As per the Kenya Demographic and Health Survey (KDHS) 2022, 14% of currently married females and 19% of unmarried sexually active females have an unmet family planning need. In Kenya, a study of young women on barriers to modern contraceptive uptake revealed that myths and misconceptions are the biggest barrier and that while awareness and knowledge are beneficial, they do not necessarily translate to use and contraceptive uptake. McKinsey in a 2021 report said that while adolescent girls and young women in Africa have a high unmet need for contraceptives, self-care can be a powerful means to addressing the challenge. The report also emphasised the need to move beyond one-size-fits-all approaches and instead design tailored solutions to match different needs within relevant population segments.
Together with our partners, Nivi is at the forefront of the universal self-care revolution by driving equitable health access to family planning services. Our automated health chatbot service, askNivi in Kenya, Nigeria and India, provides anyone with a mobile phone and WhatsApp access with a free, private, interactive information center that uses behaviour change methodology to encourage users to take advantage of the wide variety of health products and services available via our virtual marketplace.
To support the Government of Kenya and other key stakeholders on national SRH priorities, we introduced the family planning Journey on askNivi Kenya to provide awareness and increase FP service uptake in the country. In Nivi’s FP journey, users move at their own pace, as we recognise that individuals are at unique stages of FP uptake and continuation (see Figure: Current FP Journey in Kenya). Tracking user interaction related data throughout the journey enables us to improve conversion rates to eventually increase contraceptive uptake amongst users on the FP Journey on our chatbot.
Since July 2022, Nivi has been running a series of campaigns to reach a diverse segment of potential users across Kenya, deploying a range of digital marketing strategies (seeded WhatsApp groups, Facebook ads, and website banners) centered around reproductive health, family planning and modern contraceptives to onboard young men and women to the askNivi Whatsapp chatbot.
We onboarded nearly 23,500 users in Kenya who expressed an intent to learn about family planning by engaging with the marketing campaigns and completing a 3-step onboarding process.
Among these users 71.5% were females, followed by males (27.4%) and non-binary individuals (1.1%). Approximately 6.2% of the users were between 15-19 years of age, 45.5% were between 20-24 years and the largest group at 48.3% was of those 25 and above. Close to 15% of these users came from Nairobi and 85% came from the rest of Kenya. We studied how the users interacted on askNivi to understand their readiness to act by seeking a family planning referral. We also analysed user reported redemption of referrals given by askNivi to understand their behaviour towards accessing these services.
Family planning referral seeking and redemption behaviour by gender
Women were 3 times more likely than men and 2 times more likely than non-binary individuals to take a contraceptive screening and a referral.
The higher engagement observed in women is consistent with the commonly used contraceptives as women-specific methods, e.g., injectables, implants and oral contraceptives. Between non-binary individuals and men, the former lead the way as 21% of non-binary users sought a referral and 3.6% of them redeemed it while amongst men it was 15.1% and 2.9% respectively. Although the overall non-binary user numbers were a fraction of the men and women onboarded, they actively sought recommendations for FP methods and providers and Nivi served relevant referrals to support their reproductive health journey.
Although the frequency is lower than in past DHS, in Kenya, 15% of adolescents report having had a pregnancy by 20 years of age. Reducing pregnancies in this group is one of the Government of Kenya’s key objectives among its FP2030 commitments. Nivi has been particularly effective in serving adolescent populations once onboarded to the platform.
Family planning referral seeking and redemption behaviour by age-group
On askNivi, amongst all three age groups, individuals aged 15-24 were more likely to seek a method and provider recommendation than those 25 years and above. Adolescents (users aged 15-19 years) were 2 times more likely to redeem a referral than the next slightly older segment of 20-24 year-old users (8.2% vs 4.1%), and almost 3.5 times more likely to redeem a referral than individuals 25+ years (8.2% vs 2.4%). Teenage females on askNivi, especially, were more than 3 times more likely to report taking up a referral to family planning services compared to female users who were 25 years old and above. In Nairobi, this effect was even larger - teenage females were 4 times more likely than other female Nivi users.
The conventional wisdom is that adolescents face significant barriers in accessing SRH services. However, in our experience, adolescent females reported visiting Nivi’s recommended providers at much higher rates than older segments of women suggesting the digital experience is particularly useful for that demographic segment.
Family planning referral seeking and redemption behaviour by location
While the individuals in Nairobi were disproportionately more likely to seek referrals compared to those in the rest of Kenya, both segments behaved similarly in redemption averaging at a rate of 3.6% ( out of all referrals generated). One of our key priorities is to improve conversions from referrals to redemptions to further the mission towards FP service uptake in Kenya. To make redemptions even more accessible, we continue to expand our provider network by partnering with more facilities throughout Kenya. Building more active partnerships, we are standing up onboarding assets at facilities, allowing new clients and existing Nivi users to check-in for post-visit support.
We continue to refine our ability to segment and serve the fast growing user base in Kenya to meet their health aspirations by helping address their specific reproductive health needs. Organizations looking to tap into the power of digital technologies and behavioral sciences to advance public health causes have been partnering with Nivi to leverage its expertise and distribution. For organizations keen to support equitable SRH access, working with Nivi can empower access to services that reach otherwise underserved communities. If you’d like to explore how we can help further your cause and drive better public health outcomes on therapies and topics of interest to you, reach out!