Lessons from Kenya's family planning success story

As part of our series for International Women's Day, we spoke with Sophie Chabeda of the International Centre for Reproductive Health about how Kenya has increased contraceptive use and her own hopes for women

Over the past several decades, Kenya has emerged as a family planning success story. The country's modern contraceptive usage rate has increased from around 15% in 1990 to nearly 60% in 2022, averting thousands of unintended pregnancies and maternal deaths.

The country, which will soon be featured by Exemplars in Global Health as an Exemplar in family planning, has accomplished this through unwavering government support for family planning, as well as widespread access to family planning information and programs. Modern contraceptives are also freely available and health care providers have been trained in providing these methods.

We spoke with one of the partners helping conduct the Exemplars research, Sophie Chabeda, a senior research officer at the International Centre for Reproductive Health, about how Kenya has made such remarkable progress, as well as her own hopes for Kenyan women on International Women's Day.

Could you tell us about your work with the International Centre for Reproductive Health, specifically your sexual and reproductive health programs?

Chabeda: The International Centre for Reproductive Health implements programs and research in sexual and reproductive health. The programs and research fall under thematic areas of HIV and sexually transmitted infections; family planning; maternal, neonatal & child health; adolescent sexual and reproductive health and rights; and sexual and gender-based violence. Each of the thematic areas is further divided into community education and health promotion, service delivery, data collection for complex health interventions, monitoring and evaluation, and government policy and accountability for health commitments. We gather data shared at the national and subnational level to inform policy and for planning and the provision of commodities such as family planning [products] to the satellite sites. We also have programs and research projects on sexual and gender-based violence that touch on sexual and reproductive health, including addressing sexual and gender-based violence among children, adults, and the youth population.

You’re also helping lead new Exemplars in Global Health research into family planning equity in Kenya – what are some of your early insights from both that project and your work with the ICRH?

Chabeda: In terms of Exemplars in family planning, Kenya had been selected as one of the countries surpassing its FP2020 target. One of the things that is clear is the government's commitment in terms of the political will that has been there for family planning. Kenya was one of the first Sub-Saharan countries to initiate family planning programming. The government has continued to support family planning with financing. In the past, [family planning] has been donor-dependent, with international donors supporting family planning programming. But the government has continued to be committed in working toward matching the donor funding with domestic funding.

Kenya also has policies that are inclusive on sexual and reproductive health and family planning. These have been revised over time to incorporate emerging issues or address gaps in programming for family planning. Additionally, the country has been working not only with the health sector but also with non-health sectors like education and agriculture in implementing this program to be able to be successful. Kenya has incorporated actors at the table to address the gaps in family planning implementation.

Kenya’s modern contraceptive usage rate increased from around 15% in 1990 to nearly 60% in 2022, according to the most recent Demographic and Health Survey. How did this happen and what lessons could there be for other countries?

Chabeda: Kenya’s government has been committed to adopting and ratifying the international protocols, including the International Conference on Population and Development in 1994. With the adoption of that, Kenya was able to review its reproductive health policy and implement policy through its family planning programming activities. In terms of programming, Kenya has prioritized increasing access points for family planning through community-based distribution and the private sector, addressing social behavioral change through mass media and community engagement. Another key thing was the introduction of long-acting methods [of contraception] like implants and sensitizing and providing these to women.

Kenya has also been keen in implementing high-impact practices, as mentioned, in terms of the enabling environment, for example, the national level increase of domestic funding allocation for family planning, with the goal of matching international funding. In terms of service delivery, Kenya has also been able to integrate [family planning] services. For example, at the facility level, family planning has been integrated with immunization services so that women who visit health facilities to obtain vaccines for their children are able to get the contraceptive method they need. Also, there's provision of these commodities in the private sector. This has enabled women to get these commodities wherever they are. The goal of family planning leaders in Kenya is that every woman is able to get the family planning method they require, whenever they need it.

The other success has been the incorporation of adolescent reproductive health, which has been prioritized over the years, and hopefully will continue to be a priority. E-health messages reach adolescents and, if and when they require a contraceptive method, guide them to a facility where they're able to access contraception. Some of these facilities have been able to incorporate youth-friendly services that attend to SRH needs for the youth including family planning when needed. Innovative efforts include social marketing and digital health. Social marketing had ensured product accessibility through the private sector outlets such as pharmacies and mobile outreaches.

Another population that has been included is a bit marginalized; people who are disabled or enabled differently. There has been programming for them so that they are able to also access these commodities. Faming planning leaders, through digital health, are providing information on family planning through Mama Siri (a toll-free solution that provides an information and SRH referral service to women and girls with disabilities) and information is available in braille and sign language at specific health facilities with implementation by DESIP (Delivering Sustainable and Equitable Increases in Family Planning).

More broadly, how could women’s ability to exercise their rights and make their own choices about timing and method of contraception be further improved in Kenya?

Chabeda: This is still a work in progress, I believe. Kenya has made strides, including ensuring that women are able to get information and education. Having said that, we still have regional disparities. The Demographic Health Survey indicates that some parts of the country still have women who are illiterate or with a low level of education. Women who are more educated are able to make their own choices, they are able to make decisions on when to have children and how to space them. I think that's something that we as a country continue to be committed to – being able to ensure that every woman has received enough education to be able to make their own decisions.

At the community level, community-based efforts have incorporated male involvement, meaning getting men to the table, getting men to come and understand and support their partners in terms of decision making, or letting them decide when to have children and use the method that of family planning they desire. That is also a work in progress in terms getting more male involvement.

Lastly, addressing the social-cultural issues that still exist at the community level, with some cultural practices such as early marriages for adolescents, early marriage denies them opportunities for further education and in turn, undermines their decision-making rights. On this year’s IWD, what is your biggest hope for women and health?

Chabeda: For International Women's Day my biggest hope is that we embrace equity. One of the things that I expect and I hope is that even as we talk about embracing equity, it'll not just be a buzzword, but we are going to swing into action when it comes to providing women whatever support they require to unlock their potential. Being aware, this is just a day‘s commemoration, we still need to move into action. Let's ensure that these women are able to make choices and exercise their rights without any hindrances.