Covert contraceptive use and one-year trajectories of reproductive coercion and intimate partner violence in Kenya: a nationally representative cohort study.

OBJECTIVE: Covert contraceptive use-using contraception without a male partner's knowledge-is a common strategy women use to preserve reproductive autonomy when facing opposition or abuse. However, whether covert use increases women's risk of violence over time remains unclear. This study assessed whether covert contraceptive use was associated with changes in reproductive coercion (RC) and intimate partner violence (IPV) over one year. STUDY DESIGN: We used two waves (2020-2021) of the nationally representative Performance Monitoring for Action (PMA) Kenya cohort among married/cohabitating women (n=3,844). Women were classified by wave 1 contraceptive-use status: covert, overt, or non-use. Generalized estimating equations assessed changes in RC and IPV over one year, comparing covert users to overt users and non-users. Models applied inverse probability of treatment and censoring weighting and survey weights. RESULTS: At wave 1, 4.8% of women reported covert use, and overall prevalence was similar at wave 2 (4.5%); however, contraceptive-use status was dynamic, with substantial movement into and out of covert use between waves. Women reporting covert use at wave 1 had higher violence risk across both waves but showed greater relative reductions in RC compared with overt users (RRR 0.56, 95% CI: 0.33-0.94) and non-users (RRR 0.62, 95% CI: 0.39-1.00), with similar, less precise patterns for IPV outcomes. CONCLUSIONS: Current covert contraceptive use did not increase risk of abuse over one year among Kenyan women. Further research should examine nuanced covert-use and violence dynamics. Family planning services should support safe covert use and integrate survivor-centered care. IMPLICATIONS: Current covert contraceptive use did not increase violence risk over one year in a Kenyan population-based sample. Clinicians should recognize covert users' elevated risk while supporting their autonomy through confidential contraceptive options and integrating routine violence screening and safety planning into family planning care.