A stark reality is unfolding in Kenya as access to family planning services dwindles, threatening to reverse years of progress in maternal and child health. Caren Lensi's story is a poignant example. The 32-year-old mother of two, who relies on a three-year contraceptive implant, has been turned away from multiple hospitals due to stockouts, leaving her facing the anxiety of an unintended pregnancy.

Caren's experience reflects a broader crisis fueled by declining donor funding and the repercussions of policies like the U.S. President's Stop Work Order. A Kenya Medical Supplies Authority (KEMSA) report reveals shortages in implants, injectables, and pills. Shelves at Imperial, a U.S.-contracted family planning agency, are also bare, a consequence of entrusting the agency after Kemsa reported multiple scandals during Covid-19. Although the government has pending deliveries of essential commodities, bureaucratic delays stall the procurement process.

The shortage extends to condoms, a vital component of family planning. Kenya requires 450 million condoms annually, relying heavily on the Global Fund, NGOs, and well-wishers. Ironically, condoms procured under the Global Fund cannot be used in family planning clinics due to the fund's restrictions, exacerbating the scarcity.

Margaret Lubaale, executive director at Health NGO’s Network (HENNET), emphasizes the urgent need for domestic financing to bridge the gap left by dwindling donor support. She points out that family planning is often overlooked in favor of treating diseases, hindering funding for contraceptive commodities. Lubaale notes that since 1967, family planning has been donor-funded, but a 2021 Memorandum of Understanding between the Ministry of Health, USAID, the Bill & Melinda Gates Foundation (BMGF), and UK Aid aimed to shift the financial burden to the Kenyan government by 2026. However, the government has struggled to meet its funding commitments, with significant budget reductions in recent years. BMGF withdrew its funding in 2022/23 due to the government's failure to remit committed funds.

The consequences of inadequate family planning funding are far-reaching, affecting maternal and child mortality rates, population growth, economic stability, and overall national development. Lubaale stresses that family planning is not merely a health issue but also an economic one, enabling families to space births and manage family size. She laments that it's often perceived as a “woman’s issue” and marginalized in policy discussions, leading to reduced productivity and hindering progress in education, agriculture, health, and food security.

Despite these challenges, Kenya has made strides in family planning uptake, with modern contraceptive use rising to 57 percent. This progress has contributed to a decline in maternal, infant, and child mortality rates. Data from the National Council for Population and Development (NCPD) shows maternal deaths decreasing from 570 per 100,000 live births in 2003 to 355 per 100,000 in 2019. Infant mortality dropped from 77 per 1,000 live births in 2003 to 32 per 1,000 in 2022, while under-five mortality fell from 115 per 1,000 to 41 per 1,000 over the same period. An estimated 2.425 million unintended pregnancies and 602,000 unsafe abortions have been prevented because 6.439 million women are using modern contraceptives.

The NCPD urges the government to increase its annual budget for family planning commodities to Sh4 billion until 2028 and to integrate family planning into the social health scheme. They also emphasize the need for county governments to allocate budgets for family planning services. Failure to meet these commitments could jeopardize Kenya's International Conference on Population and Development (ICPD 25) goals and lead to a decline in long-term economic and social development.

Limited access to services, particularly in rural areas and slums, coupled with socio-cultural barriers, further complicate the situation. Silvia Musumba, a community health promoter in Kwa-Reuben slum in Nairobi, highlights the importance of free family planning services for women in impoverished communities. She notes that unintended pregnancies are more common during shortages due to financial constraints. Women in the poorest households have an average of 5.3 children, compared to 2.7 among women in the wealthiest households.

Organizations like inSupply Health, in partnership with the Ministry of Health, are working to expand access to family planning commodities through pharmacies under the Optimizing the Pharmacy Channel (OPC) initiative. This initiative aims to equip pharmacists with the skills to offer advanced family planning services. Despite these efforts, public health facilities remain the primary providers of family planning services, accounting for 62 percent, while private facilities, including pharmacies, account for 38 percent.

Investments in family planning have been shown to spur economic growth by empowering people to manage their family size, increasing women’s participation in the workforce, improving maternal and child health, enhancing education, and increasing disposable income. The most commonly used family planning methods among married women in Kenya are injectables (20 percent), implants (19 percent), and contraceptive pills (8 percent). Demand for contraception has grown over time, with more than 2.5 million additional users since 2012.

Kenya has set ambitious family planning 2030 Commitments, aiming to increase modern contraception from 58 to 64 percent by 2030. However, achieving this goal requires increased domestic funding, as donor priorities shift. Counties, which rely heavily on the national government for health funding, often lack specific budget lines for family planning. A study by the Urban Research and Development Centre for Africa (URADCA) in Meru and Nakuru found that while counties allocated significant portions of their budgets to health, direct spending on family planning was minimal.

Dr. Isaac Malonza, CEO and Technical Director at URADCA, notes that only four to six percent of county health budgets are directly allocated to family planning, despite ongoing advocacy for more funding. He emphasizes that while counties provide health workers, services, and supplies, family planning commodities have mostly relied on donor support.

Despite these challenges, Kenya's modern family planning uptake of 58 percent is significantly higher than countries like Nigeria, which stands at 15 percent. Sustaining and building upon this progress requires a concerted effort to prioritize domestic funding, address socio-cultural barriers, and ensure that all women, regardless of their location or economic status, have access to the family planning services they need.