Intersections of menstruation, gender-based violence and contraceptive use: qualitative insights from girls and young women's experiences in western Kenyan family planning clinics

OBJECTIVE: To examine how menstruation, contraceptive use and gender-based violence intersect to shape the sexual and reproductive health and autonomy of girls and young women in Kenya. DESIGN: Qualitative study exploring girls and young women's experiences with contraceptive use and menstrual management, using in-depth interviews and focus group discussions analysed through a reflexive thematic approach. SETTING: Four county-run family planning clinics in Uasin Gishu County, Kenya. PARTICIPANTS: 77 girls and young women aged 15-19 years (via 35 in-depth interviews and 7 focus group discussions) and 27 family planning clinic providers (via 5 focus group discussions). RESULTS: Interviewees' contributions suggest that covert contraceptive use, when discovered through menstrual monitoring, provoked intimate partner violence. Heavy menstrual bleeding, whether related to contraceptive use or not, was viewed as a sexual restriction and also fuelled intimate partner violence. Furthermore, the inability to afford sanitary pads, combined with the stigma surrounding menstruation, drove some girls and young women into exploitative sexual relationships, often resulting in unwanted or unintended pregnancies. CONCLUSIONS: Menstrual bleeding and contraceptive use, both independently and in combination, affect girls and young women's reproductive autonomy and overall health and well-being, particularly in relation to gender-based violence. Improving menstrual hygiene management, challenging the stigma and harmful norms tied to menstruation and contraception and ensuring safe contraceptive use are integral to improving sexual and reproductive health and autonomy and are requisite for preventing and eradicating gender-based violence.