{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T14:07:12Z","timestamp":1791209232064,"version":"4.1.0"},"reference-count":24,"publisher":"BMJ","issue":"10","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,9,22]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the prevalence and determinants of joint decision-making on contraceptive use among women in union in Nairobi\u2019s informal settlements, and to project the contribution of different decision-making patterns to the modern contraceptive prevalence rate (mCPR) over time.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      Analysis of repeated cross-sectional surveillance data combined with an agent-based microsimulation (Thanzi la Onse-Nairobi Urban Health and Demographic Surveillance System (NUHDSS). Determinants of joint decision-making were examined using multivariable logistic regression, and model performance was assessed using the likelihood ratio test, the Hosmer-Lemeshow goodness-of-fit test, McFadden pseudo R\n                      <jats:sup>2<\/jats:sup>\n                      and the area under the receiver operating characteristic curve. The microsimulation projected mCPR from 2012 to 2040 under joint, woman-only and spouse-only decision-making scenarios.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Two urban informal settlements, Korogocho and Viwandani, in Nairobi, Kenya, covered by the NUHDSS, 2012\u20132015.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>2085\u2009women of reproductive age (15\u201349 years) who were in union, defined as married or living with a male partner, with complete data on the decision-making outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was joint decision-making on contraceptive use (woman and partner deciding together vs the woman alone or the partner alone). The secondary outcome was the projected mCPR among women in union from 2012 to 2040 under joint, woman-only and spouse-only decision-making scenarios.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Joint decision-making prevalence was 63.7% (95% CI 61.6 to 65.8). In the adjusted model, the odds of joint decision-making were higher in male-headed households (AOR 1.53, 95% CI 1.11 to 2.10, p=0.009), among residents of Viwandani (AOR 1.30, 95% CI 1.04 to 1.64, p=0.024), among women who desired more than five children (AOR 2.27, 95% CI 1.02 to 5.12, p=0.045) and among unemployed women (AOR 1.36, 95% CI 1.09 to 1.69, p=0.006), and lower among women who did not want another child (AOR 0.63, 95% CI 0.48 to 0.82, p&lt;0.001), were undecided about childbearing (AOR 0.62, 95% CI 0.43 to 0.87, p=0.006) or had not discussed family size with their partner (AOR 0.39, 95% CI 0.31 to 0.51, p&lt;0.001). In the microsimulation, the contribution of joint decision-making to mCPR among women in union rose from 40% in 2012 to 52% in 2040, exceeding the contributions of woman-only (13% to 18%) and spouse-only (about 1% to 0.5%) decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Joint decision-making was associated with higher modern contraceptive use among women in union in Nairobi\u2019s informal settlements, and the microsimulation suggests it may contribute substantially to mCPR over time. Because the design is cross-sectional, these associations should not be interpreted as causal. Programmes that strengthen couple communication, particularly in male-headed households and among unemployed women or couples with undiscussed or discordant fertility preferences, may support progress toward national family planning targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-110099","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:17Z","timestamp":1791207317000},"page":"e110099","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Determinants and impact of joint decision-making on contraceptive use among women in union in Nairobi\u2019s urban informal settlements: a repeated cross-sectional analysis and agent-based microsimulation using the Nairobi Urban Health and Demographic Surveillance System"],"prefix":"10.1136","volume":"16","author":[{"given":"Sharon","family":"Chepkemoi","sequence":"first","affiliation":[{"name":"African Population and Health Research Center, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Mnjowe","sequence":"additional","affiliation":[{"name":"East, Central, and Southern African Health Community, Arusha, Tanzania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinpeter","family":"Momanyi","sequence":"additional","affiliation":[{"name":"African Population and Health Research Center, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatenda","family":"Kavu","sequence":"additional","affiliation":[{"name":"African Population and Health Research Center, Nairobi, Kenya"},{"name":"University of South Africa, Pretoria, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9284-8863","authenticated-orcid":false,"given":"Steve","family":"Cygu","sequence":"additional","affiliation":[{"name":"African Population and Health Research Center, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Iddi","sequence":"additional","affiliation":[{"name":"African Population and Health Research Center, Nairobi, Kenya"},{"name":"Department of Statistics and Actuarial Science, University of Ghana, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agnes","family":"Kiragga","sequence":"additional","affiliation":[{"name":"African Population and Health Research Center, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1779-1043","authenticated-orcid":false,"given":"Evans","family":"Omondi","sequence":"additional","affiliation":[{"name":"African Population and Health Research Center, Nairobi, Kenya"},{"name":"Institute of Mathematical Sciences, Strathmore University, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100506351281000_16.10.e110099.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-15620-z","article-title":"Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: an analysis of Kenya demographic health surveys","volume":"23","author":"Orwa","year":"2023","journal-title":"BMC Public Health"},{"key":"2026100506351281000_16.10.e110099.2","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/2915628","article-title":"Epidemiology of High Fertility Status among Women of Reproductive Age in Wonago District, Gedeo Zone, Southern Ethiopia: A Community-Based Cross-Sectional Study","volume":"2020","author":"Reda","year":"2020","journal-title":"Int J Reprod Med"},{"key":"2026100506351281000_16.10.e110099.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-17459-w","article-title":"Determinants of high-risk fertility behavior among women of reproductive age in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey","volume":"23","author":"Seifu","year":"2023","journal-title":"BMC Public Health"},{"key":"2026100506351281000_16.10.e110099.4","unstructured":"Kenya National Bureau of Statistics . County population projections by sex and age group, 2023\u20132027. 2023. Available: https:\/\/www.knbs.or.ke\/wp-content\/uploads\/2023\/09\/2019-Kenya-population-and-Housing-Census-Summary-Report-on-Kenyas-Population-Projections.pdf"},{"key":"2026100506351281000_16.10.e110099.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0248393","article-title":"Demand satisfied by modern contraceptive among married women of reproductive age in Kenya","volume":"16","author":"Gichangi","year":"2021","journal-title":"PLoS One"},{"key":"2026100506351281000_16.10.e110099.6","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-004643","article-title":"Benefits of family planning: an assessment of women\u2019s knowledge in rural Western Kenya","volume":"4","author":"Mutombo","year":"2014","journal-title":"BMJ Open"},{"key":"2026100506351281000_16.10.e110099.7","unstructured":"Kenya national bureau of statistics (KNBS) . Ministry of health (MOH), national aids control council (NACC), kenya medical research institute (KEMRI), national council for population and development (NCPD), & ICF international. Kenya demographic and health survey 2014: Key findings; 2015. Available: https:\/\/www.dhsprogram.com\/pubs\/pdf\/sr227\/sr227.pdf"},{"key":"2026100506351281000_16.10.e110099.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-19715-z","article-title":"Joint decision on contraceptive use and determinant factors among married women of reproductive ages (15-49) in Ethiopia: a multilevel analysis using Ethiopian Demographic and Health Survey; 2016 data","volume":"24","author":"Asratie","year":"2024","journal-title":"BMC Public Health"},{"key":"2026100506351281000_16.10.e110099.9","doi-asserted-by":"crossref","unstructured":"Demissie GD , Akalu Y , Gelagay AA , et al . Factors associated with decision making power of women to use family planning among married women in sub-saharan africa: a multilevel analysis of demographic health surveys. [Preprint] 2021. doi:10.21203\/rs.3.rs-156535\/v1","DOI":"10.21203\/rs.3.rs-156535\/v1"},{"key":"2026100506351281000_16.10.e110099.10","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-019-0749-y"},{"key":"2026100506351281000_16.10.e110099.11","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-08977-y","article-title":"Covert use of contraception in three sub-Saharan African countries: a qualitative exploration of motivations and challenges","volume":"20","author":"Kibira","year":"2020","journal-title":"BMC Public Health"},{"key":"2026100506351281000_16.10.e110099.12","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/s12910-017-0241-6","article-title":"Autonomy and couples\u2019 joint decision-making in healthcare","volume":"19","author":"Osamor","year":"2018","journal-title":"BMC Med Ethics"},{"key":"2026100506351281000_16.10.e110099.13","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2014.19.349.5090","article-title":"Male involvement in family planning decision making in sub-Saharan Africa- what the evidence suggests","volume":"19","author":"Vouking","year":"2014","journal-title":"Pan Afr Med J"},{"key":"2026100506351281000_16.10.e110099.14","doi-asserted-by":"crossref","DOI":"10.1155\/2017\/9389072","article-title":"Women\u2019s Joint Decision on Contraceptive Use in Gedeo Zone, Southern Ethiopia: A Community Based Comparative Cross-Sectional Study","volume":"2017","author":"Eshete","year":"2017","journal-title":"Int J Family Med"},{"key":"2026100506351281000_16.10.e110099.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.gloepi.2020.100024"},{"key":"2026100506351281000_16.10.e110099.16","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-11-1"},{"key":"2026100506351281000_16.10.e110099.17","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyu251"},{"key":"2026100506351281000_16.10.e110099.18","doi-asserted-by":"crossref","unstructured":"Asmamaw DB , Shewarega ES , Fentie EA , et al . Married Women Decision-Making Autonomy on Contraceptive Use in East Africa: A Multilevel Analysis of Recent Demographic and Health Survey. Sage Open 2024;14. doi:10.1177\/21582440241236567","DOI":"10.1177\/21582440241236567"},{"key":"2026100506351281000_16.10.e110099.19","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1111\/sifp.12206","article-title":"Perceptions of Partners\u2019 Fertility Preferences and Women\u2019s Covert Contraceptive Use in Eight Sub-Saharan African Countries","volume":"53","author":"Sarnak","year":"2022","journal-title":"Stud Fam Plann"},{"key":"2026100506351281000_16.10.e110099.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-022-02045-w","article-title":"Women\u2019s and male partners\u2019 socio-demographic and economic characteristics associated with contraceptive decision making in Nigeria","volume":"22","author":"Okunlola","year":"2022","journal-title":"BMC Womens Health"},{"key":"2026100506351281000_16.10.e110099.21","doi-asserted-by":"crossref","DOI":"10.1186\/s12905-018-0580-6","article-title":"Socioeconomic and religious differentials in contraceptive uptake in western Ethiopia: a mixed-methods phenomenological study","volume":"18","author":"Tigabu","year":"2018","journal-title":"BMC Womens Health"},{"key":"2026100506351281000_16.10.e110099.22","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4465.2009.00194.x"},{"key":"2026100506351281000_16.10.e110099.23","doi-asserted-by":"publisher","DOI":"10.1111\/j.1728-4465.2002.00185.x"},{"key":"2026100506351281000_16.10.e110099.24","doi-asserted-by":"crossref","first-page":"45","DOI":"10.2147\/OAJC.S285358","article-title":"Association of Effective Spousal Family Planning Communication with Couples\u2019 Modern Contraceptive Use in Harar, Eastern Ethiopia","volume":"12","author":"Zelalem","year":"2021","journal-title":"Open Access J Contracept"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-110099","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:35:20Z","timestamp":1791207320000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-110099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":24,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,5]]},"published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1136\/bmjopen-2025-110099"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-110099","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]}}}