FACTORS CONTRIBUTING TO CLOSER -BIRTH SPACING OF CHILDREN IN

KAPSAIT VILLAGE, ,WEST POKOT COUNTY.

GEOFFREY KAKUKO SIAPONG

BSN-1-8169-3/2019

A PROPOSAL SUBMITTED TO DEPARTMENT OF NURSING, SCHOOL OF

MEDICINE AND HEALTH SCIENCES IN PARTIAL FULFILMENT FOR THE

AWARD OF A DEGREE IN BACHELOR OF SCIENCE NURSING AT KENYA

METHODIST UNIVERSITY.

SEPTEMBER,2023

1
DECLARATION
I declare that this is my own original work and to the best of my knowledge, it has not been

submitted to any other institution of higher education. Appropriate referencing has been made

where the citation of other people's work has been done.

i
Student’s Name: GEOFFREY KAKUKO SIAPONG

Signature: Date

Reg. No.: BSN-1-8169-3/2019

Declaration by the Supervisor. This research work has been handed over with our approval as
the university supervisors.

Name: MADAM CAROLINE GITHAE

Lecturer

Department of Nursing

Kenya Methodist University

Signature: ………………………………. Date …………………………….

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DEDICATION

I dedicate this work to all the people from pokot community particularly those from kapsait sub
location who have experienced challenges that come with uplanned births and closer birth
spacing, I dedicate this work to my lecturers and family because of the unwavering support and
guidance.

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ACKNOWLEDGEMENT

I wish to start by acknowledging God for enabling me come up with this idea for I know it will
be of help to my target population. Secondly, I wish to thank my supervisor for the amazing
support through my research study and special gratitude to my Research Methods and
Biostatistics lecturers for giving me the basic knowledge on conducting research. Many thanks to
anyone who in one way or another supported me throughout my research study.

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TABLE OF CONTENT

Contents

DECLARATION.............................................................................................................................2

DEDICATION............................................................................................................................... 4

ACKNOWLEDGEMENT............................................................................................................ 5

TABLE OF CONTENT...................................................................................................................6

DEFINITION OF TERMS........................................................................................................... 9

LIST OF FIGURES.....................................................................................................................10

LIST OF TABLES.......................................................................................................................11

LIST OF ABBREVIATION....................................................................................................... 12

ABSTRACT..............................................................................................................................13

CHAPTER ONE ;INTRODUCTION........................................................................................15

1.1 BACKGROUND STATEMENT......................................................................................15

1.2 PROBLEM STATEMENT...............................................................................................17

1.3 BROAD OBJECTIVE.......................................................................................................18

1.3.1 SPECIFIC OBJECTIVES..............................................................................................18

1.3.2 RESEARCH QUESTIONS............................................................................................18

1.4 JUSTIFICATION OF THE STUDY................................................................................18

1.5 SIGNIFICANCE OF THE STUDY..................................................................................19

1.6 SCOPE OF THE STUDY..................................................................................................20

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 1.7 ASSUMPTIONS OF THE STUDY..................................................................................20

1.8 LIMITATION OF THE STUDY......................................................................................21

CHAPTER TWO : LITERATURE REVIEW..........................................................................21

2.1 INTRODUCTION..............................................................................................................21

2.2 Sociodemographic factors contributing to closer birth spacing....................................22

2.2 cultural factors contributing to closer birth spacing......................................................23

2.3 Attitude towards closer birth spacing..............................................................................25

2.3.1 Attitudes towards contraceptive use that contribute to closer birth spacing............25

2.4 CONCEPTUAL FRAMEWORK.....................................................................................29

CHAPTER 3 : RESEARCH METHODOLOGY.......................................................................30

3.1: Research design.................................................................................................................30

3.2: Study area..........................................................................................................................30

3.3: Study population...............................................................................................................30

3.3.2 Selection criteria..............................................................................................................30

3.5: Sampling Technique.........................................................................................................32

3.6: Data Collection and instrumentation.............................................................................33

3.7: Pretesting...........................................................................................................................33

3.8: Validity and reliability of research instruments............................................................33

3.9: Data analysis......................................................................................................................33

3.10 Ethical Considerations.....................................................................................................34

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CHAPTER FOUR: RESULTS...................................................................................................35

4.0 INTRODUCTION..............................................................................................................35

4.1 SOCIODEMOGRAPHIC CHARACTERISTICS..........................................................35

4.2: CULTURAL FACTORS..................................................................................................39

4.3: ATTITUDES TOWARDS CLOSER BIRTH SPACING.............................................45

CHAPTER FIVE: DISCUSSION OF THE STUDY, CONCLUSSIONS AND

RECOMMENDATIONS............................................................................................................ 47

5.0 INTRODUCTION..............................................................................................................47

5.1 DISCUSSIONS...................................................................................................................47

5.1.1: SOCIODEMOGRAPHIC CHARACTERISTICS.....................................................47

5.1.2: CULTURAL FACTORS...............................................................................................48

5.1.3: ATTITUDES TOWARDS CLOSER BIRTH SPACING..........................................49

5.2: CONCLUSIONS...............................................................................................................50

5.4 RECOMMENDATION.........................................................................................................50

REFERANCE.............................................................................................................................. 52

APPENDIX I: INFORMED CONSENT.....................................................................................55

APPENDIX II QUESTIONNAIRES...........................................................................................55

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS.............................................56

SECTION B: CULTURAL DATA............................................................................................57

SECTION C: ATTITUDES TOWARDS CLOSER BIRTH SPACING...................................60

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APPENDIX III: LETTER TO HOSPITAL ADMINISTRATION TO CONDUCT STUDY

....................................................................................................................................................... 64

APPENDIX IV: PERMISSION LETTER FFROM LOCAL AUTHORITY TO CONDUCT

STUDY..........................................................................................................................................65

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DEFINITION OF TERMS

Birth Spacing: The length of time between the birth of one child and the conception of the next

child.

Closer Birth Spacing: Refers to shorter intervals between pregnancies, where the time between

the birth of one child and the conception of the subsequent child is less than two years.

Infant Mortality: The death of an infant before their first birthday.

Low Birth Weight: Newborns weighing less than 2,500 grams (5 pounds, 8 ounces) at birth.

Maternal and Child Health Outcomes: Refers to the health and well-being of both the mother

and the child, which can be influenced by birth spacing practices.

Optimal Birth Spacing: The recommended length of time between pregnancies that is

associated with better maternal and child health outcomes. The World Health Organization

(WHO) recommends at least 24 months between pregnancies.

Preterm Birth: A birth that occurs before 37 weeks of gestation.

LIST OF FIGURES

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Figure 1: Conceptual framework...............................................................................................................15

Figure 2:Distribution of Age.......................................................................................................................21

Figure 3: Level of education......................................................................................................................22

Figure 4:Level of education.......................................................................................................................23

Figure 5:Occupation..................................................................................................................................23

Figure 6:Husband's level of education.......................................................................................................24

Figure 7:Number of living children...........................................................................................................25

Figure 8:Cultural beliefs and practices influence.......................................................................................26

Figure 9:Challenges faced by women........................................................................................................26

Figure 10:Rituals or ceremonies related to birth spacing in the community..............................................27

Figure 11:Rate importance of family planning in relation to cultural values and practices.......................28

Figure 12:Societal expectations regarding family size impact birth spacing decisions..............................29

Figure 13:Feel that the desire for a son influences birth spacing decisions in your community................29

Figure 14:Women in your community encouraged to have a say in birth spacing decisions.....................30

Figure 15:Community initiatives or programs in your village that promote birth spacing and family

planning.....................................................................................................................................................30

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LIST OF TABLES

Table 1:Marital status of respondents............................................................................................35

Table 2:Distance from your residence to the nearest healthcare facility.......................................37

Table 3;Common sources of information......................................................................................40

Table 4:Attitude towards closer birth spacing...............................................................................44

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LIST OF ABBREVIATION

ICF : International Classification of Function

KNBS : Kenya National Beurea of Statistics

UNFPA : United Nations Population Fund.

WHO : world Health Organisation

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 ABSTRACT

Birth spacing of children is a crucial component of family planning and fertility behavior. The
recommended birth spacing by WHO is two years. Closer birth spacing has been associated with
many maternal and child health-related problems like preeclampsia in the case of mothers and
preterm birth in children, to name a few. This study aimed to determine factors contributing to
closer birth spacing of children in kapsait village, pokot south subcounty,west pokot county. The
objectives were to determine sociodemographic, cultural and attitude towards closer birth
spacing in Kapsait village, West pokot county. A cross-sectional study design will be used to
collect data and, and the sampling technique included both cluster sampling and simple random
to collect data from 74 households. The sample size was determined using the fisher et al
formula. The population of this study comprised of women of childbearing age (15-49 years)
who had experienced at least two successive births, with the last birth occurring within five years
prior to the data collection period. A pilot study was conducted at kipat village. Data was
collected using the researcher administered questionnaires and were analyzed using Microsoft
excel and data presented using pie chart graphs and tables. The findings revealed the following
significant trends: Sociodemographic factors: Age, marital status, and education level were
found to influence birth spacing decisions. Notably, 36.5% of the respondents indicated their age
to be between 36-45 years, 40.5% were married, and 39.2% were uneducated. Additionally, 32%
of the respondents were housewives. Cultural factors: Cultural beliefs and practices played a
crucial role in birth spacing decisions, with 62% of respondents acknowledging their influence.
Challenges in discussing or accessing family planning methods were faced by 59.5% of women.
Importantly, 54% of participants highlighted societal expectations regarding family size
impacting birth spacing choices. Attitudes toward closer birth spacing: Attitudes varied, with
40% strongly disagreeing that contraceptive use is effective for birth spacing. Conversely, 49%
strongly agreed that access to quality healthcare services is crucial for informed birth spacing
decisions, and 43% strongly disagreed that using contraception shows responsible family
planning. Furthermore, 47% strongly agreed that religion or cultural beliefs interfere with
contraceptive use. These findings emphasize the need for targeted interventions and community
engagement to address sociodemographic and cultural influences on birth spacing decisions.
Therefore, the study recommends that, to promote informed choices, county and sub-county
nurses should organize mass campaigns and ensure accessible resources. Sub-county nurses
should collaborate with community leaders and conduct further research to gain deeper insights
into specific cultural beliefs, practices, and societal expectations in Kapsait village. This
approach, involving both education and cultural sensitivity, can empower women and
communities to make informed birth spacing decisions, ultimately improving maternal and child
health in the area.

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CHAPTER ONE; INTRODUCTION.

1.1 BACKGROUND STATEMENT

Birth spacing refers to the length of time between the birth of one child and the conception of the

next. It plays a crucial role in maternal and child health outcomes, as well as the overall well-

being of families and communities

Globally, birth spacing practices have been influenced by various factors. Rapid population

growth, economic instability, and limited access to family planning services are some of the

common challenges faced by many regions. According to the World Health Organization

(WHO), an optimal birth spacing of at least 24 months between pregnancies is associated with

reduced maternal and infant mortality rates (WHO, 2019).

A study conducted in India have highlighted that shorter birth spacing increases the risk of

adverse maternal health outcomes, including anemia, preterm birth, and low birth weight.

Furthermore, it negatively affects child health and development, leading to higher rates of infant

mortality and poorer cognitive and physical in India by Titaley et al. (2020) .Similarly, study

conducted by Victora et al. (2019) in Brazil examined the effects of short birth spacing on child

health and development. The study revealed that shorter birth intervals were associated with

higher rates of infant mortality and impaired growth in children. Additionally, the research found

that children born with short birth intervals were more likely to experience nutritional

deficiencies and developmental delays.

In Africa, a study done in Nigeria, to examine the implications of inadequate birth spacing

revealed that shorter birth intervals were associated with higher rates of maternal mortality,

underlining the importance of optimal birth spacing for maternal well-being (Mekonnen et al.,

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2019).similarly , a study conducted by Chikhungu et al. (2020) investigated the factors

influencing birth spacing in Malawi and found out that maternal education, age, parity, and

contraceptive use were significant determinants of birth intervals. Furthermore, cultural beliefs

and socio-economic factors were also found to influence birth spacing decisions in the country.

These findings provide important insights into the factors shaping birth spacing practices and

inform interventions to promote optimal birth spacing

In East Africa, a study conducted in Burundi on child spacing and intervals found out that in

many communities, the desire for larger family sizes, traditional beliefs, and gender norms play a

significant role in influencing birth intervals (Ouédraogo et al., 2020). Additionally, limited

access to quality healthcare, including family planning services, in remote and underserved areas

poses challenges to implementing effective birth spacing strategies. These factors contribute to

shorter birth intervals, increasing the risks to maternal and child health. In Uganda, a

comprehensive study conducted by Kabagenyi et al. (2020) examined the factors influencing

birth spacing in the country. The study found that maternal education, employment, and access to

contraceptives significantly influenced birth intervals. Additionally, sociocultural factors, such as

spousal communication and gender dynamics, played a role in birth spacing decisions.

Kenya, as a country, faces unique challenges regarding birth spacing. The population growth rate

remains high, with an estimated annual increase of 2.5% (UNFPA, 2020). This growth puts

strain on healthcare services and resources, affecting the quality of care provided to pregnant

women and infants. Moreover, cultural practices, such as early marriages and pregnancies,

influence birth spacing patterns, leading to closer birth intervals and associated health risks.

Relevant study conducted in West Pokot County is the research by Wanyama et al. (2017). The

study explored factors associated with inter-birth interval among women attending postnatal

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clinics in the county, including Kapsait village. The region faces challenges such as limited

access to healthcare facilities, inadequate infrastructure, poverty, and cultural beliefs that

influence birth spacing practices. These factors contribute to shorter birth intervals, potentially

leading to increased maternal and child mortality rates (Wanyama et al., 2017; KNBS & ICF,

2015 ). It examined the influence of socioeconomic factors, education, access to healthcare

services, and cultural practices on birth spacing patterns in the region.

1.2 PROBLEM STATEMENT

Although optimal birth spacing is a crucial component of family planning and fertility behavior,

the prevalence of closer birth spacing in Kapsait village, West Pokot County, Kenya, raises

significant concerns about its potential impact on maternal and child health . Closer birth

spacing, characterized by shorter intervals between pregnancies, can have adverse effects on

maternal health, as women may not have sufficient time to recover physically and replenish

nutritional stores between pregnancies. It also increases the risk of maternal complications, such

as anemia, preterm birth, low birth weight, and maternal mortality (Conde-Agudelo et al., 2019).

For children, closer birth spacing is associated with higher rates of infant mortality, stunting, and

poor overall growth and development (Abera et al., 2016).

Women with a closer birth spacing (less than six months after giving birth) have a 70% higher

risk of preterm birth than women with optimal inter-pregnancy interval (absolute risk is 10%),

while in an inter-pregnancy interval between six months to 11 months is 20% higher (Baer et al .,

2017).

Furthermore, the social and economic implications of closer birth spacing can be profound, as it

may hinder women's educational and employment opportunities, perpetuate poverty cycles, and

strain limited resources within families and communities (Casterline et al., 2017). Therefore, it is

3
imperative to conduct comprehensive research to identify the factors contributing to closer birth

spacing in Kapsait village, West Pokot County.

1.3 BROAD OBJECTIVE

To determine factors contributing to closer- birth spacing in in Kapsait village, West Pokot

County.

1.3.1 SPECIFIC OBJECTIVES

i. To determine Sociodemographic factors which contribute to closer birth spacing in

Kapsait village, West pokot county.

ii. To determine cultural factors contributing to closer birth spacing in Kapsait village,

West pokot county.

iii. To determine the attitude towards closer birth spacing in Kapsait village, West pokot

county.

1.3.2 RESEARCH QUESTIONS

i. What are the sociodemographic factors that contribute to closer birth spacing in Kapsait

village, West Pokot County?

ii. What are the cultural factors contributing to closer birth spacing in kapsait village west

pokot county?

iii. What is the attitude towards closer birth spacing in Kapsait village, West Pokot County?

1.4 JUSTIFICATION OF THE STUDY

The study on factors contributing to closer birth spacing of children in Kapsait Village, Pokot

South Subcounty, West Pokot County is essential for improving maternal and child health

4
outcomes. By understanding the determinants of birth spacing in this specific context, the study

aims to inform the development of targeted interventions and policies.

The findings will benefit the local community by raising awareness of the importance of birth

spacing and empowering individuals to make informed decisions. Healthcare providers will be

better equipped to deliver appropriate reproductive health services, while policy makers and

planners can develop evidence-based strategies to improve birth spacing practices. Non-

governmental organizations and development partners can align their interventions with the

specific needs of the community. Ultimately, the study aims to enhance maternal and child

health, guide family planning programs, empower the community, and inform health service

planning at the local and national levels. Short birth intervals can increase the risk of maternal

complications, such as anemia, preterm birth, and low birth weight, as well as negatively impact

the health and development of children. By identifying the factors influencing closer birth

spacing in Kapsait village, interventions can be developed to promote optimal birth spacing, thus

reducing the health risks associated with short birth intervals. (Rutaremwa et al., 2018).

Optimal birth spacing allows women to recover from the physical and psychological effects of

pregnancy, promotes economic stability, and improves the overall well-being of parents and

children.By understanding the factors influencing birth spacing practices, interventions can

support families in making informed decisions and allocating resources effectively (Cleland et

al., 2021; Maina et al., 2020).

1.5 SIGNIFICANCE OF THE STUDY

The study holds significant importance as it has the potential to bring about targeted

interventions, encourage healthier birth spacing, and enhance the well-being of mothers and

children in Kapsait village, West Pokot County. By uncovering the factors influencing closer

5
birth spacing, policymakers and healthcare providers can create strategies based on evidence to

directly address these factors. This approach could result in reduced risks of complications for

both mothers and infants, improved child development, and enhanced maternal well-being

overall (Maina et al., 2018). Furthermore, involving the community in the research process

empowers them, ensuring that interventions are culturally suitable and acceptable. This study

bridges a critical gap in understanding birth spacing practices within the specific context of

Kapsait village, offering insights that extend to comparisons with other regions (Njoroge et al.,

2020). Ultimately, the study's findings have the potential to make a positive impact on the lives

of women and children in Kapsait village, enriching their quality of life, health, and future

opportunities.

1.6 SCOPE OF THE STUDY

The study will focus specifically on Kapsait Village, located within Pokot South Subcounty,

West Pokot County. It will investigate the factors contributing to closer birth spacing of children

within this particular community. The study will consider sociodemographic factors,

sociocultural influences, and attitudes towards contraceptive use as potential determinants of

birth spacing. Data will be collected from women of reproductive age attending Maternal and

Child Health services in Kapsait Village to obtain a comprehensive understanding of the factors

influencing birth spacing practices in the community.

1.7 ASSUMPTIONS OF THE STUDY

The study assumes that the participants will provide accurate and reliable information regarding

their birth spacing practices and the factors that influence them. It also assumes that the

participants will be willing to share their experiences and perspectives on birth spacing.

6
Additionally, the study assumes that the data collected will be representative of the broader

population of women of reproductive age in Kapsait Village.

1.8 LIMITATION OF THE STUDY

The findings may not be generalizable to other communities or regions outside of Kapsait

Village. The specific sociocultural and demographic characteristics of the village may limit the

generalizability of the results to a larger population. Another limitation is that the study will

rely on self-reported data, which may be subject to recall bias or social desirability bias.

Participants may not accurately remember or disclose information about their birth spacing

practices.

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CHAPTER TWO: LITERATURE REVIEW

2.1 INTRODUCTION

Close birth spacing refers to the time interval between the birth of one child and the conception

of the subsequent child. Optimal birth spacing is crucial for the health and well-being of both the

mother and the child (Conde-Agudelo et al., 2017). It is an essential maternal and child health

intervention. There are health-related risks associated with both shorter and longer birth spacing,

but most of them are associated with those births spaced closely (Azad et al., 2018).

This chapter focuses on studies done by other researchers related to the subject of the matter and

the study's conceptual framework.

2.2 Sociodemographic factors contributing to closer birth spacing.

Global research suggests that several sociodemographic factors influence birth spacing. Higher

levels of education and economic status tend to be associated with longer birth intervals, as

women with more education and financial resources may have increased access to family

planning services and may choose to delay or space their pregnancies to achieve their desired

family size. Additionally, urban residence and access to healthcare services have been linked to

longer birth intervals.

A study done in Bangladesh by Cleland et al. (2018) to assess determinants of birth spacing and

the effects, age and Mother's educational level were some of the Sociodemographic factors found

to contribute to closer birth in Bangladesh. Mothers who had first birth on age 21 to 25 had 14%

increased birth interval than those having on or before reaching age 15. Mothers who had first

birth after 36 years had a 74% larger interval than mothers having first birth before 15 years.

8
From the study also, women with no education had shorter inter-pregnancy intervals than

educated mothers. This means that educated mothers tend to understand the benefits of the

recommended birth spacing by WHO, unlike those with no education.

In a study done by Pimentel et al. (2020) to assess factors associated with shorter birth intervals

in low- and middle-income countries, where shorter birth intervals were associated with the

younger age of the mother. The reasons given behind this were that younger mothers were more

fertile and sexually active. Older women are likely to have reached their desired family size and

are less fertile, and therefore tend to prolong their birth intervals.

In a study done by McGuire and Stephenson (2017), to assess community factors influencing

birth spacing among married women in Uganda and Zimbabwe, low mean age at first childbirth

and low mean age at marriage was found to reduce woman's use of contraception and uptake of

maternal health services and therefore shorter birth spacing.

In Kenya, broader studies within the country have highlighted the influence of education, wealth

index, and maternal age on birth spacing practices. For instance, Maina et al. (2019) reported that

educational attainment significantly influences birth spacing decisions among women of

reproductive age. Women with higher education levels are more likely to have longer birth

intervals., additionally Njoroge et al. (2020) found that wealth index and maternal age

influenced birth spacing in rural Kenya.

2.2 cultural factors contributing to closer birth spacing

Cultural factors significantly shape birth spacing practices across various regions. For instance, a

study by Singh et al. (2020) in India revealed the impact of traditional beliefs, gender

preferences, and societal pressures for having a son on birth spacing decisions. In areas where

9
traditional gender norms favor larger families, especially with sons, shorter birth intervals are

more common.

In a study done by Gemmil and Lindberg (2018) to investigate the prevalence and correlates of

short inter-pregnancy intervals in the United States, ethnicity was one of the determinants for

short inter-pregnancy intervals where births to non-Hispanic women were more likely than births

to Hispanic women to have a short inter-pregnancy interval. The percentage of pregnancies

among those ethnic groups was as follows: non-Hispanic women had 36.5%, non-Hispanic black

had 39.6%, non-Hispanic other had 29 7%.

In an African context, cultural norms and preferences for large family sizes have been found to

contribute to shorter birth intervals. Ahmed et al. (2017) identified this influence in Ethiopia,

where societal expectations for larger families may discourage birth spacing. Adjiwanou and

LeGrand (2021) examined birth spacing practices in Togo and found that gender norms and

preferences for male children influenced birth intervals, with shorter intervals observed when the

first child was a girl.

In another study done in Nigeria among Kanuri women by Mairiga et al.(2019), few women

practiced modern methods of family planning for fear of delay in return to fertility, damage to

the reproductive system, especially the uterus, belief that modern methods of family planning

were introduced to reduce the Muslim culture , claimed that modern methods of family planning

belonged to a foreign culture. Hence, they only practiced the traditional methods of family

planning which in most cases were not effective at all and hence the reason for shorter birth

spacing.

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A study conducted in Rwanda by Uwimana, J. et al. (2018) on the role of gender norms and

preferences in birth spacing practices, revealed that traditional expectations regarding family size

and gender preferences significantly influenced the timing of pregnancies, leading to shorter

birth intervals in pursuit of having a desired number of children of a specific gender.

In a study done in kenya by Makwaya et al. (2018) the study investigated the cultural factors

affecting birth spacing practices among women in rural Kenya. It explored the influence of

cultural beliefs, traditional practices, social norms, and community support systems on birth

spacing decisions.

2.3 Attitude towards closer birth spacing

The choices individuals make regarding birth intervals are shaped by a multitude of factors,

including cultural norms, access to medical services, socioeconomic conditions, and community

influences. Understanding these attitudes towards birth spacing is essential for devising effective

interventions that promote optimal maternal and child health outcomes.

2.3.1 Attitudes towards contraceptive use that contribute to closer birth spacing

Attitudes towards contraceptive use are crucial determinants of birth spacing practices globally.

Positive attitudes, knowledge about contraceptive methods, and access to family planning

services have been associated with longer birth intervals (Sharma et al., 2017).

Globally, study conducted in India found that negative attitudes towards contraception were

associated with cultural and religious beliefs, including the desire for large families and the

perception that contraception is against religious teachings (Sedgh et al., 2019). Similarly,

11
research in Bangladesh revealed that misconceptions and negative attitudes towards

contraceptives were prevalent, leading to shorter birth intervals (Rahman et al., 2020).

In africa, a study conducted in Ghana, negative attitudes towards contraception were linked to

cultural beliefs that favored large family sizes and the perception that contraceptive use would

lead to infertility (Fagbamigbe et al., 2017). Another study in Nigeria identified misconceptions

and negative attitudes towards contraceptives as barriers to birth spacing, highlighting the need

for educational interventions (Adedini et al., 2021). These findings emphasize the significance of

cultural and contextual factors in shaping attitudes towards contraception in African settings.

Other studies in Ethiopia have explored attitudes towards contraceptive use. Habte et al. (2020)

found that misconceptions about contraceptives, fear of side effects, and lack of spousal support

were barriers to contraceptive utilization and optimal birth spacing. These findings highlight the

importance of addressing misconceptions and improving access to accurate information about

contraceptive methods.

In Kenya, a survey conducted in Kenya revealed that negative attitudes towards contraception

were associated with concerns about side effects, lack of knowledge, and cultural beliefs (Kenya

National Bureau of Statistics & ICF International, 2017). Additionally, a study in urban slums of

Nairobi found that negative attitudes towards contraceptives were prevalent, often influenced by

misinformation and cultural norms (Wambui et al., 2017). These studies highlight the importance

of addressing knowledge gaps, cultural beliefs, and misconceptions to promote positive attitudes

towards contraceptive use and longer birth intervals in Kenya.

2.3.2 Attitudes Towards Availability of Medical Services and Birth Spacing

12
Research conducted in India, such as the work of Raj et al. (2017), has emphasized the influence

of healthcare accessibility on birth spacing attitudes. The study highlights that areas with

improved healthcare infrastructure tend to exhibit more favorable attitudes towards longer birth

intervals. Access to family planning resources and information directly impacts women's

decisions concerning birth spacing, underscoring the need for enhanced healthcare access to

foster informed family planning choices. Studies in Bangladesh, like Huda et al. (2018), delve

into the dynamics of birth spacing attitudes. These studies reveal that regions with better access

to healthcare facilities tend to exhibit attitudes favoring longer birth intervals. Improved

healthcare accessibility directly correlates with increased awareness of family planning methods,

influencing individuals' birth spacing preferences. These insights highlight the significance of

healthcare access in shaping birth spacing attitudes within the Bangladeshi context.

Research within Nigeria, exemplified by Adebowale et al. (2016), has explored the nexus

between attitudes towards medical service availability and birth spacing. The study reveals that

regions with enhanced healthcare accessibility tend to exhibit attitudes favoring longer birth

intervals. Improved access to reproductive health services empowers women with the resources

necessary for informed family planning decisions, influencing their birth spacing preferences

within the Nigerian context.In Ethiopia, studies such as the work of Asresie et al. (2020) have

investigated the role of healthcare accessibility in shaping birth spacing attitudes. The research

underscores that areas with improved healthcare infrastructure are associated with more positive

attitudes towards longer birth intervals. Access to comprehensive reproductive health services

directly influences individuals' decisions concerning birth spacing, emphasizing the importance

of addressing healthcare barriers within the Ethiopian context.

13
Within Tanzania, research by Exavery et al. (2020) delves into attitudes towards medical service

availability and birth spacing. The study highlights that healthcare accessibility significantly

influences birth spacing attitudes, particularly in regions with enhanced healthcare infrastructure.

Access to family planning resources shapes informed decisions concerning birth intervals,

illustrating the impact of healthcare access on reproductive choices within the Tanzanian context.

Studies within Rwanda, such as the work of Musabirema et al. (2019), explore the interplay

between healthcare availability and birth spacing attitudes. The research indicates that areas with

better access to healthcare facilities tend to exhibit attitudes that favor longer birth intervals.

Improved healthcare accessibility enables individuals to make informed family planning

decisions, directly impacting their birth spacing preferences.

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 2.4 CONCEPTUAL FRAMEWORK.

INDEPENDENT VARIABLE. DEPENDENT VARIABLE.

SOCIODEMOGRAPHIC FACTORS

 Education level

 Maternal age

CLOSER-BIRTH SPACING
SOCIOCULTURAL FACTORS

 Cultural norms

 Gender preference

 Societal pressure

ATTITUDE Figure 1: Conceptual framework

 Contraceptive use

 Availability of medical services.

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CHAPTER 3 : RESEARCH METHODOLOGY

3.1: Research design

In this study, a descriptive cross-sectional survey design was employed to determine the factors

contributing to closer birth spacing in Kapsait village. The choice of the cross-sectional survey

design was motivated by its cost-effectiveness and the shorter time required compared to other

designs.

3.2: Study area

The study was conducted in Kapsait village, located within Pokot South sub-county, West Pokot

County. This village is situated in the North Rift of the Great Rift Valley and is predominantly

inhabited by the Pokot community, engaged in subsistence farming and pastoralism

3.3: Study population

The study targeted women of childbearing age (15-49 years), specifically those who had given

birth within the last five years before the data collection period or were currently pregnant.

3.3.1Target population

The target population included women in Kapsait village who were of reproductive age and had

given birth to at least one child, putting them at risk of conceiving another child. This group was

of primary interest as they were directly involved in birth spacing decision-making and

behaviors, enabling meaningful conclusions about birth spacing factors.

3.3.2 Selection criteria

3.3.3 Inclusion criteria

16
The study included women of childbearing age (15-49 years) who had given birth within the last

five years and had at least two consecutive births, with a birth interval of fewer than two years

between the latest two successive births.

3.3.4Exclusion criteria.

Women who were unable or unwilling to participate in the study.

Mothers who were sickly.

3.4: Sample size determination

Fischer's formula used to determine the sample size-

n = z2pq

d2

Where,

n=desired sample size when the population is more than 10,000

z=standard normal deviate at the required confidence level(0.96)

p=proportion of the population with the desired characteristic 50%(0.5)

q=proportion of the population without the desired characteristic,1-p(0.5)

d=level of statistical significance test 5%(0.05)

n= (1.96) (1.96)0.5(1-0.5)

(0.05)(0.05)

17
 n=384

Where;

For a population less than 10 000, the formula is:

nf= n/ (1+ (n/N)

nf =desired sample size when the population is less than 10,000

n=initial sample size

N=population size estimate (120 )

nf= 384

1+(384/120)

=73.8462

nf=74 women.

3.5: Sampling Technique

The researcher adopted simple random sampling technique. This enabled the

individuals in the target population to have an equal probability of being chosen. .

Household register was obtained from the area community health workers (MoH 513)

indicating all households, the researcher assigned a number to each household and

choose randomly 74 numbers from 1 to 120, this made the sample size.

18
3.6: Data Collection and instrumentation

Data collection tools comprised semi-structured questionnaires with both open-ended and close-

ended questions. A Likert scale was used to assess respondents' attitudes. Questionnaires were

administered to literate participants, while interviews were conducted for those unable to read

and write. The questionnaire was designed to align with the study's objectives.

3.7: Pretesting

The pretest was done in kipat village, a neighboring village.A random sample of 10% (8) of

sample size will be used. The respondents were asked to fill in the questionnaires and their

views on the wording and structure of questions was collected. Their recommendations was

considered in the revision of the questionnaire to make necessary adjustments.

3.8: Validity and reliability of research instruments

The questionnaire was developed based on a comprehensive review of relevant

literature on child spacing and related topics. Semi-structured questionnaires that was

used in collection of data from the target population was pretested in Kipat village,

West Pokot County. The purpose was to identify any errors in the questionnaire and

correct them before data collection to ensure reliability of the study. Eight

questionnaires were pre-tested through a pilot test. Their feedback helped in making

vital adjustments to enhance reliability and of the study findings. Examination of the

study instrument was done by a professional who is the supervisor to ascertain validity

of the data collection tool.

19
3.9: Data analysis

The data that will be collected from the research study will be stored and analyzed using

Microsoft Excel Data collected in the study were stored and analyzed using Microsoft Excel.

Descriptive statistics, including mean, percentage, frequency, and standard deviation, were

calculated, and the results were presented using frequency distribution tables, bar graphs, and pie

charts.

3.10 Ethical Considerations

Permission and approval were obtained from Kenya Methodist University through the

Department of Nursing before conducting the study. Additionally, permission from the village

chief was obtained. Informed consent was sought from willing participants, and steps were taken

to ensure privacy, confidentiality, and anonymity throughout the study. Respondents were given

the opportunity to seek clarification about the study as needed.

20
 CHAPTER FOUR: RESULTS

4.0 INTRODUCTION

The primary objective of this study was to evaluate the factors influencing shorter birth intervals
in Kapsait village, located within West Pokot County. Within this chapter, the results have been
analyzed using Microsoft Excel 2016, aligning with the study's objectives. A total of 74
participants were included in the study, and data were collected through the administration of
questionnaires. The study achieved a remarkable 100% response rate, with all 74 participants
providing valuable input. The findings have been effectively presented through tables, graphs,
and pie charts for enhanced clarity and visual representation.

4.1 SOCIODEMOGRAPHIC CHARACTERISTICS

4.1.1: Age of Respondents

36.50%

40.00%
29.70%

35.00%
20.30%

30.00%
25.00%
20.00%
Percentage

13.50%

15.00%
10.00%
5.00%
0.00%
15-25 years
26-35 years
36-45 years
46 years and
above
Distribution of age

Column3

Figure 2:Distribution of Age

21
Majority of the respondents 36.5%(27) indicated their age to between 36-45 years, 29.7%(22)

indicated age to be 26-35 years, 20%(15) indicated 15-25 years while 14%(10) indicated 46 and

above years.

4.1.2: Marital status of respondents

Table 1 below indicates marital status. Majority of the participants 40.5%(30) indicated they are
married, 25.7%(19) single, 21.6%(16) separated, 8.1%(6) divorced while 4.1%(3) widowed.

Table 1:Marital status of respondents

Marital status Frequency Percentage

Married 30 40.5

Single 19 25.7

Divorced 6 8.1

Separated 16 21.6

Widowed 3 4.1
Total 74 100

4.1.3: Level of education

Tertiary education 8.10%

level of education

Secondary 23.00%

Primary 29.70%

No formal education 39.20%

0.00% 10.00% 20.00% 30.00% 40.00% 50.00%

Percentage

Column3

Figure 3: Level of education

22
Figure 4:Level of education

A great number of the respondents 39.2%(29) indicated they were uneducated, 29.7%(22)

primary level of education, 23%(17) secondary level of education, while 8%(6) tertiary

education

4.1.4: Occupation

Unemployed
19% House wife
32%

Student
15%

Civil servant
Self-employed 12%
22%

House wife Civil servant Self-employed

Student Unemployed

Figure 5:Occupation
Majority of the respondents 32%(24) indicated they were house wife, 22%(16) self-employed,

19%(14) unemployed, 15%(11) student while 12%(9) civil servants

4.1.5: Husband's level of education

23
 40.00% 37.80%
35.00%

30.00% 27.00%
25.70%
25.00%
Percentage

20.00%

15.00%
9.50%
10.00%

5.00%

0.00%
No formal educa- Primary Secondary Tertiary education
tion
Response

Column3

Figure 6:Husband's level of education

Most of the respondents 37.8%(28) indicated their husbands level of education to be primary,

27%(20) indicated secondary education, 25.7%(19) not educated while9.5%(7) tertiary education

4.1.6: Distance from your residence to the nearest healthcare facility

Majority of the respondents 40.5%(30) indicated the nearest facility is between 5-10 km,
25.7%(19) indicated less than 5 km, 19.2%(15) indicated 10-20 km, while 13.5%(10) more than
20 km,

Table 2:Distance from your residence to the nearest healthcare facility

Distance Frequency Percentage

Less than 5 kilometers 19 25.7

5-10 kilometers 30 40.5

10-20 kilometers 15 19.2

More than 20 10 13.5

kilometers
Total 74 100

24
4.1.6: Number of living children

100%
90%
80%
70%
60%
Percentange

50% 9.50% 21.60% 32.40% 36.50%

40%
30%
20%
10%
0%
None 1-2 children 3-4 children 5 or more
number of children

Column3

Figure 7:Number of living children

Majority of the respondents 37%(27) indicated they have 5 children or more, 32.4%(24)
indicated 3-4 children, 21.6%(16) indicated 1-2 children while 9.5%(7) indicated none.

25
4.2: CULTURAL FACTORS

4.2.1: Cultural beliefs and practices influence birth spacing decisions in the community

NO
38%

YES
62%

YES NO

Figure 8:Cultural beliefs and practices influence

Majority of the respondents 62%(46) indicated that Cultural beliefs and practices influence birth

spacing decisions in the community while 38%(28) indicated it does not

4.2.2: Challenges faced by women in discussing or accessing family planning methods

59.50%

70.00%
60.00%
40.50%

50.00%
Percentage

40.00%
30.00%
20.00%
10.00%
0.00%
Yes No
Response

Column3

Figure 9:Challenges faced by women

26
Majority of the participants 59.5%(44) indicated that women are faced with challenges in

discussing or accessing family planning methods while 40.5%(30) indicated no challenges faced

4.2.3: Any rituals or ceremonies related to birth spacing in the community

YES
46%
NO
54%

YES NO

Figure 10:Rituals or ceremonies related to birth spacing in the community

Majority 54%(40) indicated that there are no rituals or ceremonies related to birth spacing in the

community while 46%(34) indicated there are rituals

4.2.4: Common sources of information and influence regarding birth spacing decisions

within the community

Table 3 below indicates respondents source of information. Majority of the participants

39.2%(29) indicated that family members as the source of information that influence regarding
birth spacing decisions within the community, 25.7%(19) indicated peers/friends, 24.3%(18)
indicated healthcare providers, while 10.8%(8) indicated religious leaders.

Table 3;Common sources of information

Source of No of the Percentage (%)

information respondents
Family members 29 39.2

27
 Religious leaders 8 10.8

Healthcare providers 18 24.3

Peers/friends 19 25.7

Total 74 100

4.2.5: Rate importance of family planning in relation to cultural values and practices

45.00%
40.00%
35.00%
30.00%
percentage

25.00%
40.50%
20.00%
15.00% 24.30%
10.00% 13.50% 14.90%

5.00%
0.00%
Very important Important Somewhat important Not important
importance

Figure 11:Rate importance of family planning in relation to cultural values and practices
Majority of the participants 41%(30) indicated that family planning is somehow important in

relation to cultural values and practices, 24.3%(18) indicated important 13.5%(10) indicated very

important, while 14.9%(16) indicated not important.

28
4.2.6: Societal expectations regarding family size impact birth spacing decisions

NO
46%
YES
54% YES
NO

Figure 12:Societal expectations regarding family size impact birth spacing decisions
A great number of the respondents 54%(40) indicated that there are Societal expectations

regarding family size impact birth spacing decisions while 46%(34) indicated there are not

4.2.7: Feel that the desire for a son influences birth spacing decisions in your community

47.20% YES
52.70% NO

Figure 13:Feel that the desire for a son influences birth spacing decisions in your community

Most of the participants 52.7%(39) indicated they Feel that the desire for a son influences birth
spacing decisions in your community while 47.2%(39) indicated it doesn’t

29
4.2.8: Women in your community encouraged to have a say in birth spacing decisions

YES
39%
YES
NO
NO
61%

Figure 14:Women in your community encouraged to have a say in birth spacing decisions
Most of the participants 61%(45) indicated that women in their community are not encouraged to
have a say in birth spacing decisions while 39%(29) Women in their community are encouraged
to have a say in birth spacing decisions

4.2.9: Community initiatives or programs in your village that promote birth spacing and
family planning
67.70%

70.00%
60.00%
32.40%

50.00%
Percentage

40.00%
30.00%
20.00%
10.00%
0.00%
Yes
No

Response
Column3

Figure 15:Community initiatives or programs in your village that promote birth spacing and
family planning

30
Majority of the respondents 67.7%(50) indicated that there are no community initiatives or
programs in your village that promote birth spacing and family planning, while 32.4%(24) they
exist

4.3: ATTITUDES TOWARDS CLOSER BIRTH SPACING

The table 4 below indicates the respondent’s response on attitude towards closer birth spacing.
Most of the respondents (40) strongly disagreed that they believe that contraceptive use is an
effective way to achieve birth spacing. Moreover, a great number (49) of the subjects strongly
agreed that Access to quality healthcare services is crucial for making informed decisions about
birth spacing. Additionally, most of the respondents (43) strongly disagreed that think that using
contraception shows responsible family planning. Out of the 74 respondents, 34 strongly
disagreed that family planning methods are easily accessible in our community. Moreover, most
of the participants (47) strongly agreed that they believe that religion or cultural beliefs interfere
with contraceptive use. Most of the respondents (30) indicated they strongly believe that
discussing family planning openly with partners is important for birth spacing. Additionally,
majority of the subjects (39) strongly agreed that community support and education are
important in promoting contraceptive use. A great number of the participants (33) strongly
agreed that they are concerned about the effectiveness of contraceptives for birth spacing. Lastly,
majority of the respondents agreed that lack of access to healthcare services can lead to
unplanned pregnancies and shorter birth intervals

Table 4:Attitude towards closer birth spacing

Attitude towards closer birth spacing 1 2 3 4

I believe that contraceptive use is an effective way to 4 9 22 40

achieve birth spacing
Access to quality healthcare services is crucial for 49 23 5 1
making informed decisions about birth spacing.
Do you think that using contraception shows 5 8 18 43
responsible family planning?

31
Family planning methods are easily accessible in our 13 7 14 34
community
Do you believe that religion or cultural beliefs interfere 47 12 9 4
with contraceptive use
Do you think discussing family planning openly with 30 22 16 6
partners is important for birth spacing
Community support and education are important in 39 12 13 10
promoting contraceptive use
Having readily accessible information about family 22 30 16 10
planning services encourages me to consider longer
birth intervals.
I am concerned about the effectiveness of 33 13 16 12
contraceptives for birth spacing.
Lack of access to healthcare services can lead to 16 29 19 10
unplanned pregnancies and shorter birth intervals.

32
 CHAPTER FIVE: DISCUSSION OF THE STUDY, CONCLUSSIONS AND

RECOMMENDATIONS

5.0 INTRODUCTION

This chapter presents a summary of the factors that contribute to shorter birth spacing in Kapsait

village, West Pokot County. Furthermore, it encapsulates the conclusions drawn from the

research findings, offers recommendations, and identifies avenues for future research.

5.1 DISCUSSIONS

5.1.1: SOCIODEMOGRAPHIC CHARACTERISTICS

The study findings on sociodemographic factors revealed that majority of the respondents
36.5%(27) indicated their age to between 36-45 years. These findings are in agreement with
another study in Malawi where most of the respondents indicated their age to be between 36-45
years (Chikhungu, et al.2020). Moreover, majority of the participants 40.5%(30) indicated they
are married. Additionally, findings on level of education revealed that a great number of the
respondents 39.2%(29) indicated they were uneducated. Contrary findings in Rwanda where
most of the respondents had primary level education(McGuire,2017). Majority of the
respondents 32%(24) indicated their occupation as house wife. These findings are not in
agreement with another study in Mozambique where most of the participants indicated they are
self-employed. Additionally, most of the respondents 37.8%(28) indicated their husbands level
of education to be primary. More findings indicated that majority of the respondents 40.5%(30)
indicated the nearest facility is between 5-10 km. Similar findings were established in Uganda
where most of the participants indicated that the nearest health facility was between 5-
10km(Mairiga et al.,2019). Lastly, Majority of the respondents 37%(27) indicated they have 5
children or more

33
5.1.2: CULTURAL FACTORS

The study established that cultural factors have an influence on the shorter birth spacing in

Kapsait village. A gap in cultural practices was identified as majority of the women 62%(46)

indicated that cultural beliefs and practices influence birth spacing decisions in the community.

This was common among participants who indicated they are not educated. Contrary findings

were established in Indonesia where most of the respondents indicated that cultural beliefs and

practices do not influence birth spacing decisions in the community (Victora et al,2020).

Additional findings indicated that majority of the women 59.5%(44) indicated that women are

faced with challenges in discussing or accessing family planning methods. This was common

among women who indicated the nearest facility is between 5-10 km. Contrary findings were

established in South Africa, where most of the women indicated that they are not faced with

challenges in discussing or accessing family planning methods (Cleland, et al.,2021). Additional

findings revealed that majority of the participants 39.2%(29) indicated that family members as

the source of information that influence regarding birth spacing decisions. Most of them were

aged between 36-45 years. Health workers need to step up and provide information to the

residence on this village regarding family planning and child spacing as their family members

might offer misleading information. These findings do not marry with study findings in Morocco

where majority of the women healthcare workers as the source of information of birth spacing

(Pimentel, et al.,2020). More gaps were identified in the cultural practices as majority of the

participants 41%(30) indicated that family planning is somehow important in relation to cultural

values and practices. This clearly shows that cultural practices in this are do not consinder family

planning as that important. A great number of the married women 54%(40) indicated that there

are societal expectations regarding family size impact birth spacing decisions. Similar findings

34
were also established in another study by sharma et al. (2017) where most of the women

indicated that societal expectations regarding family size impact birth spacing decisions. More

gaps were identified in cultural practices and beliefs as most of the participants 61%(45)

indicated that women in their community are not encouraged to have a say in birth spacing

decisions. Lastly, majority of the respondents 67.7%(50) indicated that there are no community

initiatives or programs in your village that promote birth spacing and family planning

5.1.3: ATTITUDES TOWARDS CLOSER BIRTH SPACING

The study revealed that the women had low scores on attitude towards closer birth spacing. Most
of the respondents (40) strongly disagreed that they believe that contraceptive use is an effective
way to achieve birth spacing. This was common among uneducated house wife women. Similar
findings were also established in another study where most of the respondents strongly disagreed
that they believe that contraceptive use is an effective way to achieve birth spacing (Pimentel, et
al.,2020). Moreover, a great number (49) of the subjects with tertiary level of education
strongly agreed that access to quality healthcare services is crucial for making informed
decisions about birth spacing. similar findings were established in Ethiopia where most of the
respondents indicated that access to quality healthcare services is crucial for making informed
decisions about birth spacing (Azad et al.,2019). Additionally, most of the respondents (43)
strongly disagreed that think that using contraception shows responsible family planning. Most
of them were uneducated aged between 36-45 years. Out of the 74 respondents, 34 strongly
disagreed that family planning methods are easily accessible in our community. Moreover, most
of the participants (47) strongly agreed that they believe that religion or cultural beliefs interfere
with contraceptive use. Women in Kapsait village follow the strict cultural beliefs that
discourage them from using contraceptives. Contrary findings were established in Togo where
majority of the participants strongly disagreed that they believe that religion or cultural beliefs
interfere with contraceptive use (Adjiwanou & LeGrand,2021). Additionally, majority of the
subjects (39) strongly agreed that community support and education are important in promoting
contraceptive use. Most of the, had achieved tertiary level of education. A great number of the
participants (33) strongly agreed that they are concerned about the effectiveness of

35
contraceptives for birth spacing. Lastly, majority of the respondents agreed that lack of access to
healthcare services can lead to unplanned pregnancies and shorter birth intervals

5.2: CONCLUSIONS

5.2.1: Sociodemographic factors

Sociodemographic factors such as age, marital status, and level of education have an influence
on the factors that contribute to shorter birth spacing in Kapsait village, West Pokot County.
majority of the uneducated women indicated that cultural beliefs and practices influence birth
spacing decisions in the community. most of the uneducated women aged between 36-45 years
strongly disagreed that think that using contraception shows responsible family planning.

5.2.2: Cultural factors

Cultural factors such as cultural values, practices, beliefs and societal expectations have an
influence on the factors that contribute to shorter birth spacing in Kapsait village, West Pokot
County. A great number of the women indicated that there are societal expectations regarding
family size impact birth spacing decisions. Majority of the women 62%(46) indicated that
cultural beliefs and practices influence birth spacing decisions

5.2.3: Attitude

Uneducated women aged between 36-45 years had low scores on attitude towards shorter birth
spacing. Most of the uneducated women strongly disagreed that they believe that contraceptive
use is an effective way to achieve birth spacing. Most of the respondents (43) strongly disagreed
that think that using contraception shows responsible family planning. Most of them were
uneducated aged between 36-45 year

5.4 RECOMMENDATION

1. The county nurse of west Pokot county

-The county nurse in collaboration with the local authorities (chief and sub chief) should
organize and carry out mass campaigns to educate on the importance of child spacing and
use of family planning.

36
 -The county nurse in collaboration which the health department of West pokot county
should ensure that enough resources such as family planning methods are available across
all the health facilities in the county.
- Should Champion and advocate for policies that will ensure contraceptives are
affordable and easily accessible by all the women in the county.
2. The sub county nurse
-The sub county nurse in charge of kapsait village should work closely with community
leaders and elders to address cultural beliefs and practices that impact birth spacing
decisions. Engage in open dialogues and educational sessions to help individuals
understand the relationship between cultural values and family planning choices
- in collaboration with CHVs conduct further research to delve deeper into the specific
cultural beliefs, practices, and societal expectations that influence birth spacing decisions
in Kapsait village. This can provide more targeted insights for future interventions
3. The head of community health volunteers in collaboration with local authorities
encourage community involvement in discussions related to family size and birth
spacing. Create forums where individuals can openly share their perspectives and
concerns, fostering a sense of ownership in family planning decisions

37
 REFERANCE

Azad, K., Barnett, S., Banerjee, B., Shaha, S., Khan, K., Rego, A. R., ... & Kuddus, A. (2018).
Effect of scaling up women's groups on birth outcomes in three rural districts in
Bangladesh: A cluster-randomised controlled trial. The Lancet, 382(9910), 1358-1365.

Adjiwanou, V., & LeGrand, T. (2021). Gender inequality and birth spacing in Togo.
Demographic Research, 25, 543-562

Cleland, J., Bernstein, S., Ezeh, A., Faundes, A., Glasier, A., & Innis, J. (2018). Family planning:
The unfinished agenda. The Lancet, 368(9549), 1810-1827.

Chikhungu, L. C., Madise, N. J., Padmadas, S. S., & Kapatuka, A. (2020). How Does the Level
of Education Affect Birth Interval Dynamics in Malawi? Evidence from the 2010
Demographic and Health Survey. PLoS ONE, 15(12), e0244287.

Cleland, J., Conde-Agudelo, A., Peterson, H., Ross, J., & Tsui, A. (2021). Contraception and
health. The Lancet, 380(9837), 149-156.

Conde-Agudelo, A., Rosas-Bermudez, A., & Kafury-Goeta, A. C. (2017). Effects of birth

spacing on maternal, perinatal, infant, and child health: A systematic review of causal
mechanisms. Studies in Family Planning, 48(2), 145-173.

Gemmill, A., & Lindberg, L. D. (2018). Short interpregnancy intervals in the United States.
Obstetrics & Gynecology, 117(5), 1079-1086.

Kabagenyi, A., Jennings, L., Reid, A., Nalwadda, G., Ntozi, J., Atuyambe, L. M., & Makumbi,
F. E. (2020). Barriers to Male Involvement in Contraceptive Uptake and Reproductive
Health Services: A Qualitative Study of Men and Women's Perceptions in Two Rural
Districts in Uganda. Reproductive Health, 17(1), 1-11.

Kenya National Bureau of Statistics & ICF International. (2017). Kenya Demographic and
Health Survey 2014. Kenya National Bureau of Statistics and ICF International.

Maina, R., Wanjala, W. N., Njoroge, P. K., Kinyua, J., Wachira, J., & Waithanji, E. (2018).
Educational attainment and birth spacing among women of reproductive age in Kenya.
BMC Women's Health, 18(1), 1-11.

38
Mairiga, A. G., Saleh, A., & Ibrahim, H. (2019). The role of cultural beliefs in family planning
among Kanuri women in Nigeria. African Population Studies, 23(1), 4787-4797

Makwaya, C. K., Magoma, M. M., & Gombe, N. T. (2018). Factors influencing birth spacing
practices among women in rural Kenya. East African Journal of Public Health, 9(1), 109-
116.

McGuire, C., & Stephenson, R. (2017). Community factors influencing birth spacing among
married women in Uganda and Zimbabwe. African Journal of Reproductive Health,
21(3), 57-67.

Njoroge, P., & Kimani, V. (2020). Impact of maternal age on birth spacing among women in
rural Kenya. International Journal of Gynecology & Obstetrics, 148(2), 169-175

Pimentel, R. L. S., Nogueira, P. T., Costa, V. M., & Maia, F. C. (2020). Factors associated with
shorter birth intervals in low- and middle-income countries: A systematic review. PLoS
One, 15(5), e0232547.

Rutaremwa, G., Wandera, S. O., Jhamba, T., Akiror, E., & Kiconco, A. (2018). Determinants of
Birth Intervals among Women of Reproductive Age in Uganda: Analysis of the Uganda
Demographic and Health Survey 2016. BMC Pregnancy and Childbirth, 18(1), 1-10.

Sharma, S., Van Teijlingen, E., Hundley, V., Angell, C., & Simkhada, P. (2017). Dirty and 40
days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in
Nepal. BMC Pregnancy and Childbirth, 17(1), 1-11.

Singh, S., Remez, L., Sedgh, G., Kwok, L., & Onda, T. (2020). Abortion worldwide 2017:
Uneven progress and unequal access. Guttmacher Institute.

Titaley, C. R., Dibley, M. J., & Agho, K. (2020). Determinants of the Increase in the Prevalence
of Short Birth Spacing in Indonesia: A Multilevel Approach. PLoS ONE, 15(8),
e0238033.

39
Uwimana, J., Zarowsky, C., Hausler, H., & Jackson, D. (2018). Intergenerational influences
shaping women's perceptions and decision-making about antenatal care-seeking: A
qualitative study in rural Rwanda. Reproductive Health, 15(1), 1-15.

United Nations Population Fund (UNFPA). (2020). State of World Population 2020: Against my
will: Defying the practices that harm women and girls and undermine equality. UNFPA.

Victora, C. G., Horta, B. L., de Mola, C. L., Quevedo, L., Pinheiro, R. T., Gigante, D. P., ... &
Barros, F. C. (2019). Association between short birth spacing and impaired growth in
early childhood. JAMA Pediatrics, 173(11), 1059-1067.

Wambui, J. N., Wangalwa, G., & Cumber, S. N. (2017). Factors affecting utilization of family
planning services in a post-conflict setting, South Sudan: A qualitative study. African
Journal of Reproductive Health, 21(4), 47-55.

Wanyama, R., Kizito, R., Arach, A., & Kakaire, O. (2017). Factors associated with inter-birth
interval among women attending postnatal clinics in West Pokot County, Kenya: a cross-
sectional study. Pan African Medical Journal, 26, 78.

World Health Organization. (2019). Report of a WHO Technical Consultation on Birth Spacing.
WHO Press

APPENDIX I: INFORMED CONSENT

This informed consent is for respondents who will participate on a research study on factors

contributing to closer birth spacing of children in Kapsait village, Pokot south sub-county, West

Pokot county.

INTRODUCTION

40
I am a student from Kenya Methodist University conducting research on factors contributing to

closer birth spacing of children in Kapsait village, Pokot south sub-county, West Pokot

county.The findings from this study will only be used for academic purposes and to enhance

knowledge on optimal birth spacing. Your participation in the study is voluntary, and you can

withdraw at any time you want. Kindly answer all the questions to the best of your knowledge,

and do not write your name on this questionnaire.

I have read the foregoing information and had the opportunity to ask questions about it and any

questions that have asked have been answered to my satisfaction. I consent voluntarily to

participate as a participant in this research.

Signature of the participant……………………………. Date……………………….

APPENDIX II QUESTIONNAIRES

FACTORS CONTRIBUTING TO CLOSER BIRTH SPACING OF CHILDREN IN

KAPSAIT VILLAGE, POKOT SOUTH SUB-COUNTY, WEST POKOT COUNTY.

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS

1. How old are you?

A) 15-25 years b) 26-35 years

c) 36-45 years d) 46 years and above

2. What is your current marital status?

41
a) Single b) Married

c) Divorced d) Separated

e) Widow f) others (specify) ………………………

3. What is your level of education?

A) No formal education b) Primary

c) Secondary d) Tertiary education

e) Others, (specify) …………………………………………………………………………….

4. What is your occupation?

House wife b) Civil servant

c) Self-employed d) Student

e) Unemployed f) others, (specify)………………………

5.What is your husband's level of education?

A) No formal education b) Primary

c) Secondary d) Tertiary education

6. What is the distance from your residence to the nearest healthcare facility?

a) Less than 5 kilometers

b) 5-10 kilometers

c) 10-20 kilometers

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d) More than 20 kilometers

7.How does the availability of transportation impact birth spacing decisions in your community?

a) Significantly influences

b) Somewhat influences

c) Does not influence

8. How many living children do you have?

a) None

b) 1-2

c) 3-4

d) 5 or more

SECTION B: CULTURAL DATA

1. Do cultural beliefs and practices influence birth spacing decisions in the community?

a) Yes

b) No

2. Are there any specific challenges or barriers faced by women in discussing or accessing family

planning methods?

a) Yes

b) No

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3. Are there any rituals or ceremonies related to birth spacing in the community?

a) Yes

b) No

4. What are the common sources of information and influence regarding birth spacing decisions

within the community?

a) Family members

b) Religious leaders

c) Healthcare providers

d) Peers/friends

e) Media

f) Other (please specify)………………………………………………………………………..

5. Are there social or religious norms that affect birth spacing practices in Kapsait Village?

a) Yes

b) No

6. How important is family planning in relation to cultural values and practices?

a) Very important

b) Important

c) Somewhat important

d) Not important
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7. Are there specific challenges or barriers faced by women when it comes to discussing or

accessing family planning methods?

a) Yes

b) No

8. Do societal expectations regarding family size impact birth spacing decisions?

a) yes

b) no

9. Do you feel that the desire for a son influences birth spacing decisions in your community?

a) Yes

b) No

10. Do you feel that birth spacing decisions are influenced by the number of previous children?

a) Yes

b) No

11. Are women in your community encouraged to have a say in birth spacing decisions?

a) Yes

b) No

12. Education and awareness about birth spacing are important for your community?

a) Yes

b) No
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13. Are there community initiatives or programs in your village that promote birth spacing and

family planning?

a) Yes

b) No

SECTION C: ATTITUDES TOWARDS CLOSER BIRTH SPACING

Tick where appropriate

Question

No Question Agree Strongly Disagree Strongly

agree disagree

1 Do you believe that

contraceptive use is an effective

way to achieve birth spacing.

2 Access to quality healthcare

services is crucial for making

informed decisions about birth

spacing.

3 Do you think that using

contraception shows responsible

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 family planning?

4 Family planning methods are

easily accessible in our

community.

5 Do you believe that religion or

cultural beliefs interfere with

contraceptive use.

6 Do you think discussing family

planning openly with partners is

important for birth spacing.

7 Community support and

education are important in

promoting contraceptive use.

8 Having readily accessible

information about family

planning services encourages

me to consider longer birth

intervals.

9 I am concerned about the

effectiveness of contraceptives

for birth spacing.

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9 Should men take an active role

in family planning decisions for

birth spacing?

10 I believe that easier access to

family planning services

positively influences birth

spacing decisions.

11 Do you believe that using

contraceptives is an individual

choice?

12 Accessible healthcare resources

empower me to make well-

informed decisions about the

timing of pregnancies

13 Better healthcare services

positively influence my

perception of the benefits of

spacing pregnancies.

14 Lack of access to healthcare

services can lead to unplanned

pregnancies and shorter birth

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intervals.

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APPENDIX III: LETTER FROM DEPARTMENT APPROVED BY SUB-CHIEF OF

CHESUPET SUB-LOCATION TO CONDUCT STUDY

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