Contraceptive Prevalence and Correlates Among Women Who Inject Drugs in Coastal Kenya: A Cross-Sectional Analysis

Women who inject drugs (WWID) in sub-Saharan Africa face intersecting risks of HIV and unmet reproductive health needs. In Kenya, a significant evidence gap exists regarding the family planning behaviours of this marginalised group, particularly within coastal communities with established injecting drug use. This study aimed to determine the prevalence of modern contraceptive use and to identify key sociodemographic and behavioural factors associated with its use among WWID in coastal Kenya. A cross-sectional analysis was conducted using respondent-driven sampling to recruit WWID from community settings. Participants completed a structured questionnaire covering contraceptive use, sexual behaviour, and drug use patterns. Logistic regression was used to identify correlates of modern contraceptive use. Modern contraceptive prevalence was low (32%). Significant correlates of use included being in a stable partnership and having a recent HIV test. Conversely, frequent injecting and engagement in transactional sex were negatively associated with contraceptive use. There is a substantial unmet need for family planning among WWID in coastal Kenya. Contraceptive use appears influenced more by relationship dynamics and healthcare engagement than by knowledge alone. Integrated service delivery models that combine harm reduction with client-centred sexual and reproductive health services are required. Programmes should specifically address the needs of WWID engaged in sex work and those with high-frequency injecting. contraception, women who inject drugs, Kenya, reproductive health, harm reduction, cross-sectional study This study provides the first empirical data on contraceptive prevalence and its correlates among WWID in coastal Kenya, informing the development of targeted public health interventions for this key population.