UTILIZATION LEVELS OF REPRODUCTIVE HEALTH SERVICES AMONG

UNDERGRADUATE STUDENTS AGED 18-30 YEARS AT JOMO KENYATTA

UNIVERSITY OF AGRICULTURE AND TECHNOLOGY MAIN CAMPUS
KIAMBU COUNTY, KENYA

RASHID I SALMA

HSH212-0089/2017

A RESEARCH PROPOSAL SUBMITTED TO THE DEPARTMENT OF

COMMUNITY HEALTH AND DEVELOPMENT IN PARTIAL FULFILMENT
OF THE AWARD OF BACHALOR OF SCIENCE IN COMMUNITY HEALTH
AND DEVELOPMENT.

August, 2021
 DECLARATION
This research proposal is my own original work it has not been presented and will not be
presented to any other university for a similar or any other degree award and is not
previously or currently under copyright.

____________________________ _____________________
Rashid i Salma Date

HSH212-0089/2017

Supervisors’ Approval

I confirm that this proposal was developed by the candidate under my supervision and
has been submitted with my approval as the university supervisor.

___________________________ _______________________
Dr. Daniel Mokaya Date

Department of Community health and development

Jomo Kenyatta University of Agriculture and Technology, Kenya

ii
 DEDICATION
This work is dedicated to my family especially my mom, Mrs. Hawa Mohamed Jibril and
my siblings for their unending support, encouragement, sacrifice, and value towards my
education

iii
 ACKNOWLEDGEMENT
I express my heartfelt gratitude to Allah for gracing me with life and good health to
pursue this course.

My sincere special thanks go to my able supervisor, Dr. Mokaya for his reliable guidance
and support in developing this proposal.

I also acknowledge my colleagues especially Mwanamkasi Mjaidi for her assistance in

reviewing and giving insights on the proposal as well as friendship and moral support.

I am grateful to Prof. Ngure and Madam Musita for imparting knowledge on research
proposal and project planning and management..

Finally, I wish to sincerely thank my mom Mrs. Hawa Mohamed Jibril and my siblings,
Farida, Zubeida, Maimuna, Fatma and Malau for their patience, love, support and endless
encouragement, without which this work would not have been a success.

MAY ALLAH BLESS YOU ALL

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 TABLE OF CONTENTS
DECLARATION.................................................................................................................ii

DEDICATION...................................................................................................................iii

ACKNOWLEDGEMENT..................................................................................................iv

LIST OF FIGURES...........................................................................................................vii

LIST OF ACRONYMS AND ABBREVIATIONS.........................................................viii

DEFINITION OF TERMS.................................................................................................ix

ABSTRACT.........................................................................................................................x

INTRODUCTION...............................................................................................................1

1.1 Background of the study............................................................................................1

1.2 Problem statement......................................................................................................3

1.3 Justification of the study............................................................................................4

1.4 Objectives...................................................................................................................4

1.4.1 Broad objective....................................................................................................4

1.4.2 Specific objectives...............................................................................................4

1.5 Research questions.....................................................................................................5

1.6 Limitations of the study.............................................................................................5

LITERATURE REVIEW....................................................................................................6

2.1 Introduction................................................................................................................6

2.2 Prevalence of reproductive health service utilization................................................9

2.3 Level of knowledge influencing reproductive health services utilization...............10

2.4. Health reproductive source factors..........................................................................11

2.5 Health service provider factors................................................................................13

2.6 Conceptual framework.............................................................................................16

MATERIALS AND METHODS.......................................................................................17

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 3.1 Description of the Study area...................................................................................17

3.2 Study design.............................................................................................................17

3.3 Study population......................................................................................................17

3.4 Study variables.........................................................................................................17

3.5.Criteria......................................................................................................................17

3.5.1 Inclusion criteria................................................................................................17

3.5.2 Exclusion criteria...............................................................................................17

3.6 Sampling method.....................................................................................................18

3.6.1 Sample size determination.................................................................................18

3.7 Data collection tools.................................................................................................19

3.8 Statistical data management and analysis................................................................19

3.8.1 Data dissemination............................................................................................19

3.9 Ethical considerations..............................................................................................20

REFERENCES..................................................................................................................21

APPENDICES...................................................................................................................23

Appendix 1: Workplan...................................................................................................23

Appendix 2: Budget.......................................................................................................24

Appendix 3: Informed consent.......................................................................................25

Appendix 4: Questionnaire............................................................................................26

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 LIST OF FIGURES
Figure 1 showing the interaction of variables....................................................................16

vii
 LIST OF ACRONYMS AND ABBREVIATIONS
AIDS Acquired Immune Deficiency Syndrome

HIV Human Immunodeficiency Virus

HRP Human Reproduction Program

ICDP International Conference on Population and Development

IPPF International Planned Parenthood Federation

JKUAT Jomo Kenyatta University of Agriculture and Technology

KDHS Kenya Demographic Health Survey

LMICs Low and Middle Income Countries

MCH Maternal Child Health

MDG Millennium Development Goal

MOH Ministry Of Health

NGOs Non-Government Organizations

RHS Reproductive Health Services

STDS Sexually Transmitted Diseases

UNFPA United Nations Populations Fund

USDG Universal Sustainable Development Goal

VCT Voluntary Counselling and Testing

WHO World Health Organization

YFRHS Youth Friendly Reproductive Health Services

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 DEFINITION OF TERMS
Health care provider: An individual health professional or a health facility organization
licensed to provide reproductive health services diagnosis and treatment.

Healthy behavior: Any activity an individual undertakes believing themselves to be

healthy for the purpose of detecting and preventing disease in asymptomatic stage

Knowledge: Awareness of reproductive health services acquired through experience or

education

Reproductive health: A state of complete wellbeing physical, mental, and social

wellbeing and merely absence of a disease or infirmity in all matters relating to the
reproductive system and to its function

Sexual rights: Sexual rights include right of all young people to the highest attainable
standards of sexual health in essence of access to reproductive health services, access to
information related to reproductive health services.

Utilization: The ability to consume services, or the usage of reproductive health services

Youth: Period between childhood and adulthood a person age between 18-30 years

Youth friendly services: These are services that are affordable, accessible and
appropriate for youths and adolescents. The services are in the right place, being
delivered by the right person in the right style acceptable to the young people and are
effective and safe.

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 ABSTRACT
Utilization of reproductive health services is an important component in preventing
youths from different reproductive health problems. Youths globally have unique needs
and accompanying vulnerabilities. Many youths face health risks, such as sexually
transmitted infections including HIV/AIDS, unwanted pregnancies that may lead to
illegal abortions and discontinuation of studies among female student and adverse health
problems that lead to low production on studies. As a result extent of utilization of
reproductive health services should be determined before implementing any kind of
intervention. Reproductive health services have been neglected in the past. The
international Conference on Population and development endorsed the right of young
people to obtain the highest level of healthcare. Kenyan government have put in place an
adolescent and reproductive health and development policy to enhance implementation of
programs that addresses reproductive health services issues and challenges of young
people despite this utilization of reproductive health services is still low. The study
sought to determine prevalence of reproductive health utilization, level of knowledge and
health care provider factors that influence utilization of reproductive health services
among JKUAT students. A cross sectional study design will be adopted and simple
random sampling method will also be used to determine the population sample. An
interview using questionnaires will be used to collect data among the sample population
and results obtained will be analyzed using computer software Microsoft excel. The
collected data will be presented in form of tables, graphs and pie charts. . The information
generated from the study will be beneficial for programming as it will identify underlying
reasons for low utilization of RHS services. Results will help to shape SRH programs and
reduce teenage pregnancy within Kenya and other similar low middle-income countries.

x
 INTRODUCTION
1.1 Background of the study

According to World Health Organization (WHO) Reproductive health is a state of

complete physical, mental, and social wellbeing and not merely the absence of disease or
infirmity, in all matters related to the reproductive system and to its functions and
process. Reproductive health is a human right men and women have the right to be
informed and have access to safe, effective, affordable and acceptable methods of their
choice for the regulation of fertility which are not against the law, right of access to
appropriate health care services for safe pregnancy and childbirth.

During the 1960s, UNFPA established with a mandate to raise awareness about
population problems and to assist developing countries in addressing them. At that time,
the talk was of “standing room only”, “population booms, demographic entrapment” and
scarcity of food, water and renewable resources. Concern about population growth
(particularly in the developing world and among the poor) coincided with the rapid
increase in availability of technologies for reducing fertility - the contraceptive pill
became available during the 1960s along with the IUD and long acting hormonal
methods. In 1972, WHO established the Special Program of Research, Development and
Research Training in Human Reproduction (HRP), whose mandate was focused on
research into the development of new and improved methods of fertility regulation and
issues of safety and efficacy of existing methods. Modern contraceptive methods were
seen as reliable, independent of people’s ability to practice restraint, and more effective
than withdrawal, condoms or periodic abstinence. Moreover, they held the promise of
being able to prevent recourse to abortion (generally practiced in dangerous conditions)
or infanticide. Population policies became widespread in developing countries during the
1970s and 1980s and were supported by UN agencies and a variety of NGOs of which
international planned parenthood federation (IPPF).The 1994 International Conference on
Population and to Development (ICPD), the United Nation's third decennial conference
on population issues, marked a milestone in population policy and politics. It achieved
worldwide consensus that population is a top-ranking issue worthy of consideration at the
highest level by all governments; it placed the discussion of population firmly in a

1
development context; and it identified women and their status as central to sustaining
global development efforts (Cory L 1994).

Development of reproductive health, Before 1978 Alma-Ata Conference these were the
key Basic health services in clinics and health centers, Primary health care declaration
1978 : MCH services started with more emphasis on child survival, Family planning was
the main focus for mothers, Safe motherhood initiative in 1987 , Emphasis on maternal
health, Emphasis on reduction of maternal mortality. Reproductive health, ICPD in
1994 :Emphasis on quality of services ,Emphasis on availability and accessibility,
Emphasis on social injustice ,Emphasis on individuals woman's needs and
rights .Millennium development goals and reproductive health in 2000 (The Lancet 2012)
MDGs are directly or indirectly related to health ,MDG 4, 5 and 6 are directly related to
health, while MDG 1,2,3, and 7 are indirectly related to health ,World Summit 2005,
declared universal access to reproductive health. Sexual and reproductive health is
fundamental to the social and economic development of communities and nations, and a
key component of an equitable society. (The Lancet 2006)

Reproductive health is a vital aspect of general health and a precondition for social,
economic and human development. The International Conference on Population and
Development (ICPD) Program of Action states that "reproductive health means that
people can have a satisfying and safe sex life and that they can reproduce and the
freedom to choose if, when and how often to do so‖ (UNDP, 2013). Thus, the ICPD
report stressed that adolescents and the youth SRH is a basic human right and stress the
need to give sexual health services and information to adolescents and also speak of
reproductive health encounters across the lifespan (Patel and Bansal, 2010).

The Kenyan government through activities initiated by the Division of Reproductive

Health (DRH) of the Ministry of Health (MOH) and its partners has taken crucial strides
and efforts to avail and improve the quality of reproductive health care services to the
youth. These include the youth-friendly services, free maternity services, subsidized fees
in all public health facilities (NCAPD, 2013). This has seen a regular rise in demand for
services and a momentous decrease in maternal, neonatal and infant morbidity and

2
mortality. Sexual and reproductive health services remain underutilized despite all these
efforts (MOH, 2007).

1.2 Problem statement

Reproductive health targets comprehensive approaches which include family planning,

maternal and child health and other health issues related to reproduction including
sexually transmitted infections including HIV/AIDS that had been treated. According to
(WHO 2017) Some 45 million unintended pregnancies are terminated each year, 40% of
all unsafe abortions are performed by youg people age between 15 to 24. Unsafe
abortions kill an estimated 68000 women every year representing 13% of all pregnancy-
related deaths. Three quarters of all cervical cancer cases occur in developing countries
where programs for screening and treatment are deficient or lacking. Sexually transmitted
diseases are the leading cause of infertility this affect the future life of the students where
they will not be able to bear children. Young people rarely have the ability to or support
to resist pressure to have sexual relations, negotiate for safe sex or protect themselves
against unintended pregnancy and sexually transmitted infections. Evidence shows that
providing information and services to adolescents results in their improved health.Despite
this recognition health facility factors including health care provider factors causes youths
not to use this reproductive health services. Lack of utilizing reproductive health services
will not contribute to MDGs that include improvement in maternal health reduce child
mortality and combact HIV/AIDS (UFPA 2020).

The Kenyan government STI and family planning programmes offer reproductive health
services in public health facilities, ethical, institutional and structural problems create
access barriers to the services. For example lack of private consulting rooms denies
youths confidentiality and privacy, Even in JKUAT condoms dispensers are placed near
consultation area and in open spaces and some youths may feel embarrassed to pick them
while being seen. Without access, they lack the power to make decisions about their own
bodies, including whether or when to become pregnant. Young people can be labeled as
the vulnerable group, because they are subjected to curiosity, sexual maturity, and natural
liking towards experimentation, and peer pressure leads to risky behaviors.

3
1.3 Justification of the study
Utilization of reproductive health improves quality of life of the undergraduates. The
information gathered will help in understanding the demand and use of reproductive
health services among JKUAT students. Reproductive health awareness including
messages to encourage abstinence and promote the use of condoms and contraceptives by
those who are sexually active, is the front line of efforts to prevent pregnancy, AIDS and
other sexually transmitted diseases (STDs).Prevention of pregnancy and reproductive
infections among students is important because students will be able to continue with
their studies smoothly without fear of infections and unwanted pregnancies. The fight for
rights and choices must continue until they are a reality for all. The need to have a
healthy youth is of great value to the nation’s socioeconomic development. The
reproductive and sexual decision they make today will affect the health of their
communities and country in future.

1.4 Objectives

1.4.1 Broad objective

The general objective of the study is to determine the utilization levels of reproductive
health among undergraduate students in JKUAT main campus Juja, Kiambu county.
.
1.4.2 Specific objectives
i. To determine the prevalence of utilization of reproductive health services
among JKUAT students, main campus Juja, Kiambu County.

ii. To determine level of knowledge among JKUAT students that influence

utilization of reproductive health services at main campus, Juja, Kiambu
County.

iii. To determine the reproductive health service provider factors associated with
utilization of reproductive health services among JKUAT students main
campus Juja, Kiambu County.

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 iv. To determine the source of reproductive health services for JKUAT students
main campus Juja, Kiambu County.

1.5 Research questions

The study seeks to answer the following questions:

1. What is the prevalence of reproductive health services utilization among JKUAT

main campus students?
2. What is the level of awareness of reproductive health services among JKUAT
main campus students?
3. What are the reproductive health service health care provider factors associated
with utilization of reproductive health services among JKUAT main campus
students?
4. What are the reproductive health sources factors affecting utilization of
reproductive health services among JKUAT main campus students?

1.6 Limitations of the study

Limited study population would have done to several universities to get more information
about utilization of reproductive services among undergraduate student.
The time allocated to do the study is short.

5
 LITERATURE REVIEW
2.1 Introduction

The 1994 ICPD has been marked as the key event in the history of reproductive health.
Globally, improved utilization of family planning contributes in achieving the 3.7
Universal Sustainable Development Goal (USDG), which focuses on ensuring universal
access to sexual and reproductive health-care services, including for family Planning,
information and education, and the integration of reproductive health into national
strategies and programs by 2030 (ICSU, ISSC, 2016).Worldwide, UNFPA is the main
provider of reproductive health related supplies and equipment packaged and ready for
distribution for different situations and levels of service. Family planning kits, for
example, contain condoms, oral and injectable contraceptives, and intrauterine devices.
Maternal and neonatal health kits include medical equipment and supplies essential for
clinical delivery assistance and basic and comprehensive emergency obstetric care. Other
kits contain supplies for treating sexually transmitted infections, managing miscarriages,
and performing blood transfusion.(UNFPA 2019).

Worldwide, it is likely that more than 220 million women in LMICs have an unmet need
for family planning (Singh et, al., 2012). Generally, slight progress has been made in
increasing uptake of contraception. While increases in usage have been upper with
adolescents than older women, this group are more affected by contraceptive failure and
termination rates, and use of traditional methods of contraception are still prominent
(Blanc,Ann K.,et al 2009) (LIVE W.W.W 2010). Young girls who have ever had sex or
are currently sexually active are more likely to be or have been married than boys in the
same categories (WHO 2007).According to Blanc, married youths often do not want
pregnancy, but have low contraceptive proportions. Data have shown that current use of
contraceptives is often lower among sexually active, married youths (Blanc et al.,2009)A
series of complex barriers currently prohibits good sexual and reproductive health for
adolescents.

At the political level, ASRH is low priority and there are often restrictive laws and
policies in place. Numerous societal, cultural, and religious factors create an inhibitive
environment for talk of ASRH as many societies hold a deeply fixed sense of disapproval

6
of adolescent sexual activity; this is often demonstrated through the stigmatization of
sexual health concerns, in particular STIs/HIV. Judgmental attitudes about sexual activity
abound, especially for those out of marriage and sexually active girls and women. In
some regions, accepted practices of early marriage and childbearing, age differences
between partners, and societal pressure prohibiting use of contraceptive methods may
also exist. Poor ASRH can be further confounded by conflict, migration, urbanization,
and lack of schooling.
In Kenya, complications of unsafe abortion contribute 30-40% of all maternal deaths, far
more than the world wide average of 13%, making unsafe abortion a significant cause of
maternal mortality in the country which stands at 486/100,000 live births (KDHS, 2010).
Reproductive health has been considered by the World Health Organization (WHO) and
the Commission on Population and Development since 1994 as one of the indicators of
development in countries. There is a close relationship between reproductive health
literacy and demographic factors.[Dadkhah A.et.al,.2018]. This area of health includes
extensive services such as safe motherhood, family planning counselling, prevention and
treatment of reproductive system infections, sexually-transmitted diseases, as well as
prevention and treatment of gender-based violence [Khani.et.al.,2014].In LMICs(Low
and middle income countries)an estimated 220 million females of reproductive age have
an unmet need for family planning [Fenton.K.A.2001]. Due to their developing bodies
and a lack of maternal services and support, adolescents are at a five times greater risk of
maternal mortality compared to women aged 20 to 24 (WHO 2007). Young maternal age
also has consequences for the infant, namely leading to low birth weight, preterm birth,
and neonatal mortality (Sugar & Max 2012) Barriers related to the availability,
accessibility of sexual and reproductive health services make it difficult for young people
to access and utilize RHS hence exposing them to unintended pregnancy, HIV/AIDS and
other sexually transmitted infections (Zani 2014)

There are three elements that was reinforced during Cairo meeting and UN General
assembly the elements include

7
• The growing strength of women’s movement and their crisis of over-emphasis on
the control of female fertility and by extension of their sexuality to exclusion of their
needs.

• Second key development was the advent of HIV/AIDS pandemic responding to

the consequences of sexual activity other than pregnancy. It became possible to talk about
sex, sexual relations outside of marriage as well as within it, and about sexuality among
young people.

• A third development was articulation of the concept of reproductive rights. An

interpretation of international human rights treaties in terms of women’s health in general
and reproductive health

The rights in particular identified include

• The right of couples and individuals to decide freely and responsibly the number
and spacing of children and to have the information and means to do so

• The right to attain the highest standard of sexual and reproductive health

• The right to make decisions free of discrimination, coercion or violence.

A series of complex barriers currently prohibits good sexual and reproductive health for
adolescents. At the political level, ASRH is low priority and there are often restrictive
laws and policies in place. Numerous societal, cultural, and religious factors create an
inhibitive environment for talk of ASRH as many societies hold a deeply fixed sense of
disapproval of adolescent sexual activity; this is often demonstrated through the
stigmatization of sexual health concerns, in particular STIs/HIV. Judgmental attitudes
about sexual activity abound, especially for those out of marriage and sexually active
girls and women. In some regions, accepted practices of early marriage and childbearing,
age differences between partners, and societal pressure prohibiting use of contraceptive
methods may also exist. Poor ASRH can be further confounded by conflict, migration,
urbanization, and lack of schooling.Reproductive health care is defined as the
constellation of methods, techniques and services that contribute to reproductive health

8
and wellbeing by preventing and solving sexual health problems (Roudi-fahimi and
Ashford 2008)

2.2 Prevalence of reproductive health service utilization

Globally, each year, eight million of the estimated 210 million women who become
pregnant, suffer life-threatening complications related to pregnancy, many experiencing
long-term morbidities and disabilities. More than 50% of women living in the world’s
poorest regions - the percentage is higher than 80% in some countries - deliver their
babies without the help of a skilled birth attendant. In sub-Saharan Africa these
proportions have not changed over the past decade. Antenatal care is available and widely
used in industrialized countries (WHO, 2007) Contraceptive use has substantially
increased in many developing countries and in some is approaching that practised in
developed countries. Yet surveys indicate that, in developing countries and countries in
transition, more than 120 million couples have an unmet need for safe and effective
contraception despite their expressed desire to avoid or to space future pregnancies.

According to (WHO 2004 )Some 45 million unintended pregnancies are terminated each
year, an estimated 19 million of which are unsafe; 40% of all unsafe abortions are
performed on young women aged 15 to 24. Unsafe abortions kill an estimated 68 000
women every year, representing 13% of all pregnancy-related deaths.6 In addition, they
are associated with considerable morbidity; for instance, studies indicate that of every
five women who have an unsafe abortion, at least one suffers a reproductive tract
infection . Kenya has poor ASRH indicators. Adolescent pregnancy is a major problem in
Kenya, with a teenage pregnancy rate of 18%, and an unmet need of family planning
(FP)— as measured by the contraceptive prevalence rate among sexually active,
unmarried girls aged 15–19 years—of 49%( MOH 2016). It is estimated that about
13,000 girls drop out of school annually in Kenya due to early and unintended pregnancy
(Muganda 2008). Adolescent pregnancy also increases the risk of maternal and newborn
deaths and disability, including from complications from unsafe abortion, prolonged
labor, childbirth, and the postnatal period (Thomas 2015) To address the poor indicators,
in 2015, Kenya launched a National Adolescent Sexual and Reproductive Health Policy,
which provides guidance to government ministries and partners on how to respond to

9
ASRH needs (MOH 2015). The policy advocates for the ministries of education and
health, other line ministries, the political administration, and other stakeholders for
successful ASRH programs and to ensure participation of young people. In addition, it
recognizes the importance of addressing ASRH needs to achieve Kenya’s development
goals. Despite this legal framework, implementation of ASRH services has been weak
and uncoordinated. The absence of reinforcement of ASRH policies enables
administrators and service providers to impose restrictions based on their personal beliefs
that prohibit youth from gaining access to essential information and services. In addition,
there is limited evidence to support the effectiveness of initiatives that simply provide
“adolescent friendliness” training for health workers (Chandra et, al., 2015). A study of
young people’s perception of ASRH services in Kenya showed that young people wished
to see an increase in ASRH services, especially in rural areas, including the use of mobile
clinics (.Godia 2014). The study also suggested the need to increase awareness of
available ASRH services among young people and the community in general through
outreach activities in the community, schools, and churches.

2.3 Level of knowledge influencing reproductive health services utilization

According to a study done on Exploring college student sexual and reproductive health
literacy, the Internet is the most commonly accessed source of sexual and reproductive
health among university students (Yee-tak Fong et.al, 2021).
A study done in Uganda explained that young people believe that (LARC) Long acting
reversible contraceptives are mostly used by married couples. Knowledge of the site of
administrations of family planning implants, previous use, and women's attitude about the
important role of male partners in their choice of contraceptive use is associated with use
of long acting reversible contraceptives such as IUD (Azungu, D. et. al, 2014). According
to (UN Habitat 2008) Youth living on the streets are exposed to risky sexual behaviors
early motherhood. This is because of their great necessity to fill the gap of normal social
relations and lack of knowledge and skill of sexual and reproductive health services. It is
important to create awareness about reproductive health to all individuals. Young people
with little knowledge about reproductive health may have misleading or incorrect
information about fertility and contraception. The International Conference on population
and Development (ICPD), which met on 1994 in Cairo and the Fourth International

10
Conference on Women in Beijing 1995, endorsed the rights of young people to
reproductive health information and services (Senderowitz J. 2000).
"Knowledge sharing is one of the most useful and generous tools we have to improve the
implementation and scale up of services and adapt WHO global guidance for family
planning, contraception and reproductive health at every health system level in every
county" said Nandita Thatte,Technical advisor and IBPM network (WHO 2021). Little is
known about the quality and accuracy of young people’s knowledge, attitudes and
preference of health service provider for RHS,despite the mass media and community
mobilization efforts that engage parents, school teachers, community and religious
leaders to promote health services for RH, little is understood about their influence on
adolescent knowledge and attitude towards the services (Gelow et al 2008) Access to
accurate information on important reproductive health concerns, such as reproductive
functioning, family planning, sexuality, and STIs are greatly constrained at all levels in
most places (WHO, 2014).

2.4. Health reproductive source factors

Reproductive health services require that all people can safely reach services without
travelling a long distance or wasting time hence the treatments must be affordable to
people based on the principle of equity. According to (UNFPA 2020) Health systems
were strained during the pandemic, Globally United Nation survey found that 7 in 10
countries experienced disruption in contraceptive services and increase in domestic
violence cases.UNFPA projects 12 million women across 115 low- and middle-income
countries experienced contraceptive service disruptions, and 42 per cent of UNFPA
programme countries reported facility-level disruptions in family planning services.
Some also reported declines in institutional deliveries. Under these extreme
circumstances, UNFPA worked to maintain continuity of sexual and reproductive health
care, and to safeguard those providing this life-saving work. UNFPA mobilized $94.8
million in additional resources to support the pandemic response, more than a quarter of
which came from United Nations entities (UNFPA 2020).According to a survey done by
KDHS reproductive health services have improved greatly since the last survey. More
than half of the Married women age 25-49(58 percent) use contraceptives,96% of women

11
with a live birth in the five years preceding the survey were delivered in a health facility
62 percent were assisted by a skilled health care provider (KDHS 2014).
According to a study done by Miriro on utilization of reproductive health services in
tertiary institutions(,M Mriro 2018) Fear was one of the major constrain to uptake and
utilization of reproductive health services being screened for breast, cervical or prostate
cancer leads to development of fear about gynecological care for cancer being labeled as
one of the major killer disease females also believed that if their cervix is removed they
lose womanhood and sexuality that is they feel disabled (M Miriro 2018).People under
the age of 25 years represent nearly half of the world’s population giving them a powerful
role in worlds health each year about 14 million young women give birth. Among the
adolescent and young girls living in developing world there are 2.7 million unintended
pregnancies in South central and Southeast Asia,2.2 million in Latin America and the
Caribbean young people sexual and reproductive health affects their life and the life of
global community(Coley and Chase 2009). According to the KDHS 2009, there is an
increase of up take of family planning services among age 20-24 years as compared to
10-19 years. The youths are reluctant to seek care due to the national reproductive health
policies restricting care based on age and poor understanding of their changing bodies
and deficient awareness of risks associated with early sexual debut, STIs and HIV and
pregnancy. In their study in Homa Bay and Migori, FCI looked at communication
channels and found out that radio in particular, and television were the most strongly
preferred sources of health information by both men and women. Public meetings and
gatherings, church gatherings, women’s groups, and other social and economic gatherings
were important channels of information. They found that adolescent women appeared to
be particularly disadvantaged in their access to information about pregnancy and child
birth because of reluctance to seek antenatal care and lack of contacts with other channels
of communication (MOH, 2006)The findings were that new infection might occur faster
among women of low socioeconomic status. There was prevalence of 19.8 percent among
males and 30.2 percent among females. The risk of infection among low socio-economic
status women in the age’s 15-25years was associated with early sexual debut and early
marriage. Low condom use, high partner change, principally for material support,
resulting in high prevalence of STIs (MOH, 2006).Poverty is one of the factors that is

12
driving young people to engage in pre-marital sex in exchange of economical support
hence exposing them to reproductive health risks. Lack of political will has led to lack of
financial commitment by the government to supporting the health reproductive activities
and making the services accessible even for those youths who are financially
disadvantaged. The youths are under-utilizing the reproductive health services because of
lack of information and understanding of the benefits of sexual health information and
where to get it when they need it (Godia, 2010). A study done in Uganda, found out that
young people still under-utilize health services like family planning, treatment of sexually
transmitted infections and VCT services because of lack of knowledge about this services
(Biddlecom, et al., 2007). Young people who are well educated understand better their
health needs and they are likely to seek for youth friendly reproductive health services
than those with little education (KDHS 2009).
Kenya has approximately 600 health facilities. Still, not all offer comprehensive
reproductive health care (MOH, 2007). Even though there are significant gains achieved
in Kenya’s health indicators, high maternal morbidity and mortality levels still carry on,
particularly those associated with prolonged and obstructed labor, unsafe abortion,
hemorrhage, hypertensive disease of pregnancy, sepsis, anemia, malaria, STDs and
HIV/AIDS (KDHS, 2011). There is ample evidence both in the developed and
developing world that voluntary counselling and testing (VCT) for HIV/AIDS leads to
behavior change. Despite this evidence, access to VCT services is limited to urban areas.
Further, only a few existing VCT centers are youth friendly. Ministry of health
emphasizes the need to target this group with behavior change communication (BCC) to
sustain delay in initiation of sexual activity and also provide a link to services.

2.5 Health service provider factors

The health system factors that influence the utilization of the health services involves the
health service provider. Health service provider determines the quality of services the
client can get MOH, (2004). This is guaranteed through satisfactory policies, favorable
environment, better clinical and communication skills According to the National
guidelines for provision of youth friendly reproductive health services in Kenya, states
that these services should be easily accessible, available at the convenient time of the
youth’s schedule, at affordable or free of charge and being served by a friendly service

13
provider (MOH, 2008) Service providers attitude also contribute to youths seeking
reproductive health services study conducted by (Warenius et al. 2006) among Kenyans
and Zambians midwives discovered that reproductive health services are underutilized
due to judgmental attitudes of the health workers and lack of proficiency coupled with
lack of knowledge in the YFRHS provision. The attitude has been adversely mentioned to
be the major barrier for the youths who seek for the youth friendly health services,
(MOH, 2005)
Reproductive health services are an important part of social life. Yet, they regularly get
little to no attention because of cultural sensitivities. The youth have psychological and
social features that significantly differ across different cultures. In Africa; there is a
tradition of early motherhood in which the sexuality of teenagers is not a matter of age
but social and marital status. Cultural perspectives affect the decisions on the use of SRH
services like family planning services. Some cultures view the number and sex of
children as a sign of made potency and success and are therefore not likely to limit family
size or having many children is beneficial as they will support the parents in old age
(WHO, 2014). Some religions prohibit the use of any artificial method to ―be fruitful
and multiply this religious view procreation as a religious duty. Any artificial method of
birth control is viewed as contrary to divine directions (WHO, 2014). Moreover, most
cultures outline the people permitted to gain access to reproductive health services; this is
through policy restrictions, social control, laws or other mechanisms. Only married
women who are given access to family planning services in most African societies, and
the unmarried, pregnant adolescents are predominantly affected. A study done in Senegal
had a clear indication that social-cultural tradition prohibits premarital sexuality, creating
a problematic scenario for the young unmarried individuals to gain access to family
planning services without humiliation but if they do visit such service places they are not
well counseled and they do not get the required service (UN-HABITAT, 2008).
With concern to service-related obstacles, poor health systems for sexual health, family
planning, and maternal health are common, with unmarried youths ignored in some cases,
married adolescents in others, and an overall deficiency of youth-friendly services. Lack
of integration is seen where services that might address counselling and family planning
fail to include HIV/STI care. Services may also be hampered by corruption and

14
lack/erratic availability of supplies and equipment. Economic and physical accessibility
restrict adolescents’ access to services where they do exist. On a personal level, young
people's care-seeking behavior may be restricted because of fear (of people finding out
and other confidentiality issues that may result in violence), embarrassment, lack of
knowledge, misinformation and myths, stigma, and shame (Blanc Ann K.et al., 2009). A
range of people have an influence on adolescents’ access to information and services,
including peers, parents, family members, teachers, and healthcare workers. Some argue
that the single most important barrier to care is provider attitude (Morris, J.L.,and
Rushwan,H 2015). Many healthcare workers deter adolescents from using services
because of their lack of confidentiality, judgmental attitudes, disrespect, or not taking
their patients' needs seriously.

15
 2.6 Conceptual framework
INDEPENDENT INTERMEDIATE DEPENDENT

VARIABLES VARIABLE VARIABLE

Socio demographic
and cultural factors

age
Utilization of
gender Health facility factors
reproductive
Workers attitude health services
residence

religion Availability of
supplies
ethnicity
Distance of the
Servicemarital
delivery facility
status
environment

Access to
services

Quality of
care

preferenc
es

Knowledge factors

Awarenes
s of RHS

Figure 1 showing the interaction of variables

16
 MATERIALS AND METHODS
3.1 Description of the Study area

Study will be conducted at Jomo Kenyatta University of Agriculture and Technology

Main Campus. A public university in Kenya located in Juja Kiambu County. It is 36
kilometers North East of Nairobi city, along Thika superhighway. The institution offers
courses in health science, technology engineering and agriculture.

3.2 Study design

The study will adopt a descriptive cross-sectional research design that involves collection
of data at one point in time. This design will allow gathering of information about
utilization of reproductive health services in JKUAT main campus Juja Kiambu County.

3.3 Study population

The study will consist of JKUAT main campus Juja, Kiambu county undergraduate

students’ age between 18-30 years.

3.4 Study variables

The study variables will include independent, intermediate and dependent variables as
follows:

Independent variables, age, gender, residence, education, religion, ethnicity, income

source, security issues Knowledge and attitudes

Intermediate variables; health facility factors health providers’ attitude and accessibility to
reproductive health services

Dependent variables; utilization of reproductive health services

3.5.Criteria

3.5.1 Inclusion criteria

The study will include all undergraduate students who consent to participate in the study.

3.5.2 Exclusion criteria

All undergraduate students who do not consent

17
3.6 Sampling method
A simple random sampling technique will be used. This is a probability sampling method
where all units have equal chances of being selected. Simple random sampling will be
used to obtain the required respondents from the sampling frame that targets all
undergraduates students in JKUAT using computer generated random numbers.

3.6.1 Sample size determination

The quantitative sample size was determined using Fischer et al. (Mugenda1999) formula

. n = Z2 pq

d2

Where n=Desired sample size

Z =Standard Normal deviation (1.96 for a 95% confidence level)

P = the proportion of uptake of reproductive health services 50% (MOH 2016)

P =0.5

q = 1-p (1-0.5)

d = margin error set at 0.05%

n = z2 pq

d2

1.962(0.5) (0.5)

(0.05)2

= 384

Since the population is less than 10,000 the sample size is adjusted using this formula

Nf = n

1+ n

Where

Nf = desired sample size (when population is <10000)

18
N = the desired sample size (when population is >10000)

N = the population size

NF = 384

1+ 384

300

Nf = 160

3.7 Data collection tools

The data will be collected from all students who will consent and they will be provided
with questionnaires that will contain both close ended and open ended questions. Close
ended questions will have multiple choices. The questionnaire will include socio
demographic factors of the respondents and health facility factors that influence
utilization of reproductive health services.

3.8 Statistical data management and analysis

The statistical data will be analyzed using Microsoft excel. Numeric variables will be
summarized using mean and corresponding measures of dispersion, i.e. standard
deviation, while the categorical variables will be summarized using frequency or
proportions from the totals. A value less than 0.05 at 95% confidence interval will be
considered statistically significant. Data will be cleaned prior to analysis. Qualitative data
will be analyzed by descriptive statistics using frequencies, percentages, medians and
modes. Data will be presented using graphs and pie charts.

3.8.1 Data dissemination

Data collected will be presented at JKUAT School of public health department using
slides. The findings of this study will contribute to scientific knowledge and enhance
continued research in the field of reproductive health. The results will be useful in

19
advising the university on gaps to be addressed on matters concerning awareness and
utilization of reproductive health services.

3.9 Ethical considerations

Approval for the study will sought through JKUAT ethical review committee, permission
to conduct the research from Head of department. Individuals sampled will be subjected
to voluntary participation and confidentiality committee. Participant will be explained
that the study will not provide any direct benefits to them as individual but the study
aimed at improving reproductive health services in JKUAT and the entire country as a
whole. Students will fill the consent form prior to answering questionnaire.

20
 REFERENCES

Adefuye,A. S., Abiona, T. C., Balogun, J. A., & Lukobo- Durrell, M. (2009). HIV sexual
risk behaviours and perception of risk among college students: implications for
funding interventions.BMC public health, 9(1),1-13

Anguzu,R., Tweheyo, R., Sekandi, J. N., Zalwango,V., Muhumuza,C., Tusiime,S., &

Serwadda,D. (2014).Knowledge and attitudes towards use of long acting reversible
contraceptives among women of reproductive age in Lubaga division,Kampala
district, Uganda. BMC research notes,7(1), 1-9.

Blanc, A. K., Tsui, A. O., Croft, T. N., & Trevitt, J.L. (2009). Patterns and trends in
adolescents contraceptive use nd discontinuation in developing countries and
comparisons with adult women. International perspectives on sexual and
reproductive health,63-71

Cohen, S. A., & Richards, C. L. (1994).The Cairo Consensus:population,development

and women.(ICPD 1994)

Fenton, Kevin A.(2001). Strategies for improving sexual health in ethnic

minorities.current opinions on infectious diseases,14 (1),63-69

Gibbs,C.M.,Wendit, A.,Peters,S.,& Hogue C. J. (2012). The impact of early age at first

childbirth on maternal and infant health.Paediatric and perinatal
epidemiology,26,259-284.

Godia, P.(2010) Youth Friendly Sexual and Reproductive health services provision in
Kenya. What is the best model? Nairobi MOH.

ICSU, I.(2016). Review of the sustainable development goals: the science perspective.
International Council for science (ICSU); 2015

KDHS (2011) Kenya Demographic Health Survey on adolescent reproductive health

services

KDHS (2014) Kenya Demographic Health Survey report on reproductive health services
Kenya MOH (2016). National guidelines for provision of adolescent and youth friendly
services in Kenya,second edition. Nairobi.

Khani, S., Moghaddam Banaem, L., Mohammadi, E., Vedadhir, A., & Hajizedah, E.
(2014). The most common sexual and reproductive health needs in women referred
to healthcare and triangle centers of sari-2013. Journal of Mazandaran University of
Medical sciences 23(1),41-53

Kohan, S., Moammadi, F., Yazdi, M.,& Dadkhah,A. (2018). Evaluation of relationship
between reproductive health literacy and demographic factors in women. Journal of

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 health literacy 3(1),20-29

LIVE,W. A. W. (2010). Facts on sexual and reproductive health of adolescent women in

developing world.

Miriro, M.(2018) Fcators associated withlow uptake and utilization of reproductive health
services by female students in Masvingo Tertiary Institutions.

Morris, J.L., & Rushwan, H.(2015). Adolescent sexual and reproductive health:The
global challenges. International Journal of Gynecology &Obstetrics, 131,S40 –S42.

Obong’o, C. O., & Zani, A. P. (2014) Evaluation of the provision of sexual and
reproductive health services to ypoung people in Wagari and Keromo divisions,
Siaya County, Kenya. American journal of social sciences and humanities , 1(1),31-
42.

Roudi-Fahimi, Farzaneh, and Ashford, l. (2008). Sexual reproductive health in the middle
East and north Africa

Singh, S., & Darroch, J. E. (2012). Adding it up : cost and benefits of contraceptive
services- estimates 2012

Sugar, M. (Ed.). (2012). Adolescent parenthood. Springer Science & Business media.

Tegegn, A., Yazachew, M., & Gelaw, Y. (2008). Reproductive health knowledge and
attitude among adolescents: a community based study in Jimma Town, Southwest
Ethiopia. The Ethiopian journal of health development 22 (3).
UN- HABITAT (2008) A human rights imperative Geneva 2008(1993)

UNFPA (2019) Adolescent and youth demographics

UNFPA (2019)United Nation Population Fund Activities. The World population.

Ensuring rights and choices for all since 1969

WHO (2007) World Health organization. The Right to Health

WHO (2014).World Health Organization. Maternal, newborn,child and adolescent health

Yee-Tak Fong.(2021) An interactive Web-Based Sexual Health Literacy Program for

Safe Sex Practice for Female Chinese University Students: Multicenter randomized
Controlled Trial. Journal of medical Internet Research 23:3

22
 APPENDICES

Appendix 1: Workplan
ACTIVITY MAY JUNE JULY AUGUS SEP OCT NOV DEC
T
2021 2021 2021 2021 2021 2021 2021
2021

Topic
identification

Proposal
writing

Proposal
submission

Data
collection

Data analysis

Report
writing

Report
submission

23
Appendix 2: Budget
ITEM DESCRIPTION NO. OF ITEMS UNIT COST (KSHS.) TOTAL COST
(KSHS.)

STATIONERY

Ball pen 10 30 300

Hb Pencil 10 20 200

Eraser 5 10 50

Ruler 3 30 90

Sharpener 5 10 50

Ruled note books 5 50 250

Clipboard 2 100 200

Document wallet 3 50 150

Subtotal 1290

SERVICE

Internet access 1 1000 1000

Questionnaire photocopying 160 30 4800

DVD-RW 3 50 150

Typesetting 1 300 300

Binding 3 100 300

Proposal Photocopying 4 400 1600

Subtotal 8150

OTHER EXPENSES

Transport 1 3000 3000

Lunch 1 2000 2000

Miscellaneous 1 3000 3000

Subtotal 8000

GRAND TOTAL 17440

24
Appendix 3: Informed consent
Introduction: Good morning! My name is Rashid Salima from Jomo Kenyatta University
of Agriculture and Technology, Juja Campus. I am conducting a study on utilization of
reproductive health services among JKUAT students. For this reason I wish to have you
as one of my interview respondents.

Note:

1. This interview schedule is purely for academic purpose and all information
obtained herewith will be treated with strict confidentiality.

2. Response is purely on voluntary basis and no identification by name or

whatsoever will be required.

Do you wish to consent to participate?

1. Yes

2. No (end interview)

Please feel comfortable to answer all the questions and contact me for further
information or clarifications.

25
Appendix 4: Questionnaire
Section I: Demographic characteristics of the respondent

No. Question Coding categories

1.1 Age in years

1.2 Gender of respondent Male……………1

Female……………2

1.3 Year of study 1st year ……………1

2nd year ……………2
3rd year ……………3
4th year ……………4
5th year ……………5
6th year ……………6

1.4 Religion Protestant……………1

Catholic……………2
Muslim……………3

1.5 Home county

1.6 Living arrangements With a female roommate(s) within university…………

1
With a female roommate(s) outside university………
…2
With a male roommate(s) within university …………3
With a male roommate(s) outside university …………4
Living alone within university …………5
Living alone outside university …………6

Section 2: Reproductive health needs University students

26
No. Question Coding categories

2.1 What do you think are HIV & AIDS………………1

the main sexual
reproductive health Unwanted Pregnancies………………2
problems facing
Peer Influence………………3
university students
like yourself? Sexual Experimentation………………4
Sexual assaults………………5
Sexual exchange for favours………………6
STDs and STIs………………7

2.2 Do you think it is HIV & AIDS……………1

necessary for students
like you to be Guidance & Counselling……………2
provided with
STDs & STIs……………3
reproductive health
information? If yes Reproductive cancers……………4
concerning what?
Sexual orientation……………5
Sexual behaviours……………6

2.3 What are some of the Guidance & Counselling ……………1

reproductive health
services do you seek STDs & STIs screening & treatment……………2
as a university
HIV & AIDS testing & treatment……………3
student?
Cancer screening……………4
Pregnancy testing ……………5
Birth control……………6
HIV & AIDS prevention……………7

2.4 What are some of the Guidance & Counselling ……………1

reproductive health
services does the STDs & STIs screening & treatment……………2
university offer to you
HIV & AIDS testing & treatment……………3
as a student?
Cancer screening……………4
Pregnancy testing ……………5
Birth control……………6

27
 HIV & AIDS prevention……………7

2.5 Have you ever Yes……………1

attended any sessions
that encouraged you to No……………2
seek reproductive
health services as a
student?

2.6 How often are these Monthly……………1

sessions held in the
university? Fortnightly……………2
Weekly……………3
Daily……………4
No programme……………5

2.6 What reproductive Guidance & Counselling ……………1

health services have
you ever sought as a STDs & STIs screening & treatment……………2
student?
HIV & AIDS testing & treatment……………3
Cancer screening……………4
Pregnancy testing ……………5
Birth control……………6
HIV & AIDS prevention……………7
Other……………8
None……………9

2.7 How often do you Monthly……………1

seek reproductive
health services? Fortnightly……………2
Weekly……………3
Daily……………4
No programme……………5

2.8 Where do you oftenly University hospital……………1

seek reproductive
health services? Public hospital……………2
Private hospital……………3

28
 Other……………4

2.9 How did you learn Friends……………1

about the services you
sought and where to Social media……………2
seek them?
Mainstream media……………3
University campaigns/sessions……………4
Other……………4

3.1 Did you face any Yes……………1

difficulties in seeking
the services you No……………2
sought?

If yes, what The facility is far……………1

difficulties?
Unfriendly staff……………2
Affordability……………3
Confidentiality issues……………4
Inadequate services……………5
Other……………6

3.2 Do you think the Yes……………1

university is doing
enough to educate No……………2
students on matters
reproductive health?

3.3 What improvements

would you
recommend to the
university on matters
reproductive health?

29