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. 2025 Oct 1;10(1):64.
doi: 10.1186/s40834-025-00394-z.

Piloting measures of provider-imposed contraceptive coercion among reproductive-aged contraceptive users in Kisumu, Kenya: a cross-sectional, population-based study

Brooke W Bullington  1 , Stephanie Chung  2 , Dickens Otieno Onyango  3 , Leigh Senderowicz  4 , Emilia Goland  2 , Claire W Rothschild  5 , Abigael Mwanyiro  6 , Ben Wekesa  6 , Brian Frizzelle  7 , Ginger Golub  6 , Katherine Tumlinson  7   8
Affiliations

Piloting measures of provider-imposed contraceptive coercion among reproductive-aged contraceptive users in Kisumu, Kenya: a cross-sectional, population-based study

Brooke W Bullington et al. Contracept Reprod Med. .

Abstract

Introduction: Little research has focused on measuring free contraceptive choice, or whether individuals can make decisions about contraception without barriers or coercion. To advance measurement, we pilot survey questions focused on experiences of provider-imposed contraceptive coercion using population-based data collected among contraceptive users in Kisumu, Kenya.

Methods: We describe the percentage of women who reported provider-imposed coercion-related outcomes. We then examine demographic and facility-level correlates of feeling pressured or unable to say no to contraception and compare the extent that measures of feeling pressured and unable to say no to contraception overlap using 2 × 2 tables and Cohen's Kappa Statistic.

Results: The percentage of participants who reported provider-imposed coercion ranged by question from 1% to 57%. There were no associations between demographic or facility characteristics, including age, marital status, parity, and facility type (public or private), and either reporting feeling pressured or reporting feeling unable to say no to using contraception. There was no agreement between measures of feeling pressured and unable to say no to contraception (Kappa statistic - 0.11).

Conclusions: Our findings suggest that many women in Kisumu report experiencing some form of provider-imposed contraceptive coercion, though the proportion who report such experiences varies based on survey question. Further research is needed to improve reliable measurement of free contraceptive choice.

Keywords: Autonomy; Coercion; Contraception; Family planning; Measurement; Quality of care.

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Conflict of interest statement

Declarations. Ethical approval and informed consent: Ethical approval for the study protocol was provided by the University of North Carolina at Chapel Hill (21-2217, PI: Tumlinson) and Maseno University (MSU/DRPI/MUERC/01054/22, PI: Tumlinson) in Kenya. Ethical approval was obtained from all local ethics committees. Competing interests: The authors declare no competing interests.

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