The buzz outside the clinics: conversations and contraception in Nyanza Province, Kenya

Abstract

When women talk with each other about family planning outside the clinic, are they really only spreading myths and rumors? If nurses give good information about family planning, why do women go and talk with other women? Why would a woman instructed by a nurse at a workshop want to talk to the workshop cleaner as well? To answer these questions, findings are used from a household survey and in-depth interviews that examine the role of informal social interaction in influencing the use of contraceptives in rural Kenya. The women in the study area are found to be ambivalent about family planing, and they supplement providers' instructions with the experiences of women whose bodies and circumstances are similar to their own. Family planning programs could improve their effectiveness by viewing clients and providers not only as individuals but also as members of informal networks that are meaningful to them.

PIP: Data from a 1994-95 study in rural Kenya were analyzed to determine 1) if women communicate only "myths and rumors" when they discuss family planning (FP) among themselves outside of the clinic; 2) why women find it necessary to talk over this information with other women (assuming that FP personnel provide good information about FP); and 3) why a woman leaving a FP consultation with a nurse would ask the clinic janitor for clarification. Data were gathered from household surveys involving 866 female respondents, in-depth interviews with 40 women, 9 focus group discussions, and ad hoc interviews with health personnel. It was found that active and pervasive debates over family size and FP are occurring in the many social interactions that take place in the study area. FP is a frequent topic of conversation as friends, relatives, and neighbors engage in daily activities. These conversations are of sufficient depth to detail opinions and FP experience. Results are given for the percentage of women who discussed FP informally, their socioeconomic relationship to the people they communicated with, the FP experience of these information providers, and sources of FP education. The data also show that there is an unmet need for contraception among the respondents who, nevertheless, appear to be ambivalent about the value of smaller families and modern contraception. It was also found that the most common FP topic discussed was the side effects (factual and fallacious) of modern contraception (especially oral contraceptives). It was concluded that quality of care can be improved by 1) addressing concerns about side effects, 2) addressing concerns that methods "rhyme" (are compatible) with individual bodies, and 3) linking formal information channels with informal gossip networks.