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Despite decades of progress, access to family planning in hard-to-reach and underserved areas of Kenya remains a significant challenge.
Many women in arid and semi-arid regions, as well as those in deeply traditional communities, struggle with access to contraceptive methods due to cultural beliefs, misinformation and weak healthcare infrastructure.
The Delivering Sustainable and Equitable Increases in Family Planning (DESIP) programme, funded by UK Aid, has played a pivotal role in bridging this gap by increasing contraceptive prevalence and providing sustainable solutions for reproductive health.
Yet, as Kenya aims to meet its FP2030 goals, stakeholders emphasise the need for continuous investment in family planning services to sustain these gains.
“Today, we are here sharing dissemination of information gathered through a project focused on family planning in hard-to-reach areas and vulnerable populations,” said Dr Issak Bashir, Head of the Department of Family Health at the Ministry of Health.
“We have worked for the last six years in 12 counties, with a focus on those with less than a 45 per cent contraceptive prevalence rate (CPR), some even lower than 5 per cent, like Mandera, Wajir and Garissa.”
Family planning in Kenya has evolved significantly over the past few decades. In 1989, only 18 per cent of married women used modern contraceptive methods. By 2022, this figure had risen to 57 per cent, reflecting increased awareness and access to family planning services.
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Despite this progress, disparities remain, particularly in marginalised counties where cultural norms, misconceptions and limited access to healthcare services influence family planning decisions.
The National DESIP Dissemination Conference, held in Nairobi in January 2025 by Population Services Kenya (PS Kenya), provided insights into the changing landscape of family planning in Kenya and highlighted the impact of the six-year DESIP programme.
Modern family planning methods available in Kenya include injectables, implants, pills, intrauterine devices (IUDs), male and female condoms and permanent solutions like tubal ligation and vasectomy.
Injectables and implants are particularly popular, with injectables being the most commonly used, accounting for 595,700 new clients and 1.8 million revisits in 2021.
The 5-year implants have been the most common method, at 52 per cent between 2019 and 2023, followed by Depot medroxyprogesterone acetate (DMPA) at 15 per cent, 3-year implants at 14 per cent and intra-uterine contraceptive devices (IUCD) at 10 per cent.
Natural family planning is used by 7 per cent of the population, while permanent methods like tubal ligation and vasectomy account for much smaller numbers; 3,616 women underwent tubal ligation and 248 men opted for vasectomy in 2021.
“Kenya should be very proud of its achievements in reproductive health,” said Eduarda Mendonca-Gray, Deputy Development Director at the British High Commission. “This programme put Kenya on the world stage by developing the first Development Impact Bond for family planning, which has now been scaled up globally. More than 400,000 girls and women in low-income settings have received family planning services under this initiative.”
Traditional family planning methods have also played a role, especially in rural areas. These methods include the calendar method, withdrawal (coitus interruptus) and prolonged breastfeeding, which naturally delays ovulation.
Herbal remedies and traditional abstinence practices, often guided by cultural or religious beliefs, have been widely used.
While these methods can be effective when used correctly, they generally have higher failure rates compared to modern contraceptives.
Many women in remote areas continue to rely on traditional methods due to mistrust of modern contraceptives, fear of side effects or influence from community elders and religious leaders.
Natural Family Planning (NFP) falls between traditional and modern methods, using fertility tracking techniques such as the Standard Days Method, cervical mucus monitoring and basal body temperature tracking.
NFP is widely promoted in communities where religious or cultural beliefs discourage artificial contraception. It is also gaining popularity among women who prefer hormone-free methods. However, its effectiveness depends on strict adherence, education and regular monitoring, making it less reliable in areas with limited access to health information.
Family planning methods vary in type and effectiveness. Implants are small, flexible rods inserted under the skin of a woman’s upper arm that release hormones to prevent pregnancy for several years.
Depot medroxyprogesterone acetate (DMPA) is an injectable contraceptive given every three months to prevent ovulation.
Intrauterine contraceptive devices (IUCDs), commonly known as coils, are small T-shaped devices inserted into the uterus to prevent pregnancy for up to ten years.
Bilateral tubal ligation (BTL) is a permanent surgical method that involves closing or blocking a woman’s fallopian tubes to prevent pregnancy.
Other methods include combined oral contraceptive pills, which contain oestrogen and progestin hormones to prevent ovulation, and progestin-only pills, which are suitable for breastfeeding mothers.
Emergency contraceptive pills, often called the “morning-after pill,” are used after unprotected sex to prevent pregnancy.
Vasectomy is a permanent contraceptive procedure for men, where the tubes carrying sperm are cut or sealed.
Cycle beads, also known as the Standard Days Method, help women track their menstrual cycle to determine fertile and infertile days for natural family planning.
Child spacing is a critical aspect of family planning, allowing women to recover between pregnancies and ensuring better health outcomes for both mothers and children.
Medical experts recommend spacing pregnancies by at least two years to reduce health risks, improve child survival rates and enable families to allocate resources more effectively.
Proper spacing contributes to better nutrition, education and economic stability within households, especially in low-income communities where resources are often stretched.
Social inclusivity is also key in making family planning accessible to all. The DESIP programme has emphasised reaching different social classes, including persons with disabilities (PWDs), who have historically been overlooked in reproductive health discussions.
By addressing accessibility barriers and incorporating disability-friendly services, DESIP has helped ensure that everyone, regardless of their physical abilities or economic status, has access to reproductive healthcare.
Dr Margaret Njenga, CEO of Population Services Kenya, explained, “Social inclusion in family planning is about ensuring that no one is left behind. We are working towards making services accessible to all women, including those with disabilities, so they can make informed choices about their reproductive health.”
Education and awareness campaigns have played a crucial role in promoting family planning. Organizations such as the Kenya National Bureau of Statistics (KNBS) and the Ministry of Health have been instrumental in disseminating information.
As a result, nearly all women and men (99 per cent each) are aware of modern contraceptive methods. Yet, despite this high level of awareness, some counties continue to lag.
The DESIP programme has focused on counties such as Turkana, Elgeyo Marakwet, Narok and Baringo, which have seen significant increases in contraceptive prevalence rates, with Turkana leading at 33.4 per cent.
Dr Njenga emphasised the importance of collaboration in achieving these gains. “Under the DESIP programme, we have seen a lot of success because of partnerships. Working with government, religious leaders and local communities has been key to increasing access to contraceptive services, particularly in arid and semi-arid areas. Contraception is not just about health; it’s an economic issue that helps households plan better for their families.”
While access to contraceptive options has increased over the years, adoption remains inconsistent across different regions.
For instance, counties such as Marsabit, Garissa and Samburu report lower contraceptive uptake due to social and religious influences. Many women in these areas face pressure from spouses, community leaders and religious figures who discourage contraceptive use, often linking it to cultural taboos or misconceptions about infertility.
In contrast, urban and peri-urban areas, with stronger healthcare systems and advocacy, report a higher usage of modern contraceptives.
Moving forward, addressing the barriers to family planning in Kenya’s marginalised areas will require a multi-faceted approach. Strengthening community engagement, improving healthcare infrastructure and integrating culturally sensitive education programs can help bridge the gap.
Additionally, increasing male involvement in family planning discussions may shift the prevailing attitudes that hinder uptake.
Dr Charlotte Pahe, Director of Programmes at PS Kenya, explained, “In some regions, we work with religious leaders, using scriptural texts to show that child spacing is not against faith but ensures the well-being of mothers and children. The Manyatta model has also been effective in reaching nomadic communities, delivering services directly to where they are.”
Dr Susan Ontiri from the International Centre for Reproductive Health emphasised the role of data in sustaining these achievements. “Data has been critical in this programme. It has helped track where the gaps are, ensuring that family planning commodities are available where they are most needed. By relying on evidence, we have been able to refine our strategies and improve access to services.”
As the country strives to meet its reproductive health goals, ensuring that all women, regardless of location, have access to safe and effective family planning options remains a crucial objective. These findings and lessons from can inform future policies and interventions, reinforcing the commitment to equitable and sustainable family planning for all Kenyans.
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