Prevalence and biostatistical analysis of health facility related predictors of adherence to healthy timing and spacing of pregnancy among multiparous women in Wajir County, Kenya

Douglas Sendora Okenyoru; Vincent Matoke; Hellen Waititu

doi:10.18203/2394-6040.ijcmph20261399

Authors

Douglas Sendora Okenyoru Department of Community Health and Development, Catholic University of Eastern Africa, Nairobi, Kenya
Vincent Matoke Department of Community Health and Development, Catholic University of Eastern Africa, Nairobi, Kenya
Hellen Waititu Department of Mathematics and Actuarial Science, Catholic University of Eastern Africa, Nairobi, Kenya

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20261399

Keywords:

Healthy timing and spacing of pregnancy, Health facility factors, Family planning services, Multiparous women

Abstract

Background: Globally, healthy timing and spacing of pregnancy is important for reducing maternal and child health risks, yet adherence remains unpredictable. Sub-Saharan Africa faces high rates of short birth intervals due to inadequate contraception, cultural norms, and weak health systems. In Kenya, and especially Wajir County, poor adherence is driven by low contraceptive uptake, high fertility, and early pregnancies.

Methods: The study employed a cross-sectional descriptive-analytical design. It included multiparous women. A sample of 368 participants was selected using Fisher's formula via systematic sampling. Data were collected with structured questionnaires and analyzed using SPSS version 26.0.

Results: The results revealed that 56.5% of respondents adhered to heathy timing and spacing of pregnancy in Wajir County with 34.2 under age pregnancy, 15.8% abortion/miscarriage and 32.6% short inter-birth interval. The predictors of adherence based on health facility related factors were; time taken to reach nearest health facility offering family planning services (AOR=0.464, p=0.016), ever missed family planning services due to stock-out (AOR=3.902, p=0.001) and availability of contraceptive at health facilities (AOR=2.768, p=0.013) significantly influenced the adherence.

Conclusions: The study found that the health facility related factors that predicted the adherence were; time taken to reach nearest health facility offering family planning (AOR=0.464, p=0.016), ever missed family planning services due to stock-out (AOR=3.902, p=0.001) and availability of contraceptive at health facilities (AOR=2.768, p= 0.013).

References

WHO. Birth spacing. Geneva: World Health Organization. 2022. Available at: https://www.who.int. Accessed on 12 January 2026.

WHO. Delaying First Pregnancies to Improve Adolescent Health. Geneva: World Health Organization. 2022. Available at: https://www.who.int/publications/i/item/9789241502214. Accessed on 12 January 2026.

Aleni M, Mbalinda SN, Muhindo R. Birth Intervals and Associated Factors among Women Attending Young Child Clinic in Yumbe Hospital, Uganda. Int J reprod med. 2020;2020:1326596.

Davis P, Jones M. Short interbirth intervals and maternal health risks: An international overview. J Obstet Gynecol. 2022;48(2):123-31.

Ndwiga C, Okumu C, Tunde M. Addressing barriers to FP and optimal birth spacing in sub-Saharan Africa. Afr Popul Stud. 2023;37(1):88-102.

Akinyemi AI, Omoluabi E, Adedini SA. Promoting healthy timing and spacing of pregnancies in sub-Saharan Africa: A systematic review of interventions. BMC Public Health. 2023;23(1):45.

WHO. Adolescent pregnancy. Geneva: World Health Organization. 2024. Available at: https://www.who.int/news-room/fact-sheets/detail/adolescent-pregnancy. Accessed on 12 January 2026.

Kenya National Bureau of Statistics (KNBS), Ministry of Health Kenya, National AIDS and STI Control Programme (NASCOP), et al. Kenya Demographic and Health Survey. 2022. Available at: https://www.dhsprogram.com/. Accessed on 12 January 2026.

Beyene FY, Wudineh KG, Bantie SA, Tesfu AA. Effect of short inter-pregnancy interval on perinatal and maternal outcomes among pregnant women in SSA 2023: Systematic review and meta-analysis. PloS one. 2025;20(1):e0294747.

AFIDEP. Reproductive, maternal, neonatal and child health: Wajir County. African Institute for Development Policy. 2017. Available at: https://afidep.org/publication/reproductive-maternal-neonatal-and-child-health-wajir-County/. Accessed on 12 January 2026.

Machoka BN, Kabiru CW, Ajayi AI. "My father insisted that I have the baby but not in his house": Adolescent pregnancy, social exclusion and (dis)empowerment of girls in an urban informal settlement in Kenya. PLOS glob public health. 2024;4(9):e0003742.

Diabelková J, Rimárová K, Dorko E, Urdzík P, Houžvičková A, Argalášová Ľ. Adolescent Pregnancy Outcomes and Risk Factors. Int J environ res public health. 2023;20(5):4113.

Fowler FJ. Survey research methods. 2nd ed. Los Angeles: Sage Publications. 1998.

WHO. Adolescent pregnancies in sub-Saharan Africa: A review of global statistics. World Health Organization. 2020. Available at: https://www.who.int/reproductivehealth/adolescent-pregnancy-sub-saharan. Accessed on 12 January 2026.

Yussif AS, Lassey A, Ganyaglo GYK, Kantelhardt EJ, Kielstein H. The long-term effects of adolescent pregnancies in a community in Northern Ghana on subsequent pregnancies and births of the young mothers. Reprod health. 2017;14(1):1-7.

Kuta JM. Determinants of Timing and Spacing of Pregnancies among Women int. The Reproductive Age in Kajiado County, Kenya (Doctoral Dissertation, Kenyatta University). 2022.

Shumet T, Geda NR, Hassan JA. Barriers to modern contraceptive utilization in Ethiopia. Contracept reprod med. 2024;9(1):47.

Damtie Y, Kefale B, Yalew M, Arefaynie M, Adane B. Short birth spacing and its association with maternal educational status, contraceptive use, and duration of breastfeeding in Ethiopia. A systematic review and meta-analysis. PLoS One. 2021;16(2):e0246348.

Wassihun B, Wosen K, Getie A, Belay K, Tesfaye R, Tadesse T. Prevalence of postpartum FP utilization and associated factors among postpartum mothers in Arba Minch town, South Ethiopia. Contracept reprod med. 2021;6(1):6.

Aleni LM, Mureithi JN, Mburu PS. Trends in birth spacing and its impact on maternal and child health in sub-Saharan Africa: A review. Int J Public Health. 2020;65(4):479-87.

Jena BH, Biks GA, Gete YK, Gelaye KA. Incidence of preterm premature rupture of membranes and its association with inter-pregnancy interval: a prospective cohort study. Sci rep. 2022;12(1):5714.

Supaki EK, Owaka IO, Mutisya RK, Okari GM, Matoke VO. Accessibility factors associated with adherence to healthy timing and spacing of pregnancy among women of reproductive age in Kilifi County, Kenya. Int J Community Med Public Health. 2024;11(11):4154-61.

Kamau SM, Maina MK, Muiruri AK. Access to FP and its impact on adherence to health timing and spacing of pregnancy in rural Kenya: A cross-sectional study. Afr Health Sci. 2022;22(1):83-92.

Mutua MK, Njoroge PK, Omondi D. Enhancing adherence to healthy timing and spacing of pregnancies through community interventions in Kenya. Glob Health Res Policy. 2022;7(1):14.

Ministry of Health Kenya. Kenya community health strategy 2020–2025. Nairobi: Ministry of Health Kenya. 2020. Available at; https://repository.kippra.or.ke/items/074e9b85-640b-4aab-9a2f-efd0c488ee22. Accessed on 12 January 2026.

Ministry of Health. Kenya community health strategy 2020–2025. 2021. Available at: http://guidelines.health.go.ke:8000/media/Kenya_Community_Health_Strategy_20202025_January_2021.pdf. Accessed on 12 January 2026.

Kamau RK, Muthoni S, Mwangi W. Determinants of short interbirth intervals in Kenya: A case study of Wajir County. Afr J Reprod Health. 2022;26(1):82-92.

Mbalinda SN, Muhindo R. Reproductive health services and HTSP adherence in East Africa. East Afr J Public Health. 2020;17(3):108-15.

Ezeh A, Okpala P, Asare G. Improving adherence to health timing and spacing of pregnancy through counseling interventions in sub-Saharan Africa. Reprod Health Matters. 2022;29(1):45-53.

Opoku S, Addai B. FP uptake and birth spacing in sub-Saharan Africa: Policy implications. Health Policy Plan. 2022;37(4):553-63.

Chigbu CO, Onyeaghala A, Nwachukwu A. Barriers to health timing and spacing of pregnancy in rural Kenya. Glob Health Action. 2022;15(1):245-52.

Okenyoru DS. Healthcare system aspects influencing modern contraceptive utilization amongst females of reproductive age in Turkana, Kenya. World J Phar Med Sci. 2025;1(1):25-30.

Johnson P, Mitchell A, Robinson J. Enhancing postpartum contraceptive counseling to improve adherence to HTSP in industrialized countries. Int J Fam Plann. 2022;28(4):271-6.

Tunde M, Ezeh A, Akinyemi A. Short birth intervals and associated risk factors in sub-Saharan Africa. Demogr Res. 2023;48:321-42.

Tunde SO, Odebode TO, Adedeji J. Cultural attitudes toward FP in sub-Saharan Africa: Implications for HTSP. Int J Soc Behav Sci. 2023;19(4):290-5.