Prevalence and factors associated with covert contraceptive use in Kenya: a cross-sectional study

Background: Family planning (FP) is a key intervention for preventing unplanned pregnancies, unsafe abortions,

and maternal death. Involvement of both women and their partners promotes contraceptive acceptance, uptake

and continuation, couple communication and gender-equitable attitude. Partner involvement is a key strategy for

addressing about 17.5% of the unmet needs in FP in Kenya. This study assessed the prevalence and factors

associated with covert contraceptive use (CCU) in Kenya.

Methods: We used data from the sixth and seventh rounds of the performance monitoring for accountability

surveys. We defined CCU as “the use of contraceptives without a partner’s knowledge”. We used frequencies and

percentages to describe the sample characteristics and the prevalence of CCU and assessed the associated factors

using bivariate and multivariable logistic regressions.

Results: The prevalence of CCU was 12.2% (95% CI: 10.4–14.2%); highest among uneducated (22.3%) poorest

(18.2%) and 35–49 years-old (12.8%) women. Injectables (53.3%) and implants (34.6%) were the commonest

methods among women who practice CCU. In the bivariate analysis, Siaya county, rural residence, education,

wealth, and age at sexual debut were associated with CCU. On adjusting for covariates, the odds of CCU were

increased among uneducated women (aOR 3.79, 95% CI 1.73–8.31), women with primary education (aOR 1.86, 95%

CI 1.06–3.29) and those from the poorest (aOR 2.67, 95% CI 1.61–4.45), poorer (aOR 1.79, 95% CI 1.05–3.04), and

middle (aOR 2.40, 95% CI 1.52–3.78) household wealth quintiles and were reduced among those with 2–3 (aOR

0.49, 95% CI 0.33–0.72) and ≥ 4 children (aOR 0.62, 95% CI 0.40–0.96). Age at sexual debut (aOR 0.94, 95% CI 0.89–

0.99) reduced the odds of CCU.

Conclusion: About one in 10 married women in Kenya use contraceptives covertly, with injectables and implants

being the preferred methods. Our study highlights a gap in partner involvement in FP and calls for efforts to

strengthen their involvement to increase contraceptive use in Kenya while acknowledging women’s right to make

independent choices.