Reversing the declining trends in Family Planning in Kenya

Esther Kamau is the Liaison Officer for the Global Financing Facility (GFF) in Kenya. She supports effective and inclusive government-led partnership and coordination processes for RMNCAH-N in Kenya. She is a Health Management Specialist with over 15 years’ experience in managing healthcare programs. Before joining the GFF, Esther worked with the Ministry of Health, the Council of Governors, World Relief South Sudan, and RefugePoint.

Reversing the declining trends in Family Planning in Kenya

 Mariam, a 40-year-old mother of three, is visiting a health center in Nairobi for a tubal ligation. During the family planning consultation, she asks if the procedure can be done within the day, so she can get back home without her husband’s knowledge. She is informed that tubal ligation cannot be performed at this health center, instead, she will be referred to the county hospital or wait until there is a family planning outreach at the sub-county. She is disheartened, feeling that her family planning choice is circumscribed by clinical guidelines and requirements, her husband’s disapproval, and the additional time and money that will have to be invested to get the service. As a result, Mariam is unsure whether she will ever use this modern family planning method.

Mariam’s situation is reflective of a decline in the uptake of modern family planning among women of reproductive age in Kenya. This decline went from 56.3% in 2013/2014 to 49.1% in 2015/2016 to 37% in 2017/2018 (DHIS2).   While the Health Strategic Plan (2018-2023) prioritizes meeting the modern family planning needs of women of reproductive age, notably seeking to reach a 65% uptake by 2021, the country is far from meeting expected targets.  In 2021, the use of modern family planning methods had further plummeted to 35.3%, in large part because the COVID-19 pandemic restricted access to health services, including family planning services[i].

The main barriers to the demand for family planning services are well documented [ii]

• Fear of side effects, patients, often feel they must choose between two evils.
• Socio-cultural norms and beliefs, including high desired fertility.
• The cost associated with visiting a health facility, including transportation. Only 52% of Kenyans access health facilities within a 5km radius.

On the supply side,

• public health facilities provide a limited range of modern family planning methods.
• private clinics are too expensive for most of the population. In addition, health insurance companies rarely cover contraceptive methods such as tubal ligations and vasectomies.
• poor quality of family planning services by healthcare providers

The quality of care in family planning (FP) services has been associated with increased and continued use of contraceptive methods. Quality of care in family planning encompasses a wide range of issues including technical competence of providers, choice of contraceptive methods available, the information given to clients, and access to family planning services. At the same time, the quality of data used to measure contraceptives prevalence may also affect the outcome through its accuracy, completeness, reliability, and timeliness.

While a variety of interventions have been designed and implemented in Kenya to meet the needs of women of reproductive age, such as health education through community health workers and family planning outreaches, the need to further focus our attention on data quality is paramount. Most of the private specialists’ clinics, as well as chemists, do not upload their family planning data on the DHIS 2, yet they serve a big population with these services. There is a need to ensure family planning indicators are measured correctly at different levels, comprehensively from all family planning service providers, and uploaded promptly to inform real-time decision-making.

To reverse the declining trends in contraceptive preference rates, stakeholders must invest resources in research and development on the quality of family planning services as well as the quality of data. Key areas of focus include widening the range of contraceptives being offered, improving the supply chain management systems, refresher training for healthcare workers, and ensuring completeness and timeliness of family planning data.

[i] Implementation Status and Results Report, Transforming Health Systems for Universal Care Project, World Bank, 2021

[ii] Silumbwe, A., Nkole, T., Munakampe, M. N., Milford, C., Cordero, J. P., Kriel, Y., Zulu, J. M., & Steyn, P. S. (2018). Community and health systems barriers and enablers to family planning and contraceptive services provision and use,