Relationship power and partner support for family planning among postpartum adolescents in Kenya

Abstract Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa have significant unmet need for family planning (FP). Lack of partner support for FP may be a barrier to contraceptive use, and low relationship power may negatively impact AGYW’s ability to negotiate FP use and fertility desires with their partners. Research on partner support for family planning (FP) and relationship power dynamics among adolescents is lacking, and understanding these associations is important to provide optimal services that effectively address barriers AGYW face to access contraception. We aimed to identify correlates of partner support for FP after delivery and risk factors of low relationship power among AGYW in in Kenya. Methods: We conducted a cross-sectional study using survey data collected at two public-sector hospitals in the Nyanza region of Kenya. We used Poisson generalized linear regression with a log link function to assess for correlates of reported partner support for FP and low relationship power. Relationship power was measured using the Sexual Relationship Power Scale (SRPS). Categorical variables for all AGYW were compared using chi-square tests in analyses of social support for FP and of factors considered important in FP decision-making. Results: Overall, 498 postpartum AGYW, aged 14-21, participated in our study. Among AGYW with partners (n=353), relationship power was lower among those who reported their last pregnancy was unintended compared to intended/ambivalent (POR=2.58; 95% CI 1.79 to 3.72; p<0.001) and relationship power was higher among current contraceptive users than non-users (POR=0.55; 95% CI 0.38 to 0.79; p=0.001). AGYW who indicated that they had ever discussed FP with their partner, their partner knew about their FP use, or had received FP counseling with partner had lower odds of low relationship power (p<0.001 for all). Factors related to increased couple communication about FP were also associated with higher reported partner support for FP after delivery, including discussing FP with partner (POR=1.76; 95% CI 1.27 to 2.44, p<0.001), partner knowing about their FP (POR=2.41; 95% CI 1.53 to 3.80, p<0.001), and receiving FP counseling with partner (POR=1.32; 95% CI 1.02 to 1.70, p<0.001). Conclusion: We found AGYW whose most recent pregnancies were unintended had higher odds of low relationship power than those whose pregnancies were intended. AGYW who used modern contraception in the postpartum period and who reported more communication about FP with their partner were more likely to report high relationship power than those who did not use modern contraception or who did not report communication with their partner about FP. Additionally, partner support for FP was reported more often among AGYW who communicated with their partner about FP or received counseling about FP with their partner. AGYW with low relationship power may not be able to negotiate with their partner about their fertility intentions or preferences. Intervention strategies that encourage couple communication about FP may be effective in increasing partner support for FP and mitigating the risks to negative reproductive health outcomes associated with low relationship power.