Menstruation Requirements as a Barrier to Contraceptive Access in Kenya
BACKGROUND: In many countries, non-menstruating women are routinely denied contraceptive services even when pregnancy can easily be ruled out. OBJECTIVE: To determine whether menstruation requirements in Kenya constitute a barrier to access for potential family planning clients. DESIGN: Prospective and retrospective observational study. SETTING: Nine family planning clinics in western Kenya. SUBJECTS: Women presenting as new clients at Ministry of Health family planning clinics. INTERVENTIONS: Researchers used prospective tracking and retrospective record reviews to compare the menstrual status of women presenting for family planning services with that of women who received methods in family planning clinics. MAIN OUTCOME MEASURES: Dichotomous outcomes (menstruating versus non-menstruating women). RESULTS: During the eight-week period that tally sheets were used in the one hospital and eight health centres, 45% of the 760 women presenting for services as new clients were not menstruating (clinic range = 19%-70%). In contrast, information from clinic registers and client records in the same nine clinics showed that the (weighted) proportion of registered new clients who were menstruating was 85% (n = 102). We estimated that 78% of non-menstruating women (35% of all potential new clients) were sent away without services. CONCLUSION: For most women turned away, it is likely that pregnancy could be ruled out easily with a history and an examination. Menstruation as a pre-condition for provision of contraception wastes valuable resources and denies women their right to contraception.