outcome variable. It was measured based on the question; “ Are you or your partner currently doing something or using any method to delay or avoid getting pregnant? ” which was coded as 1 for modern contraceptive users and 0 for traditional users and non-users. The independent variables included sociodemographic which were age of respondents, education levels, wealth quintiles, parity, marital status, awareness of modern contraceptive, religion and county of residence. The ages were categorized as 15–19, 20–24, 25–29, 30–34, 35–39, 40–44 and 45–49 years. Marital statuses were classified into Married, living with a partner, divorced/separated, widow and never married. Levels of education were categorized into never educated, primary, secondary, vocational, college and university. Wealth quintiles were classified into five wealth quintiles; poorest, poor, middle, high and highest were computed based on wealth index generated using principal component analysis from the household assets, walls, flooring and roofing materials. Parity was categorized into 0–1, 2–3 and 4+. The counties of residence were Nairobi, Bungoma, Kericho, Kiambu, Kilifi, Kitui, Nandi, Nyamira, Siaya, Kakamega and West Pokot, while residence was either rural or urban. The second independent variable is health system factors, which are defined as facility type (public and private) commodities stock outs (yes or no). This includes facilities that support community Health Volunteers (CHVs) (yes or no), FP providing days (less than seven days, 8–14 days, 15–21 days and 22–30 days), NHIF-covered FP services (yes or no), FP services available to adolescent aged 15 to 19 years (Never offered; counselled-(on the use, side effects and correct use); counselled and prescribed; counselled and provided; counselled; provided and prescribed; prescribed; provided or prescribed and prescribed), and whether the FP Client pays any fees (yes or no). Data source and measurement The study used pooled data from Kenya’s performance monitoring for action 2019 survey. The survey used a multi-stage stratified cluster design with urban-rural and county as strata. A total of 308 enumeration areas were selected from the Kenya National Bureau of Statistics (KNBS) master sampling frame. In each EA, 35 households were randomly selected where the household interviews were conducted. Within the selected households all females aged 15–19 were eligible for the female questionnaires. The survey interviewed 10,581 households and 9477 females. A total of 945 service delivery points serving the enumeration areas were also interviewed. Data collection procedures and instruments Data collection was done by PMA survey project that was conducted in November and December 2019. It used an open-source software program called Open Data Kit (ODK). That was customized for ease of updating and addition of security features. All of the survey were programmed and loaded into the project's smartphones. The ODK surveys had automatic skip-patterns and built-in reply limits to minimize data entry errors. Three main types of questionnaires were used: household, female and service delivery point (SDP). Data management and analysis The PMA data is free available upon request which is shared with all other study components. Coding was done for the different independent variables for ease of analysis. The analysis aimed at showing how certain socio-demographic and Health system variables are associated with contraceptive use among women in Kenya. Analysis was done using Stata 16.1. Survey weights were applied to account for the complex survey design. Statistical significance was set at p-value <0.05. The sample's variables were described using frequencies and percentages and bivariate and multivariable logistic regressions were used to depict the independent variables associated with the use of modern contraceptives. Results A total of 9477 women and 945 service delivery points completed the survey and were eligible for the analysis. Table 1 shows the socio-demographic characteristics of the sample. Majority of the respondents (39.2%) in the survey were aged young women 15–24 years while about (7.8%) were 45–49 years. More than half (53.4%) of the women were married, about a third (32.0%) were unmarried. About eight in every 10 women had basic education (primary and secondary levels), while (4.5%) had no basic education level. Majority of the women were Protestants (70.7%) and nearly all study participants (98.4%) were aware of modern contraceptive methods. Women who had at most one child were more (44.1%), whereas those who had two to three or four and more children were less common (28.8%) and (27.1%), respectively. Dispensaries (30.1%) were the most preferred source of contraceptives. Half (50.7%) of the facilities that offered contraceptive methods experienced or had an episode of contraceptive stock outs. More than half of the facilities (53.4%) supported community health volunteers in providing family planning services. The NHIF-covered facilities with FP services were less prevalent (7.14%) than those without NHIF (92.86%). Adolescents were more (51.95%) likely to use FP services in facilities that offered counseling, provision, and prescription of family planning methods. Table 1. Distribution of survey respondents by the selected variables. Variables Percentage N [Weighted] MCM Yes 43.2 4095 No 56.8 5382 Age in years 15–19 21.6 2047 20–24 17.6 1665 25–29 16.3 1546 30–34 15.4 1461 35–39 11.8 1119 40–44 9.5 904 45–49 7.8 735 Marital status Married 53.4 5056 Living with a partner 5.8 550 Divorced / separated 5.9 562 Widow / widower 2.9 278 Never married 32.0 3029 Residency Urban 30.2 2859 Rural 69.8 6618 Education Never 4.5 427 Primary 45.2 4284 Secondary 35.6 3378 Vocational 2.1 199 College 9.7 923 University 2.8 266 Religion Protestants 70.7 6702 Catholic 18.1 1717 Islam 3.7 354 Other 2.4 229 No religion 5.0 473 Awareness of modern contraceptive Yes 98.4 9326 No 1.6 151 Parity 0–1 44.1 4177 2–3 28.8 2729 4+ 27.1 2569 Wealth index Poorest 20.4 1934 Poor 22.6 2139 Middle 21.0 1986 High 18.8 1784 Highest 17.2 1634 Visited by HCW who talked about FP Yes 9.9 941 No 90.1 8532 Visited a facility and discussed FP Yes 40.1 2404 No 59.9 3593 County Bungoma 9.1 865 Kakamega 16.8 1592 Kericho 11.5 1092 Kiambu 7.2 681 Kilifi 10.4 985 Kitui 7.5 706 Nairobi 10.1 959 Nandi 7.7 725 Nyamira 5.5 521 Siaya 7.4 702 West Pokot 6.9 650 Health system characteristics Facility types where FP was obtained Hospital 28.6 1146 Health center 24.4 976 Dispensary 30.1 1204 Pharmacy and others 16.9 676 Commodity stock outs No 49.3 457 Yes 50.7 469 Facility supports CHVs * No 46.6 402 Yes 53.4 460 Days FP is offered in a month Less than 7days 1.19 11 8-14 days 1.94 18 15-21days 79.16 733 22-30days 17.71 164 Facility with FP service covered by NHIF Yes 7.14 66 No 92.86 859 Facilities offering FP services to adolescents Do not offer adolescents 3.57 33 Counseled 4.33 40 counseled prescribed 1.08 10 counseled provided 32.58 301 counseled provided prescribed 51.95 480 Prescribed 0.97 9 Provided 3.79 35 provided prescribed 1.73 16 Clients are charged for any FP service Yes 6.05 56 No 93.95 870 * This excludes pharmacies in the sample; FP: Family Planning; CHVs: Community Health Volunteers, HCW: Healthcare worker, N: Number of respondents, MCM: Modern Contraceptive Methods; NHIF: National Hospital Insurance Fund Prevalence of modern contraceptive use In Table 2 below, the overall modern contraceptive use was 43.2% (95% CI; 41.7, 44.8). Modern contraceptive use was high among the older women (greater than 20 years), 34.0% (95% CI; 29.74,38.46, p=0.000) among those above 45 years, while least among the adolescents 12.1% (95% CI; 10.4, 14.05). About five in every 10 married women were using a modern contraceptive, while only about two in every 10 of the unmarried were using a modern contraceptive. Modern contraceptive prevalence was low among rural dwellers 41.4% (95% CI; 39.62, 43.17, p=0.001) as compared to urban dwellers. MCM increased with education attainment from 24.7% (95%CI; 19.45, 30.7) among those with non-formal education, to 47.8% (95% CI; 40.79, 54.9, p=0.000) among those with tertiary education. Modern contraceptive use was also noted to be higher among women who had a contact with the community health workers 51.5% (95% CI; 47.29, 55.67, p=0.000) at their homes in comparison to those who were not visited by HCW. About six in 10 of the women who visited a facility and discussed family planning with the health providers were using a modern contraceptive method 59.5% (95% CI; 1.76, 2.37, P=0.000). Table 2. Factors associated with modern contraceptive use among women of reproductive age 15–49 years. Bivariate model Multivariable model Variables Prevalence cPOR [95% CI] P value aPOR [95% CI] P value MCM Yes 43.21[41.7,44.8] No 56.79[55.2,58.4] Age 15–19 12.1 [10.4,14.05] Ref Ref 20–24 47.5 [44.41,50.54] 6.6 [5.4, 7.97] 0.0000 2.4 [1.87, 3.15] 0.0000 25–29 56.2 [53.04,59.31] 9.3 [7.64, 11.36] 0.0000 1.8 [1.37, 2.47] 0.0000 30–34 58.5 [55.64,61.2] 10.2 [8.34, 12.51] 0.0000 1.5 [1.13, 1.99] 0.0050 35–39 56.3 [52.95,59.58] 9.4 [7.68, 11.38] 0.0000 1.1 [0.84, 1.56] 0.388 40–44 50.4 [46.71,53.99] 7.4 [5.9, 9.19] 0.0000 1.1 [0.77, 1.5] 0.676 45–49 34.0 [29.74,38.46] 3.7 [2.97, 4.69] 0.0000 0.6 [0.39, 0.78] 0.0010 Marital status Married 57 [55.08,58.79] Ref Ref Living with a partner 54.1 [47.05,61.08] 0.9 [0.66, 1.21] 0.459 1 [0.7, 1.36] 0.8810 Divorced / separated 46.4 [41.2,51.68] 0.7 [0.53, 0.81] 0.0000 0.7 [0.53, 0.96] 0.0250 Widow / widower 32.3 [25.91,39.4] 0.4 [0.26, 0.49] 0.0000 0.4 [0.26, 0.63] 0.0000 Never married 18.7 [16.61,20.96] 0.2 [0.15, 0.2] 0.0000 0.5 [0.39, 0.56] 0.0000 Residency Urban 47.5 [44.39,50.55] Ref Ref Rural 41.4 [39.62,43.17] 0.78 [0.68, 0.9] 0.0010 0.8 [0.63, 0.98] 0.0330 Education Never 24.7 [19.45,30.7] Ref Ref Primary 47.8 [45.49,50.04] 2.8 [2.05, 3.81] 0.0000 2.7 [1.82, 4.01] 0.0000 Secondary 38 [35.94,40.12] 1.87 [1.37, 2.57] 0.0000 2.2 [1.34, 3.55] 0.0020 Vocational 42.1 [35.25,49.34] 2.23 [1.49, 3.33] 0.0000 2.5 [1.61, 3.87] 0.0000 College 48.7 [44.08,53.28] 2.9 [2.05, 4.09] 0.0000 2.6 [1.68, 4.09] 0.0000 University 47.8 [40.79,54.9] 2.8 [1.87, 4.18] 0.0000 2.7 [1.62, 4.6] 0.0000 Awareness of modern contraceptive No Ref Ref Yes 43.9 [42.29,45.48] 31.38 [6,164.23] 0.0000 4.52 [0.8, 25.46] 0.0870 Religion Catholic 43.6 [40.61,46.68] Ref Ref Islam 36.7 [27.83,46.48] 0.75 [0.5, 1.13] 0.164 0.6 [0.42, 0.89] 0.0100 No religion 34 [27.5,41.24] 0.67 [0.48, 0.93] 0.016 0.8 [0.54, 1.23] 0.3310 Other 46.9 [39.89,53.94] 1.14 [0.82, 1.58] 0.432 1.1 [0.8, 1.62] 0.4640 Protestant 44 [42.26,45.67] 1.01 [0.89,1.15] 0.834 0.9 [0.79, 1.12] 0.466 Parity 0–1 25.3 [23.3,27.39] Ref Ref 2–3 59.9 [57.58,62.09] 4.4 [3.88, 5] 0.0000 2.5 [2.05, 3] 0.0000 4+ 54.7 [52.15,57.28] 3.57 [3.11, 4.1] 0.0000 3.6 [2.74, 4.62] 0.0000 Wealth index Poorest 37.7 [34.79,40.78] Ref Ref Poor 42.3 [39.6,45.05] 1.21 [1.04, 1.4] 0.0110 1 [0.85, 1.27] 0.7190 Middle 44.9 [42.23,47.55] 1.34 [1.15, 1.57] 0.0000 1.3 [1.04, 1.57] 0.0170 High 46.5 [43.61,49.43] 1.43 [1.21, 1.7] 0.0000 1.4 [1.07, 1.8] 0.0140 Highest 45.3 [41.62,48.97] 1.36 [1.12, 1.66] 0.0020 1.3 [0.96, 1.79] 0.0920 Visited by HCW who talked about FP No 48.5 [40.63,44.01] Ref Ref Yes 51.5 [47.29,55.67] 1.45 [1.21, 1.73] 0.0000 1 [0.77, 1.29] 0.987 Visited a facility and discussed FP No 41.8 [39.4,44.27] Ref Ref Yes 59.5 [56.57,62.27] 2.04 [1.76, 2.37] 0.000 1.5 [1.27, 1.77] 0.0000 County Bungoma 50.5 [46.13,54.93] | | | | Kericho 42.8 [38.02,47.76] 0.73 [0.56, 0.96] 0.0220 0.6 [0.45, 0.89] 0.0080 Kiambu 46.9 [41.38,52.42] 0.86 [0.65, 1.15] 0.309 0.8 [0.55, 1.15] 0.225 Kilifi 35.2 [29.69,41.23] 0.53 [0.39, 0.73] 0.0000 0.6 [0.38, 0.78] 0.0010 Kitui 41.3 [35.83,47.04] 0.69 [0.51, 0.92] 0.0130 0.7 [0.51, 0.98] 0.0390 Nairobi 47 [41.67,52.44] 0.87 [0.66, 1.15] 0.3230 0.7 [0.49, 1.12] 0.1510 Nandi 49.3 [44.9,53.69] 0.95 [0.74, 1.22] 0.6950 0.8 [0.6, 1.15] 0.2660 Nyamira 49.5 [43.89,55.12] 0.96 [0.72, 1.28] 0.7760 1 [0.71, 1.48] 0.9060 Siaya 41.2 [37.18,45.32] 0.69 [0.54, 0.87] 0.0030 0.6 [0.4, 0.76] 0.0000 Kakamega 47.3 [43.58,50.94] 0.88 [0.7, 1.1] 0.2620 0.9 [0.62, 1.18] 0.3520 West Pokot 19.3 [13.54,26.85] 0.23 [0.15, 0.37] 0.0000 0.3 [0.17, 0.44] 0.0000 Health system characteristics Facility type where FP was obtained Hospital 46.5 [36.2,57.2] Ref Ref Health center 42.7 [35.9,49.9] 0.86 [0.51,1.46] 0.568 Dispensary 37.8 [32.9,43.1] 0.7 [0.43,1.15] 0.157 Pharmacy and others 42.3 [30.5,55.2] 0.84 [0.44,1.61] 0.606 Stockouts among facilities offering FP No 43.5 [38.4,48.7] Ref Ref Yes 37.5 [32.8,42.5] 0.779 [0.59,1.03] 0.5874 Facility supports CHVs * No 42.6 [36.8,48.6] Ref Ref Yes 38.2 [33.5,43.0] 0.832 [0.61,1.13] 0.233 FP offering days per month Less than 7 days 32.9 [15.7,56.4] Ref 8–14 days 43.1 [20.1,69.5] 1.542 [0.39,6.02] 0.532 15–21 days 39 [34.8,43.4] 1.303 [0.48,3.52] 0.600 22–30 days 49.9 [40.8,59.0] 2.03 [0.74,5.59] 0.170 NHIF covered FP services No 41.4 [37.7,45.3] Ref Yes 27 [16.9,40.3] 0.523 [0.29,0.96] 0.040 0.535 [0.29,0.98] 0.043 FP services offered to unmarried adolescents [age 10–19] Do not offer 41.7 [23.7,62.2] Ref counseled 32.9 [19.2,50.2] 0.685 [0.23,2.01] 0.489 0.682 [0.23,1.99] 0.484 counseled prescribed 32.6 [10.9,65.7] 0.677 [0.14,3.28] 0.627 0.713 [0.15,3.37] 0.668 counseled provided 42.2 [35.8,48.9] 1.022 [0.43,2.44] 0.962 1.045 [0.44,2.5] 0.920 counseled provided prescribed 37.7 [33.2,42.4] 0.845 [0.35,2.01] 0.702 0.857 [0.36,2.04] 0.726 prescribed 64.2 [29.9,88.2] 2.503 [0.48,12.94] 0.273 2.456 [0.48,12.7] 0.282 provided 59.7 [39.7,77.0] 2.072 [0.6,7.18] 0.250 2.077 [0.6,7.17] 0.246 provided and prescribed 74.6 [50.9,89.3] 4.105 [1.07,15.71] 0.039 4.029 [1.05,15.41] 0.042 FP clients pay any fee irrespective of obtaining a method No 40.7 [36.8,44.7] Ref Yes 43.1 [29.2,58.3] 0.535 [0.58,2.1] 0.75 * This excludes pharmacies in the sample *Statistically significant at p<0.05, APOR: Adjusted Prevalence Odd Ratio, C.I: Confidence interval, COR: Crude Prevalence Odd Ratio, FP: Family Planning; CHVs: Community Health Volunteers, HCW: Healthcare worker, MCM: Modern Contraceptive Methods; NHIF: National Hospital Insurance Fund The variables that were significant in the bivariate were included in the multivariable model. The odds of modern contraceptive use were higher among young women aged 20–24 years (prevalence 47.5) (aPOR 2.4, 95% CI; 1.87, 3.15, p=0.000), middle-aged women aged 25–29 (prevalence 56.2) (aPOR 1.8, 95% CI; 1.37, 2.47, p=0.000) and aged 30–34 (prevalence 58.5) (aPOR 1.5, 95% CI; 1.13, 1.99, P= 0.0050) as compared to adolescents. The odds of modern contraceptive use were (aPOR 0.7, 95% CI; 0.53, 0.96, P= 0.0250) less among divorcee (prevalence 46.4), (aPOR 0.4, 95% CI; 0.26, 0.63, P=0.000) less among the widow (prevalence 32.3) and (aPOR 0.5, 95% CI; 0.39, 0.56, p=0.000) less among the non-married women (prevalence 18.7) compared to the married women (prevalence 57.0) respectively. Rural women (prevalence 41.4) were 80% less likely to modern contraceptive use as compared to the urban women (prevalence 47.5) (aPOR 0.8, 95% CI; 0.63, 0.98, p= 0.0330 ). The odds of modern contraceptive use were three-fold higher among women with education, (aPOR 2.7, 95% CI; 1.82, 4.01, p=0.000) (aPOR 2.2, 95% CI; 1.34, 3.55, p=0.020), (aPOR 2.5, 95% CI; 1.61, 3.87, p=0.000), (aPOR 2.6, 95% CI; 1.68, 4.09, p=0.000) (aPOR 2.7, 95% CI; 1.62, 4.6, p=0.000) among those with primary (prevalence 47.8), secondary (prevalence 38.0), vocational (prevalence 42.1), college (prevalence 48.7) and university (prevalence 47.8) respectively as compared to those with no formal education. Women affiliated with the Islam religion (prevalence 36.7) were 60% less likely to use modern contraceptive (aPOR 0.6, 95% CI; 0.42, 0.89, p=0.010), as compared to the Catholics (prevalence 43.6). Among those who had children, the odds of modern contraceptive use were three and four folds higher among those with two to three and more than four children respectively as compared to those with less than two children (aPOR 2.5, 95% CI; 2.05, 3.0, p=0.000) prevalence 59.9) and (aPOR 3.6, 95% CI; 2.74, 4.62, p=0.000) (54.7) respectively. Women from middle (prevalence 44.9) and high wealth quintiles (46.5) had a higher odd of modern contraceptive use (aPOR 1.3, 95% CI; 1.04, 1.57, p=0.017) and (aPOR 1.4, 95% CI; 1.07, 1.8, p=0.0140) as compared to those from the poorest wealth quintile. Among women who visited and discussed FP with the provider, the odds of their modern contraceptive use were 1.5 times higher as compared to those who never discussed family planning after visiting the facility. County wise, the odds of contraceptive use were less likely, in Kericho (prevalence 42.8) (aPOR 0.6, 95% CI; 0.45, 0.89, p=0.008), Kilifi (prevalence 35.2) (aPOR 0.6, 95% CI; 0.38, 0.78, p=0.001), Kitui (prevalence 41.3) (aPOR 0.7, 95% CI; 0.51, 0.98, p=0.039), Siaya (prevalence 41.2) (aPOR 0.6, 95% CI; 0.4, 0.76, p=0.000) and West Pokot (prevalence 19.3) (aPOR 0.3, 95% CI; 0.17, 0.44, p=0.000) as compared to Bungoma (prevalence 50.5). Women who received NHIF-covered FP services were (aPOR 0.5,95%CI; 0.29,0.98, p=0. 043) less likely to utilize MCM than their counterparts, and the difference was statistically significant. The odds of using MCM was higher (aPOR 4.0,95% CI; 1.05,15.41, P=0.042) among adolescents aged 15 to 19 years who were offered provision and prescription of FP services than those who were not. Discussion We analyzed the secondary data collected by PMA 2019 survey. The survey gathered quantitative data to examine the factors associated with the uptake of modern contraception among Kenyan women of reproductive age. From these study findings, we found out that the prevalence of modern contraceptives in the 11 Counties in Kenya during the performance monitoring survey 2019 was 43.2%. A larger number (21.6%) of respondents were between the ages of 15 and 19, while most (53.4%) were married, the majority (69.8%) lived in rural areas, and just 4.5% had no formal education. We also discovered that the majority of health facilities (92.86%) with FP services were not covered by NHIF. The Kenya Demographic Health Survey 21 reports modern contraceptive prevalence rates among married women is (57.0%) and sexually active unmarried women aged 15–49 years is 59%. Our study found that modern contraceptive use was high among the older women (greater than 20 years) while least among the adolescents 12.1% (95% CI; 10.4, 14.05) and those above 45 years 34.0% (95% CI; 29.74,38.46, p=0.000). This is consistent with another prior studies in Kira-Uganda 5 which reported more limited MCM use among adolescent girls when compared to older age groups. Similarly a previous study done in Kwale county-Kenya noted that healthcare system constraints such as a lack of youth-friendly services, sexual and reproductive health commodities, with deeply rooted negative attitudes, significant anxiety and myths and misconceptions among adolescents serve as impediments to the beginning and ongoing utilization of contraceptive use and side effects 22 . It is therefore critical to promote family planning education and information to dispel myths and misconceptions 22 and provide a variety of service options to fit their needs 22 . The study further found that about roughly five in every 10 married women were using a modern contraceptive while only about two in every 10 of the unmarried were using a modern contraceptive. This suggests that married women have a greater desire to space or limit pregnancies 23 by study done in Uganda. The study further shows that the level of education was a determinant of contraceptive use as the level of education increased from non-formal education 24.7% (95% CI; 19.45, 30.7) so was the increase in contraceptive use among those with tertiary level 47.8% (95% CI; 40.79, 54.9). Two previous studies 23 , 24 in Uganda and Ghana reported that the use of contraceptives is significantly influenced by education this suggests that persons with higher levels of education were definitely more conscious of the advantages and significance of using contraceptives, they are also more informed which enhances access to services and offers them greater negotiating power when making decisions about using contraceptives. This study's further conclusion demonstrates that in comparison to Catholics, women associated with the Islam faith were less likely to use modern methods of contraception (aPOR 0.6, 95% CI; 0.42, 0.89). This is consistent with a study undertaken in five countries (Democratic Republic of the Congo, India, Kenya, Nigeria, and Burkina Faso) 25 that found Muslim married women have lower probabilities of using MCM than their Catholic counterparts. Likewise, a study in three African nations 26 found that having a strong religious identity can affect women's uptake of MCM. The consumption of contraceptives was also linked to a woman's parity, according to our study, women who had two to three children used MCM at a rate of about 59.9%, compared to only 25.3% among women who have less than one child. This could mean that women of low parity are under pressure to have more children as reported by study 5 , 27 from two countries Uganda and India. Another research study which was done in India reported that women with no child once married are forced to prove their fertility due to pressures from spouses, in laws and communities 27 . Women from middle and high wealth quintiles had a higher odd of modern contraceptive use [aPOR 1.3, 95% CI; 1.04, 1.57] and [aPOR 1.4, 95% CI; 1.07, 1.8] as compared to those from the poorest wealth quintile. Findings from previous studies 5 , 28 in Uganda agrees with our results, married women living in communities with high poverty levels were less likely to use modern contraceptives compared to those who live in communities that were in low poverty levels. Economically needy communities may be less likely to invest in women’s education, resulting in a lower level of understanding of contraceptive use, and less autonomy 23 as was seen in a recent study in Uganda. Distance to health services may also be major barrier leading to very low contraceptive use 29 , 30 as seen in Guatemala - Latin America and USA. Additionally, study findings in Ghana discovered that communities with more working married women have higher likelihood of using modern contraception which is consistent with the results of our study. Women who work are able and willing to spend their money on the necessary medical expenses and they also have the freedom to decide on family planning with their partners, which may not be the case for married women who are reliant on their husbands and do not work 24 . Residents of West Pokot [aPOR 0.3, 95% CI; 0.17, 0.44] were less likely to use modern contraceptives as compared to Bungoma county, this is in line with a study by Kenya health survey 21 that reports that the percentage of currently married women using a modern method which is lowest in almost all counties of Northern part of Kenya; Mandera (2%), followed by Wajir (3%), Marsabit (6%), and Garissa (11%). It was discovered from this study that the lower the level of the facility types, the less the MCM consumption, with dispensaries at 37.8% (95% CI; 32.9,43.1), and health centers at 42.7% (95% CI; 35.9,49.9) as compared to hospitals (46.5%) (95% CI; 36.2,57.2). The health system in a woman's environment may affect her choice to use contraception depending on factors like the availability of methods, accessibility to facilities and the level of care 31 , 32 . Contraceptive prevalence was also low at 37.5% (95% CI; 32.8,42.5) among women who visited facilities with episodes of contraceptive stock outs, unlike those who visited facilities which did not experience stock outs. This is in line with 18 who reported that insufficient stocks and restricted usage of available methods create conditions that ultimately restrict their use. Additional research done in Kenya indicates that providing high-quality FP services can raise user satisfaction which will encourage clients to use the service repeatedly and consistently whenever they need a method 13 . In addition, this study found that the uptake of FP services was lower in facilities covered by NHIF (aPOR 0.5,95%CI; 0.29,0.98, p=0. 043) than in those not covered. This is corroborated by research conducted in Laos 16 which found that equitable advances in the modern contraceptive prevalence rate (mCPR) across demographic groups cannot be guaranteed by the formal inclusion of family planning services in health insurance benefits packages. It has been reported that insurance plans payment structures for repaying providers for family planning services can either promote or discourage the provision of specific methods. This is consistent with a recent study in a Kenya 33 that indicates that despite the widespread belief that health care financing and spending lead to improvements in health status and the inclusion of family planning services, its data is scant and conflicting, especially for low and middle-income countries (LMICs) like Kenya. Contraceptive prevalence is also higher among adolescents aged 15 to 19 years who were offered and prescribed FP services compared to those who were not offered any FP services. A previous study 5 in Uganda states that the lack of youth-appropriate facilities limits young people's access to counseling and knowledge about contraception. Another study 7 in Benin also demonstrates that unmarried young women are hesitant to obtain contraception despite their desire to avoid pregnancy since their communities perceive them as unsuitable for sexual activity. These can be addressed by providing a wide selection of modern contraceptive methods, whether through health institutions or community-based distributors, as well as client-centered thorough counseling to enable people to make informed and voluntary decisions about FP usage. Similarly, a steady availability of cheap contraceptive methods correlates to increasing and consistent use of modern contraception among this age group 34 by a study done in Kinshasa – Uganda. Strengths and limitations The randomized and representative sample created by the sampling methods was a major strength in this study. The researchers made certain that the data collection methods were well-structured and that all relevant study criteria were considered. The PMA survey only gathered quantitative data, as a result, some of the crucial details found in the qualitative aspects of the data which could give meaning to the quantitative data are missing. Second, survey design flaws like social desirability bias and recollection bias may be present when data was being gathered. Generalizability of the results may be limited. Conclusions and recommendation Our study shows that participants with higher levels of formal education were more willing to embrace MCM adoption than those with low education attainment. The result also indicates a relatively low overall contraceptive prevalence of 43.2%. Results also show that there was a period of commodity stock out, indicating that women are missing out on their preferred FP options. County school health coordinators should ensure integration of sexual reproductive health sessions in the school curriculum. The county reproductive health coordinators and health promotion officers should advocate on modern contraceptive methods to increase services access to comprehensive education on FP service availability and MCM service alongside client centred contraceptive counselling to support a patient’s reproductive autonomy. County health products and technologies coordinators should ensure timely quantification and forecasting and availability of all family planning commodities in all health facilities. What is known about this topic Contraceptive awareness in Kenya is high, but the uptake is still low, therefore the unmet needs still exist. Family planning is very crucial in terms of decreasing maternal mortality, reducing poverty and environmental degradation. Contraceptive method choices availability and accessibility promotes uptake of contraceptives. Data availability To access PMA data used in the analysis of the manuscript, the procedure is as follows. 1. Login into www.pmadata.org 2. Choose a country as Kenya 3. Request for dataset and create account 4. Choose the thematic area which is family planning. 5. Choose household/female dataset and 2019 as the year and purpose of the data 6. Submit the request. 7. The admin will send a package of the data, tools and data use guide. Authors’ contributions Jane Nyakundi: Conceptualization, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Shadrack Yonge: Supervision, Validation, Writing – Review & Editing Samuel Kiiru: Data Curation, Formal Analysis, Methodology, Writing – Review & Editing Peter Gichangi: Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Acknowledgements The authors wish to acknowledge the research assistants and the 11 counties that participated in this study. Faculty Opinions recommended References 1. Hubacher D, Trussell J: A definition of modern contraceptive methods. Contraception. 2015; 92 (5): 420–421. PubMed Abstract | Publisher Full Text 2. Akoth C, Oguta JO, Gatimu SM: Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study. BMC Public Health. 2021; 21 (1): 1316. PubMed Abstract | Publisher Full Text | Free Full Text 3. 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PubMed Abstract | Publisher Full Text | Free Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 24 Apr 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Environmental and Health Sciences, Technical University of Mombasa, Mombasa, Mombasa County, Kenya 2 Ministry of Health, Kilifi County Government, Kilifi, Kilifi, Kenya 3 Research, Monitoring and Evaluation, International Centre for Reproductive Health Kenya, Mombasa, Mombasa County, Kenya 4 Technical University of Mombasa, Mombasa, Mombasa County, Kenya 5 Department of Primary Health Care, Ghent University, Ghent, Flanders, Belgium Jane Bitutu Nyakundi Roles: Conceptualization, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Shadrack Yonge Roles: Supervision, Validation, Writing – Review & Editing Samuel Kiiru Roles: Data Curation, Formal Analysis, Methodology, Writing – Review & Editing Peter Gichangi Roles: Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This work was supported by the Gates Foundation [OPP1198333]. The funders had no role in the study design, collection, analysis, and interpretation of data, in writing of the report, or in the decision to submit for publication. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 19 Aug 2024, 8:32 https://doi.org/10.12688/gatesopenres.15283.2 version 1 Published: 24 Apr 2024, 8:32 https://doi.org/10.12688/gatesopenres.15283.1 Copyright © 2024 Nyakundi JB et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads Gates Open Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Nyakundi JB, Yonge S, Kiiru S and Gichangi P. Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.12688/gatesopenres.15283.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 19 Aug 2024 Revised Views 0 Cite How to cite this report: Bandoh DA. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38935 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38935 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 08 Feb 2025 Delia Akosua Bandoh , University of Ghana, Accra, Ghana Approved with Reservations VIEWS 0 https://doi.org/10.21956/gatesopenres.17669.r38935 The authors summarize factors influencing modern contraceptive uptake in Kenya using secondary data. Below are a few comments for consideration In the last paragraph of the introduction, the authors make very definitive statements that need ... Continue reading READ ALL The authors summarize factors influencing modern contraceptive uptake in Kenya using secondary data. Below are a few comments for consideration In the last paragraph of the introduction, the authors make very definitive statements that need to be modified to reflect the type of study and its methods. Eg. “this study will examine the factors influencing the uptake of modern contraception among Kenyan women of reproductive age and fill this gap” a cross-sectional study would not provide full solutions to end this problem. It can only contribute to the solution. “Finally, we shall come up with solid recommendations on how to improve contraceptive uptake and usage with the ultimate goal of accelerating the country's growth and development.” What do authors define as solid recommendations? How can a cross-sectional study using secondary data help you come up with this? Authors should note that the language for writing proposals or grants is not used when writing scientific papers. What new information does this current paper add to already existing literature? Authors should highlight that clearly in the paper because a lot of work has been done on modern contraceptives Under strengths of the paper - This was work done with secondary data. What exactly does this statement mean when data was not collected by the authors? “The researchers made certain that the data collection methods were well-structured and that all relevant study criteria were considered.” Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Epidemiology, Nutrition, Maternal and child health, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Bandoh DA. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38935 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38935 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Cleland J. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38941 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38941 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 20 Dec 2024 John Cleland , London School of Hygiene & Tropical Medicine, London, UK Not Approved VIEWS 0 https://doi.org/10.21956/gatesopenres.17669.r38941 1. In the methods section, please describe exactly how the health system variables were linked to the women’s file, particularly when the survey cluster was in the catchment area of more than one type of FP facility. ... Continue reading READ ALL 1. In the methods section, please describe exactly how the health system variables were linked to the women’s file, particularly when the survey cluster was in the catchment area of more than one type of FP facility. 2. In table 1 the Ns for “visited a facility and discussed FP” sum to 5947 which suggest that there are missing values for 3536 women. Please explain and amend. 3. I think that the variable “facility types where FP was obtained” refers to the source where current users first obtained their method. The Ns for this variable sum to 4002 which is close to the number of current users. It makes no sense to use this variable as a predictor of current use and it should be removed. 4. Only 1.6% of women were not aware of modern contraceptives and the paper would be strengthened if this variable was removed. 5. The variable “facilities offering FP services to adolescents” is difficult to understand and needs reconsideration. What is the difference between counselled/provided and counselled/provided/prescribed ? Can services really be provided without any counselling? I think that it might be more sensible to represent this variable as a simple dichotomy “services provided versus not provided” though only 8.9% of facilities fall into the not provided category. I further note that the results in table 2 make no sense. They show that contraceptive use is much higher in the very small number of clusters served by a facility that apparently provides FP services without counselling than in clusters with a facility that provides and counsels. Finally, I suggest that it might be preferable to perform a sub-analysis restricting the sample to sexually active single adolescents, because it is unclear why adolescent services should influence the FP uptake among older married women. 6. You include in your analytic sample divorced, widowed and never married women without taking into account whether or not they are sexually active. The low levels of FP use that you report among the unmarried groups reflects no need for FP because of sexual inactivity. As you note in the first paragraph of the Discussion, the most recent Kenya DHS shows that FP use is higher among sexually active unmarried women than among married women. I strongly recommend that you re-do the whole analysis after excluding unmarried women who report no sex in the prior1, 3 or perhaps 6 months. 7. You will need to re-visit the Discussion after any changes that you make in the statistical analysis. On several occasions you mention differences that were not statistically significant even in the bivariate analysis. This temptation should be avoided. I also noticed that the first sentence of the last paragraph in the Discussion is not supported by your analysis. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Cleland J. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38941 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38941 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Saleem S. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38430 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38430 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 02 Dec 2024 Sarah Saleem , Population and Reproductive Health Section of CHS, AKU, The Aga Khan University, Karachi, Sindh, Pakistan Not Approved VIEWS 0 https://doi.org/10.21956/gatesopenres.17669.r38430 Abstract: Please remove extra words The prevalence of modern contraceptives uptake was 43.2% uptake was 43.2% among all WRA. write P value as p value. Please double check p value here (aPOR 4.0 95% CI; 1.05,15.41, p=0.42 ). Overall Introduction ... Continue reading READ ALL Abstract: Please remove extra words The prevalence of modern contraceptives uptake was 43.2% uptake was 43.2% among all WRA. write P value as p value. Please double check p value here (aPOR 4.0 95% CI; 1.05,15.41, p=0.42 ). Overall Introduction section needs better writeup, suggest to consult a language expert. Introduction section: last 3 lines of first paragraph --"For example, in Benin, adolescence is seen as the start of the continuity of medical care for reproductive newborn, maternal, and pediatric health. During this time poor access to and utilization of contraception are likely to have a negative impact on health outcomes overall 7 ." is confusing and needs clarity what authors are trying to convey. Please be consistent in using number of digits before and after a decimal point be these aPOR of of p values. Interpretation of aPOR should be given appropriately in the language understandable to common people and to the policy makers. aOPR less than 1 are interpreted wrongly, which is a serious mistake and needs corrections. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: maternal and newborn health, family planning, I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Saleem S. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38430 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38430 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Winch PJ. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38427 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38427 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Nov 2024 Peter J Winch , Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA Approved with Reservations VIEWS 0 https://doi.org/10.21956/gatesopenres.17669.r38427 1. The article starts out with various statements to the effect that a low proportion of women are on modern contraceptive methods. However, the levels are very high compared to West Africa and Central Africa. Therefore, such statements should be ... Continue reading READ ALL 1. The article starts out with various statements to the effect that a low proportion of women are on modern contraceptive methods. However, the levels are very high compared to West Africa and Central Africa. Therefore, such statements should be qualified. It might be better to make a statement such as: - Kenya has a moderate level of women on MCM, higher than most countries in West and Central Africa, but lower than some countries in southern Africa. 2. Rather than "Low uptake for MCM is influenced by sociodemographic factors and Health system factors" in the Conclusion of the Abstract, I might write "Kenya has moderate and highly variable uptake of MCM, with uptake is influenced by sociodemographic and health system factors". 3. "low and middle income countries" =" should be written as "low- and middle-income countries" 4. " The majority of underdeveloped countries including Kenya, however, utilize few contraceptive methods hence they have a lot of unmet needs11." => As stated above, Kenya has a moderate level of MCM uptake => "Underdeveloped" is avoided in current scholarly writing. Better to say "low- and middle-income countries". If Kenya is being compared to other lower-middle income countries in the Discussion, then that term might be introduced at this point. 5. Unexplained comma here: "using the most up-to-date Performance, monitoring for Action (PMA) survey data" => Rewrite as "using the most up-to-date Performance Monitoring for Action (PMA) survey data" 6. "The study was carried out in 11 of the 47 counties Nairobi, Kiambu, Kericho, Kitui, Kilifi, Bungoma, Siaya, Nyamira Nandi, Kakamega, and West Pokot." No comment is made on the distribution of these counties within Kenya. Does this set of 11 counties include representation from all the geographic regions of Kenya? 7. Related to #6, there is no explanation or discussion of the pattern of MCM uptake by county - "County wise, the odds of contraceptive use were less likely, in Kericho (prevalence 42.8) (aPOR 0.6, 95% CI; 0.45, 0.89, p=0.008), Kilifi (prevalence 35.2) (aPOR 0.6, 95% CI; 0.38, 0.78, p=0.001), Kitui (prevalence 41.3) (aPOR 0.7, 95% CI; 0.51, 0.98, p=0.039), Siaya (prevalence 41.2) (aPOR 0.6, 95% CI; 0.4, 0.76, p=0.000) and West Pokot (prevalence 19.3) (aPOR 0.3, 95% CI; 0.17, 0.44, p=0.000) as compared to Bungoma (prevalence 50.5)." => Is there a pattern (geographic, ethnic, administrative, health systems etc.) that would explain why some counties have lower MCM uptake? => The authors should assume that the reader has limited understanding of the location of counties within Kenya. The authors should help the reader interpret these data. => This finally comes out in the Discussion a little bit "Residents of West Pokot [aPOR 0.3, 95% CI; 0.17, 0.44] were less likely to use modern contraceptives as compared to Bungoma county, this is in line with a study by Kenya health survey21 that reports that the percentage of currently married women using a modern method which is lowest in almost all counties of Northern part of Kenya; Mandera (2%), followed by Wajir (3%), Marsabit (6%), and Garissa (11%)." Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Health behavior change, qualitative research, reproductive health, environmental health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Winch PJ. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38427 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38427 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Brittain A. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r37768 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-37768 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Aug 2024 Anna Brittain , Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia Approved with Reservations VIEWS 0 https://doi.org/10.21956/gatesopenres.17669.r37768 I have no further comments to make beyond ... Continue reading READ ALL I have no further comments to make beyond what was submitted in my first review. Thank you. Competing Interests: No competing interests were disclosed. Reviewer Expertise: adolescent sexual and reproductive health and adolescent sexual and reproductive health services (quality and access) I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Brittain A. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r37768 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-37768 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 24 Apr 2024 Views 0 Cite How to cite this report: Brittain A. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.16631.r37016 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v1#referee-response-37016 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Jul 2024 Anna Brittain , Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia Approved with Reservations VIEWS 0 https://doi.org/10.21956/gatesopenres.16631.r37016 This article addresses assessing factors associated with contraceptive uptake among women of reproductive age 15 to 49 years in Kenya and adds to the field by providing up-to-date information on use of modern contraceptive method use in multiple counties in Kenya ... Continue reading READ ALL This article addresses assessing factors associated with contraceptive uptake among women of reproductive age 15 to 49 years in Kenya and adds to the field by providing up-to-date information on use of modern contraceptive method use in multiple counties in Kenya as well as useful suggestions to inform increasing access to MCM based on the updated data and study findings. To improve this manuscript for indexed, the following items should be addressed: Abstract: Authors should edit this: Performance, monitoring for Action (PMA). Should there be a comma after Performance? And capitalize “monitoring” since it is part of the acronym. Suggest editing “The prevalence of modern contraceptives uptake was 43.2% among all WRA, which was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55)” suggest change to two sentences. “The prevalence of modern contraceptives uptake was 43.2% among all WRA. Prevalence was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55).” For this statement, “Adolescent FP service provision and prescription was significant (aPOR 4.0 95% CI; 1.05,15.41, p=0.42).” Was significant how? When compared to what group? Adult FP service provision and prescription? Main article: First sentence: Add “A” to the beginning of the sentence. Add citation for: “Of the 1.11 billion women of reproductive age who needed family planning services in 2019 only 842 million got them, leaving 270 million women around the world with unmet demands. Instead of “developing countries” consider using “low- and middle-income countries.” The citation used for this sentence is not a suitable citation as the article cited does not speak to “developing countries” as a whole, but rather just one area in one country. Either revise the sentence or use a correct citation that represents the global need. In discussion on Benin in the introduction, suggest using something like, “for example” as this is just one country and authors in the introduction are speaking globally. Also, the meaning of this sentence is unclear. Suggest reviewing the cited article and revising to make more clear, “Adolescence is seen in the country of Benin as the start of the continuity of medical care for reproductive newborn, maternal, and pediatric health.” Consider dropping, “the availability of” from this sentence: “Modern contraceptives are so effective that they reduce the availability of maternal death by more than 20% and newborn mortality by 17%.” Suggest citing the actual 2017 World Family Planning Highlights document in this sentence, rather than an article on Ethiopia. “According to the UN’s 2017 World Family Planning highlight levels of unmet family planning need greater than 20% are considered high, and those less than 10% are deemed low.” Suggest, if the citations show this, that the sentence, “Around the world, 38% of contraceptive users stopped using them after the first year,” be changed to, “Studies have shown that, in some countries in Africa, 38% of contraceptive users stopped using them after the first year.” Suggest hyphen between “this” and “31%” in this sentence, “Kenya is not exempt from this 31% of users of contraceptives discontinued use within a year of beginning use.” Suggest make this one sentence, “This indicates that some people who have unmet family planning needs have previously used contraception. Even though Kenya has made a sizable effort in raising knowledge about the methods and encouraging the use of contraceptives.” Rather than “a spike in discontinuations,” authors have described a high level of discontinuations, so suggest rephrasing sentence to the following and also adding “and” where it has been added in bold: “In addition, insufficient stocks and restricted usage of available methods create conditions that ultimately restrict women’s choices and use and are likely contributing factors to the prevalence of contraceptive discontinuations.” Recommend authors have an editor review the paper for grammatical and punctuation, as there are several errors in the remainder of the text, which I will not point out from here further. Spell out on first mention on p. 4- enumeration area (EA) Check acronyms throughout the paper. Once an acronym is given, no need to spell out when used afterwards. It would be helpful for readers if the authors described how cost may affect use of MCM. The healthcare financing paragraph on p. 3 is helpful, but it is unclear what individuals must do to get MCM in terms of payment. What are the out of pocket costs for individuals seeking MCM? Are contraceptives available at no cost to patients in some locations? All locations? Do NHIF facilities provide MCM at no cost whereas other locations charge a cost? Are there instances where individuals must pay for MCM to acquire them and if so, what are those instances? Study variables: It would be helpful to clarify the definitions of counseled, prescribed, provided. For instance, is it possible to “provide” a method without also prescribing it? Does “prescribed” mean that a prescription was written but the individual would have to then go elsewhere to get the method? This is helpful to know as it would require that additional step for the woman and that could be another barrier. Also, please use a semicolon between the different answer choices in this phrase, “FP services available to adolescent aged 15 to 19 years (Never offered, counseled, counseled and prescribed, counseled and provided, counseled, provided and prescribed, prescribed, provided or prescribed and prescribed).” Was sexual activity assessed and were questions only asked of those sexually active? Thinking not, since this is not described. Could it be, then, that contraceptive use is lower among adolescents because some are not yet sexually active? This should be part of the discussion. Data management and analysis: For the sentence, “The analysis aimed at showing how certain socio-demographic and Health system variables influenced contraceptive use among women in Kenya,” since this was a cross sectional study, causal effect cannot be known so suggest the sentence is revised to something like this: “The analysis aimed at showing how certain socio-demographic and Health system variables are associated with contraceptive use among women in Kenya.” Results: Suggest adding what is in bold for clarity: “The odds of modern contraceptive use were higher among young women aged 20–24 years (aPOR 2.4, 95% CI; 1.87, 3.15, p=0.000), middle-aged women aged 25-29 (aPOR 1.8, 95% CI; 1.37, 2.47, p=0.000) and aged 30-34 (aPOR 1.5, 95% CI; 1.13, 1.99, P=0.0050) as compared to adolescents.” Add the prevalence amounts for each group in this sentence, “The odds of modern contraceptive use were (aPOR 0.7, 95% CI; 0.53, 0.96, P= 0.0250 ) less among divorcee, (aPOR 0.4, 95% CI; 0.26, 0.63, P=0.000) less among the widow and (aPOR 0.5, 95% CI; 0.39, 0.56, p=0.000) less among the non-married women compared to the married women respectively.” Add word in bold here, “Rural women were 80% less likely to modern contraceptive use as compared to the urban women (aPOR 0.8, 95% CI; 0.63, 0.98, p= 0.0330).” Add the prevalence amounts for each group in this sentence, “Among those who had children, the odds of modern contraceptive use were three and four folds higher among those with two to three and more than four children respectively as compared to those with less than two children (aPOR 2.5, 95% CI; 2.05, 3.0, p=0.000) and (aPOR 3.6, 95% CI; 2.74, 4.62, p=0.000) respectively.” Discussion: Suggest removing “only” from the following sentence and replacing “influencing” with something like “associated with” or “correlated with.” “The survey only gathered quantitative data to examine the factors influencing the uptake of modern contraception among Kenyan women of reproductive age.” Suggest a different phrasing in this sentence, “This is consistent with another prior studies in Kira-Uganda6 which reported that adolescent girls use MCM poorly.” Perhaps something like, “This is consistent with another prior studies in Kira-Uganda6 which reported more limited MCM use among adolescent girls when compared to older age groups.” Review the study cited in this sentence, “This suggests that married women have a greater desire to space or limit pregnancies24 by study done in Uganda.” According to the study abstract, “married women in Uganda are less likely to use modern contraceptives as compared to other marital categories” which is different than your study findings. Suggest discussing what the reasons might be for married women in your study having higher prevalence of contraceptive use than unmarried women and then comparing to similar studies. Could it be that they have more desire for spacing and limiting? Could it be that their husbands are more permissive of MCM use than those with partners outside of marriage? Suggest breaking this sentence up into multiple sentences and citing studies that offer similar explanations as the ones you pose. “Two previous studies24,25 in Uganda and Ghana reported that the use of contraceptives is significantly influenced by education this suggests that persons with higher levels of education were definitely more conscious of the advantages and significance of using contraceptives, they are also more informed which enhances access to services and offers them greater negotiating power when making decisions about using contraceptives.” In addition to the reason offered, authors could explore alternative reasons for the associations with parity in this paragraph. For instance, could it be that women with more children desire MCM more than women with less children? Could there be other explanations? Explore the literature to see what other reasons may be offered in addition to the explanation offered here. “The consumption of contraceptives was also linked to a woman’s parity, according to our study, women who had two to three children used MCM at a rate of about 59.9%, compared to only 25.3% among women who have less than one child. This could mean that women of low parity are under pressure to have more children as reported by study6,28 from two countries Uganda and India. Another research study which was done in India reported that women with no child once married are forced to prove their fertility due to pressures from spouses, in laws and communities28.” Suggest a different phrasing for these types of sentences, “Economically needy communities may be less likely to invest in women’s education, resulting in low understanding of contraceptive use, low autonomy24 by a study in Uganda.” Consider something like, “Economically needy communities may be less likely to invest in women’s education, resulting in a lower level of understanding of contraceptive use, and less autonomy24 as was seen in a recent study in Uganda.” What does “the lower the level” mean in this phrase, “the lower the level of the facility types”? I do not believe that phrasing was used in the study variable descriptions. Perhaps this refers to the level of care provided at the facility? Were the differences between facility types and those who experienced stock outs versus those that did not statistically significant? If not, suggest not discussing the differences in the discussion narrative or at least making reference to the fact that the differences were not statistically different. Suggest naming the study in words, rather than just with the citation number in this sentence, “This is in line with 34 who reported that insufficient stocks and restricted usage of available methods create conditions that ultimately restrict their use.” Maybe, “This is in line with a 2015 study by Hubacher and Trussell that reported…” or something like that. This sentence seems to contradict the paragraph on healthcare financing on p. 3 in the introduction. “This is consistent with a recent study in a Kenya35 that indicates that despite the widespread belief that health care financing and spending lead to improvements in health status and the inclusion of family planning services, its data is scant and conflicting, especially for low and middle-income countries (LMICs) like Kenya.” Authors need to address this. Discussion starting on p. 10 regarding those providing and prescribing MCM should address that the odds of those who were counseled, offered provision and prescription of FP services were not statistically different in use of MCM than those who were not offered any FP services. The authors state, “A previous study6 in Uganda states that the lack of youth-appropriate facilities limits young people’s access to counseling and knowledge about contraception,” but this study’s findings show no difference among those that “counseled, provided, prescribed” than those that “do not offer.” Discussions on limitations could include that while this study does offer value in providing estimates of contraceptive uptake and factors associated with uptake, the indicators did not assess patient’s desire for contraception or desire to avoid or achieve a pregnancy so the study is limited in its ability to assess unmet need. In line with reproductive autonomy and client-centeredness, suggest authors not talk about increasing services uptake and utilization but rather discuss increasing access to comprehensive education on FP services available and MCM and access to these services alongside client-centered contraceptive counseling to support a patient’s reproductive autonomy. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: adolescent sexual and reproductive health and adolescent sexual and reproductive health services (quality and access) I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Brittain A. Reviewer Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.16631.r37016 ) The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v1#referee-response-37016 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 24 Apr 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 5 Version 2 (revision) 19 Aug 24 read read read read read Version 1 24 Apr 24 read Anna Brittain , Centers for Disease Control and Prevention, Atlanta, Georgia Peter J Winch , Johns Hopkins University, Baltimore, USA Sarah Saleem , The Aga Khan University, Karachi, Pakistan John Cleland , London School of Hygiene & Tropical Medicine, London, UK Delia Akosua Bandoh , University of Ghana, Accra, Ghana Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Bandoh D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 08 Feb 2025 | for Version 2 Delia Akosua Bandoh , University of Ghana, Accra, Ghana 0 Views copyright © 2025 Bandoh D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors summarize factors influencing modern contraceptive uptake in Kenya using secondary data. Below are a few comments for consideration In the last paragraph of the introduction, the authors make very definitive statements that need to be modified to reflect the type of study and its methods. Eg. “this study will examine the factors influencing the uptake of modern contraception among Kenyan women of reproductive age and fill this gap” a cross-sectional study would not provide full solutions to end this problem. It can only contribute to the solution. “Finally, we shall come up with solid recommendations on how to improve contraceptive uptake and usage with the ultimate goal of accelerating the country's growth and development.” What do authors define as solid recommendations? How can a cross-sectional study using secondary data help you come up with this? Authors should note that the language for writing proposals or grants is not used when writing scientific papers. What new information does this current paper add to already existing literature? Authors should highlight that clearly in the paper because a lot of work has been done on modern contraceptives Under strengths of the paper - This was work done with secondary data. What exactly does this statement mean when data was not collected by the authors? “The researchers made certain that the data collection methods were well-structured and that all relevant study criteria were considered.” Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Epidemiology, Nutrition, Maternal and child health, I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Bandoh DA. Peer Review Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38935) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38935 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Cleland J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 20 Dec 2024 | for Version 2 John Cleland , London School of Hygiene & Tropical Medicine, London, UK 0 Views copyright © 2024 Cleland J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. In the methods section, please describe exactly how the health system variables were linked to the women’s file, particularly when the survey cluster was in the catchment area of more than one type of FP facility. 2. In table 1 the Ns for “visited a facility and discussed FP” sum to 5947 which suggest that there are missing values for 3536 women. Please explain and amend. 3. I think that the variable “facility types where FP was obtained” refers to the source where current users first obtained their method. The Ns for this variable sum to 4002 which is close to the number of current users. It makes no sense to use this variable as a predictor of current use and it should be removed. 4. Only 1.6% of women were not aware of modern contraceptives and the paper would be strengthened if this variable was removed. 5. The variable “facilities offering FP services to adolescents” is difficult to understand and needs reconsideration. What is the difference between counselled/provided and counselled/provided/prescribed ? Can services really be provided without any counselling? I think that it might be more sensible to represent this variable as a simple dichotomy “services provided versus not provided” though only 8.9% of facilities fall into the not provided category. I further note that the results in table 2 make no sense. They show that contraceptive use is much higher in the very small number of clusters served by a facility that apparently provides FP services without counselling than in clusters with a facility that provides and counsels. Finally, I suggest that it might be preferable to perform a sub-analysis restricting the sample to sexually active single adolescents, because it is unclear why adolescent services should influence the FP uptake among older married women. 6. You include in your analytic sample divorced, widowed and never married women without taking into account whether or not they are sexually active. The low levels of FP use that you report among the unmarried groups reflects no need for FP because of sexual inactivity. As you note in the first paragraph of the Discussion, the most recent Kenya DHS shows that FP use is higher among sexually active unmarried women than among married women. I strongly recommend that you re-do the whole analysis after excluding unmarried women who report no sex in the prior1, 3 or perhaps 6 months. 7. You will need to re-visit the Discussion after any changes that you make in the statistical analysis. On several occasions you mention differences that were not statistically significant even in the bivariate analysis. This temptation should be avoided. I also noticed that the first sentence of the last paragraph in the Discussion is not supported by your analysis. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? No Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Not applicable Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Cleland J. Peer Review Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38941) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38941 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Saleem S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 02 Dec 2024 | for Version 2 Sarah Saleem , Population and Reproductive Health Section of CHS, AKU, The Aga Khan University, Karachi, Sindh, Pakistan 0 Views copyright © 2024 Saleem S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Abstract: Please remove extra words The prevalence of modern contraceptives uptake was 43.2% uptake was 43.2% among all WRA. write P value as p value. Please double check p value here (aPOR 4.0 95% CI; 1.05,15.41, p=0.42 ). Overall Introduction section needs better writeup, suggest to consult a language expert. Introduction section: last 3 lines of first paragraph --"For example, in Benin, adolescence is seen as the start of the continuity of medical care for reproductive newborn, maternal, and pediatric health. During this time poor access to and utilization of contraception are likely to have a negative impact on health outcomes overall 7 ." is confusing and needs clarity what authors are trying to convey. Please be consistent in using number of digits before and after a decimal point be these aPOR of of p values. Interpretation of aPOR should be given appropriately in the language understandable to common people and to the policy makers. aOPR less than 1 are interpreted wrongly, which is a serious mistake and needs corrections. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? No Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise maternal and newborn health, family planning, I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Saleem S. Peer Review Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38430) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38430 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Winch P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Nov 2024 | for Version 2 Peter J Winch , Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA 0 Views copyright © 2024 Winch P. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions 1. The article starts out with various statements to the effect that a low proportion of women are on modern contraceptive methods. However, the levels are very high compared to West Africa and Central Africa. Therefore, such statements should be qualified. It might be better to make a statement such as: - Kenya has a moderate level of women on MCM, higher than most countries in West and Central Africa, but lower than some countries in southern Africa. 2. Rather than "Low uptake for MCM is influenced by sociodemographic factors and Health system factors" in the Conclusion of the Abstract, I might write "Kenya has moderate and highly variable uptake of MCM, with uptake is influenced by sociodemographic and health system factors". 3. "low and middle income countries" =" should be written as "low- and middle-income countries" 4. " The majority of underdeveloped countries including Kenya, however, utilize few contraceptive methods hence they have a lot of unmet needs11." => As stated above, Kenya has a moderate level of MCM uptake => "Underdeveloped" is avoided in current scholarly writing. Better to say "low- and middle-income countries". If Kenya is being compared to other lower-middle income countries in the Discussion, then that term might be introduced at this point. 5. Unexplained comma here: "using the most up-to-date Performance, monitoring for Action (PMA) survey data" => Rewrite as "using the most up-to-date Performance Monitoring for Action (PMA) survey data" 6. "The study was carried out in 11 of the 47 counties Nairobi, Kiambu, Kericho, Kitui, Kilifi, Bungoma, Siaya, Nyamira Nandi, Kakamega, and West Pokot." No comment is made on the distribution of these counties within Kenya. Does this set of 11 counties include representation from all the geographic regions of Kenya? 7. Related to #6, there is no explanation or discussion of the pattern of MCM uptake by county - "County wise, the odds of contraceptive use were less likely, in Kericho (prevalence 42.8) (aPOR 0.6, 95% CI; 0.45, 0.89, p=0.008), Kilifi (prevalence 35.2) (aPOR 0.6, 95% CI; 0.38, 0.78, p=0.001), Kitui (prevalence 41.3) (aPOR 0.7, 95% CI; 0.51, 0.98, p=0.039), Siaya (prevalence 41.2) (aPOR 0.6, 95% CI; 0.4, 0.76, p=0.000) and West Pokot (prevalence 19.3) (aPOR 0.3, 95% CI; 0.17, 0.44, p=0.000) as compared to Bungoma (prevalence 50.5)." => Is there a pattern (geographic, ethnic, administrative, health systems etc.) that would explain why some counties have lower MCM uptake? => The authors should assume that the reader has limited understanding of the location of counties within Kenya. The authors should help the reader interpret these data. => This finally comes out in the Discussion a little bit "Residents of West Pokot [aPOR 0.3, 95% CI; 0.17, 0.44] were less likely to use modern contraceptives as compared to Bungoma county, this is in line with a study by Kenya health survey21 that reports that the percentage of currently married women using a modern method which is lowest in almost all counties of Northern part of Kenya; Mandera (2%), followed by Wajir (3%), Marsabit (6%), and Garissa (11%)." Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Health behavior change, qualitative research, reproductive health, environmental health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Winch PJ. Peer Review Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r38427) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-38427 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Brittain A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Aug 2024 | for Version 2 Anna Brittain , Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 0 Views copyright © 2024 Brittain A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I have no further comments to make beyond what was submitted in my first review. Thank you. Competing Interests No competing interests were disclosed. Reviewer Expertise adolescent sexual and reproductive health and adolescent sexual and reproductive health services (quality and access) I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Brittain A. Peer Review Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.17669.r37768) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v2#referee-response-37768 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Brittain A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Jul 2024 | for Version 1 Anna Brittain , Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 0 Views copyright © 2024 Brittain A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This article addresses assessing factors associated with contraceptive uptake among women of reproductive age 15 to 49 years in Kenya and adds to the field by providing up-to-date information on use of modern contraceptive method use in multiple counties in Kenya as well as useful suggestions to inform increasing access to MCM based on the updated data and study findings. To improve this manuscript for indexed, the following items should be addressed: Abstract: Authors should edit this: Performance, monitoring for Action (PMA). Should there be a comma after Performance? And capitalize “monitoring” since it is part of the acronym. Suggest editing “The prevalence of modern contraceptives uptake was 43.2% among all WRA, which was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55)” suggest change to two sentences. “The prevalence of modern contraceptives uptake was 43.2% among all WRA. Prevalence was lower among rural dwellers 41.4% (95% CI 39.62, 43.17) as compared to urban dwellers 47.5 (95% CI 44.39,50.55).” For this statement, “Adolescent FP service provision and prescription was significant (aPOR 4.0 95% CI; 1.05,15.41, p=0.42).” Was significant how? When compared to what group? Adult FP service provision and prescription? Main article: First sentence: Add “A” to the beginning of the sentence. Add citation for: “Of the 1.11 billion women of reproductive age who needed family planning services in 2019 only 842 million got them, leaving 270 million women around the world with unmet demands. Instead of “developing countries” consider using “low- and middle-income countries.” The citation used for this sentence is not a suitable citation as the article cited does not speak to “developing countries” as a whole, but rather just one area in one country. Either revise the sentence or use a correct citation that represents the global need. In discussion on Benin in the introduction, suggest using something like, “for example” as this is just one country and authors in the introduction are speaking globally. Also, the meaning of this sentence is unclear. Suggest reviewing the cited article and revising to make more clear, “Adolescence is seen in the country of Benin as the start of the continuity of medical care for reproductive newborn, maternal, and pediatric health.” Consider dropping, “the availability of” from this sentence: “Modern contraceptives are so effective that they reduce the availability of maternal death by more than 20% and newborn mortality by 17%.” Suggest citing the actual 2017 World Family Planning Highlights document in this sentence, rather than an article on Ethiopia. “According to the UN’s 2017 World Family Planning highlight levels of unmet family planning need greater than 20% are considered high, and those less than 10% are deemed low.” Suggest, if the citations show this, that the sentence, “Around the world, 38% of contraceptive users stopped using them after the first year,” be changed to, “Studies have shown that, in some countries in Africa, 38% of contraceptive users stopped using them after the first year.” Suggest hyphen between “this” and “31%” in this sentence, “Kenya is not exempt from this 31% of users of contraceptives discontinued use within a year of beginning use.” Suggest make this one sentence, “This indicates that some people who have unmet family planning needs have previously used contraception. Even though Kenya has made a sizable effort in raising knowledge about the methods and encouraging the use of contraceptives.” Rather than “a spike in discontinuations,” authors have described a high level of discontinuations, so suggest rephrasing sentence to the following and also adding “and” where it has been added in bold: “In addition, insufficient stocks and restricted usage of available methods create conditions that ultimately restrict women’s choices and use and are likely contributing factors to the prevalence of contraceptive discontinuations.” Recommend authors have an editor review the paper for grammatical and punctuation, as there are several errors in the remainder of the text, which I will not point out from here further. Spell out on first mention on p. 4- enumeration area (EA) Check acronyms throughout the paper. Once an acronym is given, no need to spell out when used afterwards. It would be helpful for readers if the authors described how cost may affect use of MCM. The healthcare financing paragraph on p. 3 is helpful, but it is unclear what individuals must do to get MCM in terms of payment. What are the out of pocket costs for individuals seeking MCM? Are contraceptives available at no cost to patients in some locations? All locations? Do NHIF facilities provide MCM at no cost whereas other locations charge a cost? Are there instances where individuals must pay for MCM to acquire them and if so, what are those instances? Study variables: It would be helpful to clarify the definitions of counseled, prescribed, provided. For instance, is it possible to “provide” a method without also prescribing it? Does “prescribed” mean that a prescription was written but the individual would have to then go elsewhere to get the method? This is helpful to know as it would require that additional step for the woman and that could be another barrier. Also, please use a semicolon between the different answer choices in this phrase, “FP services available to adolescent aged 15 to 19 years (Never offered, counseled, counseled and prescribed, counseled and provided, counseled, provided and prescribed, prescribed, provided or prescribed and prescribed).” Was sexual activity assessed and were questions only asked of those sexually active? Thinking not, since this is not described. Could it be, then, that contraceptive use is lower among adolescents because some are not yet sexually active? This should be part of the discussion. Data management and analysis: For the sentence, “The analysis aimed at showing how certain socio-demographic and Health system variables influenced contraceptive use among women in Kenya,” since this was a cross sectional study, causal effect cannot be known so suggest the sentence is revised to something like this: “The analysis aimed at showing how certain socio-demographic and Health system variables are associated with contraceptive use among women in Kenya.” Results: Suggest adding what is in bold for clarity: “The odds of modern contraceptive use were higher among young women aged 20–24 years (aPOR 2.4, 95% CI; 1.87, 3.15, p=0.000), middle-aged women aged 25-29 (aPOR 1.8, 95% CI; 1.37, 2.47, p=0.000) and aged 30-34 (aPOR 1.5, 95% CI; 1.13, 1.99, P=0.0050) as compared to adolescents.” Add the prevalence amounts for each group in this sentence, “The odds of modern contraceptive use were (aPOR 0.7, 95% CI; 0.53, 0.96, P= 0.0250 ) less among divorcee, (aPOR 0.4, 95% CI; 0.26, 0.63, P=0.000) less among the widow and (aPOR 0.5, 95% CI; 0.39, 0.56, p=0.000) less among the non-married women compared to the married women respectively.” Add word in bold here, “Rural women were 80% less likely to modern contraceptive use as compared to the urban women (aPOR 0.8, 95% CI; 0.63, 0.98, p= 0.0330).” Add the prevalence amounts for each group in this sentence, “Among those who had children, the odds of modern contraceptive use were three and four folds higher among those with two to three and more than four children respectively as compared to those with less than two children (aPOR 2.5, 95% CI; 2.05, 3.0, p=0.000) and (aPOR 3.6, 95% CI; 2.74, 4.62, p=0.000) respectively.” Discussion: Suggest removing “only” from the following sentence and replacing “influencing” with something like “associated with” or “correlated with.” “The survey only gathered quantitative data to examine the factors influencing the uptake of modern contraception among Kenyan women of reproductive age.” Suggest a different phrasing in this sentence, “This is consistent with another prior studies in Kira-Uganda6 which reported that adolescent girls use MCM poorly.” Perhaps something like, “This is consistent with another prior studies in Kira-Uganda6 which reported more limited MCM use among adolescent girls when compared to older age groups.” Review the study cited in this sentence, “This suggests that married women have a greater desire to space or limit pregnancies24 by study done in Uganda.” According to the study abstract, “married women in Uganda are less likely to use modern contraceptives as compared to other marital categories” which is different than your study findings. Suggest discussing what the reasons might be for married women in your study having higher prevalence of contraceptive use than unmarried women and then comparing to similar studies. Could it be that they have more desire for spacing and limiting? Could it be that their husbands are more permissive of MCM use than those with partners outside of marriage? Suggest breaking this sentence up into multiple sentences and citing studies that offer similar explanations as the ones you pose. “Two previous studies24,25 in Uganda and Ghana reported that the use of contraceptives is significantly influenced by education this suggests that persons with higher levels of education were definitely more conscious of the advantages and significance of using contraceptives, they are also more informed which enhances access to services and offers them greater negotiating power when making decisions about using contraceptives.” In addition to the reason offered, authors could explore alternative reasons for the associations with parity in this paragraph. For instance, could it be that women with more children desire MCM more than women with less children? Could there be other explanations? Explore the literature to see what other reasons may be offered in addition to the explanation offered here. “The consumption of contraceptives was also linked to a woman’s parity, according to our study, women who had two to three children used MCM at a rate of about 59.9%, compared to only 25.3% among women who have less than one child. This could mean that women of low parity are under pressure to have more children as reported by study6,28 from two countries Uganda and India. Another research study which was done in India reported that women with no child once married are forced to prove their fertility due to pressures from spouses, in laws and communities28.” Suggest a different phrasing for these types of sentences, “Economically needy communities may be less likely to invest in women’s education, resulting in low understanding of contraceptive use, low autonomy24 by a study in Uganda.” Consider something like, “Economically needy communities may be less likely to invest in women’s education, resulting in a lower level of understanding of contraceptive use, and less autonomy24 as was seen in a recent study in Uganda.” What does “the lower the level” mean in this phrase, “the lower the level of the facility types”? I do not believe that phrasing was used in the study variable descriptions. Perhaps this refers to the level of care provided at the facility? Were the differences between facility types and those who experienced stock outs versus those that did not statistically significant? If not, suggest not discussing the differences in the discussion narrative or at least making reference to the fact that the differences were not statistically different. Suggest naming the study in words, rather than just with the citation number in this sentence, “This is in line with 34 who reported that insufficient stocks and restricted usage of available methods create conditions that ultimately restrict their use.” Maybe, “This is in line with a 2015 study by Hubacher and Trussell that reported…” or something like that. This sentence seems to contradict the paragraph on healthcare financing on p. 3 in the introduction. “This is consistent with a recent study in a Kenya35 that indicates that despite the widespread belief that health care financing and spending lead to improvements in health status and the inclusion of family planning services, its data is scant and conflicting, especially for low and middle-income countries (LMICs) like Kenya.” Authors need to address this. Discussion starting on p. 10 regarding those providing and prescribing MCM should address that the odds of those who were counseled, offered provision and prescription of FP services were not statistically different in use of MCM than those who were not offered any FP services. The authors state, “A previous study6 in Uganda states that the lack of youth-appropriate facilities limits young people’s access to counseling and knowledge about contraception,” but this study’s findings show no difference among those that “counseled, provided, prescribed” than those that “do not offer.” Discussions on limitations could include that while this study does offer value in providing estimates of contraceptive uptake and factors associated with uptake, the indicators did not assess patient’s desire for contraception or desire to avoid or achieve a pregnancy so the study is limited in its ability to assess unmet need. In line with reproductive autonomy and client-centeredness, suggest authors not talk about increasing services uptake and utilization but rather discuss increasing access to comprehensive education on FP services available and MCM and access to these services alongside client-centered contraceptive counseling to support a patient’s reproductive autonomy. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise adolescent sexual and reproductive health and adolescent sexual and reproductive health services (quality and access) I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Brittain A. Peer Review Report For: Factors influencing contraceptive uptake among women of reproductive age in Kenya [version 2; peer review: 3 approved with reservations, 2 not approved] . Gates Open Res 2024, 8 :32 ( https://doi.org/10.21956/gatesopenres.16631.r37016) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://gatesopenresearch.org/articles/8-32/v1#referee-response-37016 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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