Challenges and opportunities for effective contraceptive counselling in a low-resource setting: insights from a qualitative study in western Kenya

Background: Evidence from parts of sub-Saharan Africa shows variations in contraceptive counselling by type of sector (public or private) and socio-economic background of clients. There is, however, limited understanding of the nature of interactions between family planning service providers and their clients that could ultimately influence the quality of counselling received by different sub-groups of clients. This paper explores the challenges and opportunities for effective contraceptive counselling in a low-resource setting in Kenya. Data Source and Methods: Data are from a qualitative study that was conducted in 2018 among 42 women of reproductive age who participated in a longitudinal research project in Homa Bay County. The data were analysed using an exploratory inductive content analysis approach. Results: The findings showed that challenges to effective contraceptive counselling were both provider- and client-related. Provider-related challenges included workload, lack of competence in contraceptive counselling in general and on side effects in particular, and negative attitudes towards specific methods. Client-related challenges entailed presenting with fixed minds, lack of awareness of what to expect during interactions with providers, passive involvement in consultation process, and familiarity with service providers. Conclusion: Some of the challenges could be addressed by information, education and communications interventions to empower clients to demand quality services as well as skills updates for providers to improve their capacity to respond to clients’ needs.