Baby boom looms as family planning funds dwindle

Dr Margaret Lubaale, executive director at Health NGO’s Network (HENNET). She encourages domestic financing to fill gap on FP as donor pulls out.[Courtesy]

Caren Lensi is facing an uphill battle in accessing family planning services.

The 32-year-old mother of two has been using a three-year contraceptive implant and was due for a re-insertion.

Her search for the service in several hospitals is however yet to bear fruit, pushing her into an uncertain future.

Caren’s first visited Awendo Sub-County Hospital early last month, hoping to get the implant reinserted, but the commodity was out of stock.

She tried Otacho Dispensary and later Ongombita, but none of the facilities had the commodity. Disheartened, she gave up.

“I have visited three facilities, but they all tell me the three-year contraceptive is out of stock. It is frustrating because I rely on family planning to plan my life, space my children, and focus on raising them well,” Carren says.

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Without access to her preferred method, Caren and her husband have resorted to using condoms. However, even these are scarce.

For Caren, family planning is a necessity.

As a mother to a six-year-old and a two-year-old, she values the ability to space her children for their well-being and financial stability.

“For now, I am comfortable raising two children, but I fear an unintended pregnancy because I have no access to contraceptives,” she narrates.

Though private health facilities offer the implant, she says the Sh1,000 charge is prohibitive- as she cannot afford.

Her struggle mirrors crisis in family planning access, exacerbated by a reduction in donor funding and the Stop Work Order signed by U.S. President Donald Trump that has left thousands of women vulnerable to unintended pregnancies and even unsafe abortions.

A report by the Kenya Medical Supplies Authority (kemsa) obtained by The Saturday Standard reveal a stock-out of family planning commodities.

Among the contraceptives currently out of stock are implants, injectables, and pills.

According to report released last week, the agency has only 2,000 vials of injectables available, despite a monthly demand of 83,587 vials.

Shelves at Imperial, a U.S.-contracted family planning agency, are also empty. The agency was contracted by U.S, after Kemsareported multiple scandals during Covid-19.

Though the government has pending deliveries of implants, pills, and injectables, but they remain at the award stage despite long procurement processes lasting nine months at the minimum.

A shortage of free condoms has also left many unable to afford commercial ones, priced between Sh50 and Sh1,000.

Kenya needs 450 million condoms annually but relies on the Global Fund, well-wishers, and NGOs.

Interestingly condoms procured under Global Fund cannot be used in family planning clinics because of the fund restriction exacerbating the stock outs.

Despite dwindling donor support, the government is yet to fully fund family planning, a gap experts warn could trigger a baby boom, where births could triple from the current 1.5 million annually.

This woule in effect, increase demand for vaccinations, antenatal care (ANC), and maternal health services, while straining the national budget.

Margaret Lubaale, executive director at Health NGO’s Network (HENNET), observes that in Kenya, health is often seen as disease that require treatment, sidelining family planning, perception that hinder funding for contraceptive commodities.

“The lack of awareness about family planning importance makes dedicated financing difficult,” says Lubaale.

Family planning has been a donor funded program since 1967, but in 2021 the Ministry of Health, alongside key donors namely USAID, the Bill & Melinda Gates Foundation (BMGF), and UK Aid, signed a Memorandum of understanding to support family planning commodity security in Kenya with the expectation that the government would fully finance the commodities in 2026.

The agreement required the Government of Kenya to provide matching funds that donors would complement.

While USAID began its support in the 2021/22 financial year under the memorandum, the BMGF withdrew its funding in 2022/23 due government’s failure to remit its committed funds.

While discussions on sustainable financing are ongoing, Lubaale questions whether concrete budget allocations exist.

Data reveals a drastic reduction in Kenya’s budgetary allocation for family planning over the years, even with plans to be self sustainable by 2026.

For instance under 2022/23, budgetary allocation for family planning was Sh1.2 billion, that was dropped to Sh500 million and eventually no money was disbursed to procure commodities in the same financial year.

In 2023/24 no disbursements was done against the allocation of Sh1billion and in 2024/25 only Sh150 million has been released to procure family planning commodities, well below the budget allocation of Sh1billion.

With declining donor support and zero domestic disbursement, health indicators on maternal and child mortality are compromised, population growth trajectory is affected, economic stability is compromised, and national development is under strain.

“Family planning is not just a health issue, it impacts on economic well-being by allowing individuals to space births and manage family size. Yet, it is often seen as a ‘woman’s issue’ and sidelined in policy discussions,” regrets Lubaale.

She notes that frequent pregnancies reduce productivity, affecting education, agriculture, health, and food security.

“If female teachers take maternity leave annually, how does that impact on learning outcomes?” she questions.

“Family planning helps governments to manage population growth, allocate resources effectively, and is a pillar of sustainable development, and that prioritizing its funding is urgent”.

Data from the National Council for Population and Development (NCPD) shows a rise in modern family planning uptake to 57 per cent.

Progress in uptake of family planning has helped reduce maternal, infant, and child mortality.

Maternal deaths declined from 570 per 100,000 live births in 2003 to 355 per 100,000 in 2019.

Similarly, 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.

With 6.439 million women using modern contraceptives, an estimated 2.425 million unintended pregnancies and 602,000 unsafe abortions have been prevented.

To avoid losing gains made over the years, NCPD urges the government to secure sufficient domestic funding for family planning commodities, recommending an annual budget increase to Sh4 billion until 2028.

It also proposes progressively allocating Sh2 billion for family planning, integrating it into the social health scheme to ensure sustainable financing, improved service delivery, and increased access to contraceptives.

With healthcare devolved, county governments are also required to allocate budgets for family planning services.

“If the government fails to meet its family planning funding commitments and disburse sufficient funds, Kenya risks falling short of its International Conference on Population and Development ICPD 25 goals, including zero preventable maternal deaths and reduced unintended pregnancies,” warns NCPD.

Additionally, it warns of a catastrophic decline in Kenya’s long-term economic and social development if family planning funding is not sustained.

The agency highlights historical evidence showing that quality family planning programs drive both direct and indirect economic growth.

Kenya’s 2030 family planning targets aim to increase modern contraceptive access to at least 64 per cent of women.

However, the achievement of this intervention is fully dependent on availability and continuous access to the family planning commodities at and when needed.

However, even with significant progress in promoting family planning, there is still limited access to services more so people in rural areas and slums.

Socio-cultural barriers are also reported more so religious beliefs and gender norms, in addition to inadequate funding.

Silvia Musumba, a community health promoter in Kwa-Reuben slum in Nairobi, says family planning has helped households have children they can comfortably support.

Musumba oversees about 100 households, where she documents the number of sexually active individuals, pregnant women, and breastfeeding mothers.

For those who are sexually active, she advises on family planning methods, while new mothers are referred to hospitals for post-partum family planning.

“Women are only able to access family planning of their choice if given for free. High cases of unintended pregnancies are usually high during shortages because of financial struggle facing women in slums.,” Musumba told The Standard.

Women in the poorest households for example have 5.3 children on average compared to 2.7 among women in richest household.

“When the need for family planning is not met, women and families have more children than they intended, and populations grow more rapidly than economic and social development can keep pace with children of the poor are likely to be less well-nourished and less well-educated than those from wealthier families,” states family planning experts.

Organisations like inSupply Health, in partnership with the Ministry of Health, is expanding access to family planning commodities through pharmacies under the Optimizing the Pharmacy Channel (OPC) initiative.

The organization supplies family planning commodities to chemists and pharmacists, strengthening their role in reproductive healthcare.

“Pharmacies are often the first point of care for many Kenyans yet remain underutilized for advanced family planning services. Creating awareness and demand will encourage more women to seek client-centered family planning services at pharmacies,” says inSupply Health chief executive, Yasmin Chandani.

The initiative is active in Nairobi, Embu, Kajiado, Uasin Gishu, Kiambu, Nakuru, Kisumu, and Meru.

Aligned with the 2018 Revised National Family Planning Guidelines, inSupply Health is working with the Ministry of Health to equip pharmacists and pharmaceutical technologists with skills to offer advanced family planning services beyond dispensing condoms and contraceptives.

Despite these efforts, public health facilities remains the largest provider of family planning services in the country, at 62 percent while private health facilities, including pharmacies, account for 38 per cent.

More studies have also revealed that investments in family planning can spur economic growth development 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, which can be invested in housing, healthcare, education, and other economic areas.

In Kenya the most commonly used family planning methods among married women are injectables, at 20 per cent, followed by implants at 19 per cent and contraceptive pills at 8 per cent.

In 2024, the country reported decrease in injectables from 26 percent in 2014 to 20 percent in 2022, and a marked increase in use of implants from 10 percent to 19 percent over the same period.

Demand for contraception in Kenya has grown over time, with additional more than 2.5 million additional users of family planning since 2012, which signals increased demand for family planning services that necessitates increased financial resources.

In 2023, the country reached 6,502,000 users with family planning services.

As a result, family planning averted 2,440,000 unintended pregnancies, 10,000 maternal deaths and prevented 608,000 unsafe abortions.

Nationally, Kenya adopted family planning 2030 Commitments that partly seek to increase modern contraception from 58 to 64 per cent by 2030.

Nonetheless, with donor priorities shifting, Kenya must increase domestic funding for family planning, as it has committed to fully finance its family planning needs by 2030.

Counties, however, rely heavily on the national government for health funding, despite health being a devolved function.

A study by Urban Research and Development Centre for Africa (URADCA) in Meru and Nakuru between 2016/17 and 2018/19 found that counties allocated 41 to 44 per cent and 56 to 67 per cent of their budgets to health, respectively.

However, there was no direct spending on family planning, even as health budgets increased.

The estimated indirect family planning spending was 5.2 percent (Sh147 million) in Meru and 2.9 percent (Sh102 million) in Nakuru.

The study also revealed that both counties lack a budget line for family planning, with family planning commodities being procured nationally by the Kenyan government and donors.

They also had no budget lines for Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) and family planning.

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.

URADCA works across all 47 counties, generating and analysing data to help the Ministry of Health craft better maternal health and FP policies.

“While counties provide health workers, services, and supplies, FP commodities have mostly relied on donor support,” Malonza says.

Malonza explains that Kenya’s FP budget is based on population growth, past consumption trends, and donor commitments.

Despite funding challenges, Kenya’s modern FP uptake stands at 58 percent, far ahead of countries like Nigeria, which lags at 15 per cent.