NAROK COUNTY, Kenya – Decades of progress in expanding access to contraception in Kenya could be unravelling, as global funding for contraception plummets. Stocks of many contraceptives are now dwindling in public hospitals, health workers told UNFPA, the United Nations sexual and reproductive health agency, during a mid-June visit.
UNFPA has been able to keep supplies flowing to a number of clinics across Kenya, with more than $3 million going to procure contraceptive commodities for 2025. That, along with support from the Kenyan Government, will cover an estimated 17 per cent of the reproductive commodity requirements for the year.
Yet contraceptives from other suppliers are running low.
In Narok, a vast rural county that is home to the famous Maasai Mara national park, health workers expressed concerns about their ability to meet family planning demands.
At Ololulung’a Sub-County Hospital, nurse Jacqueline juggles a heavy caseload of women who are pregnant, postpartum or seeking contraception. When asked about her greatest challenges, she did not hesitate. “The workload,” she said, coupled with “stockouts, especially of short-term methods – the most commonly used in this area.”
The most desired form of contraception, the injectable, was not available at all, she added.
She recited from memory the supplies she has on hand: “I only have the three-year Levoplant,” a contraceptive implant. “I don't have the five-year. I don't have a hormonal IUD.” There are some longer-term methods available, “but it's not so popular,” she explained.
Choice is narrowing
A similar situation was found in the pharmacy storeroom at the Narok County Referral Hospital, about an hour away. There, Dr. Felistas Misati, the sub-county pharmacist for Narok County East, logged into the Logistics Management Information System (LMIS), an inventory programme supported by UNFPA and other donors. The LMIS gives a view into the movement of contraceptive stocks at all levels of the public health system, from the health ministry’s Kenya Medical Supplies Authority to small facilities around the country.
The system showed that injectable contraceptives “are currently stocked out at the national level,” Dr. Misati said. She added that the number of contraceptive implants received in the county’s last delivery was just one fifth of the amount requested.
So far, health facilities had been able to reallocate stocks from along the supply chain to meet needs, she said. “Some still have very low quantities.”
But they are running out.
Bracing for consequences
Some women will be able to switch to contraceptive methods that remain available. For example, UNFPA-procured condoms stocks are projected to last at least through 2025, offering an important buffer in the face of uncertainty. But the reality is that contraceptive methods are not always interchangeable. For many women, choice matters – not just for their convenience but also for their body, health and circumstances.
When that choice is removed, women face increased risks of unintended pregnancy, unsafe abortion and even violence.
Hormonal methods, for example, require consistency of use to be effective. And options like the injectable are often selected because they can be used clandestinely.
“It's a discreet method,” said Evans Nyabwari, a nurse and reproductive health coordinator in Narok. “The challenge we have is men not wishing their women to use” family planning.
If women are found to be using contraception, their partners sometimes become violent, health workers explained. If women switch from contraceptive injections to implants or other non-discreet methods, they may be at risk from their partners.
“There was a time when a lady came for an implant, and when the husband realized, he almost chopped it out with his own knife,” said Elizabeth Samanta, the community health focal point for Narok North sub-county.
Already, some women are asking for the implants to be placed in the thigh instead of the arm for better concealment, said Emma Kugotha, the reproductive health coordinator for Narok South sub-county, at the Ololulung’a Sub-County Hospital. She, too, has encountered situations where men forcibly remove contraceptive implants: “The men go home and search for it and remove it,” she said. “We have women bring it back in cartons.”
The health system as a whole is bracing for serious shortages in the coming months. A government report issued in March projected that the loss of donor funds would result in “no access to [family planning] services for over 6.2 million clients in 2025, increased unintended pregnancies, unsafe abortions, maternal deaths and a decline in contraceptive prevalence rate.”
In Narok County, unintended pregnancies are especially dangerous. More than half of women in the county have undergone female genital mutilation, and the adolescent pregnancy rate is twice the national average – both factors that greatly increase complications during pregnancy and childbirth. Narok also has one of the highest maternal death rates in Kenya.
Broken promises
It is a frustrating situation for health workers who have spent years helping women take control of their bodies, lives and futures.
Globally, donor funding for contraception had already plummeted to its lowest point in nearly a decade when the world’s largest donor to sexual and reproductive health programmes ended support to international family planning earlier this year
Creating awareness about safe, reliable, modern contraceptives has been a slow and steady process, but one embraced rapidly by women. “You give that information to the community, and within a day you get an influx of clients,” Mr. Nyabwari said.
Women often walk for hours across rough terrain to reach their nearest clinic. Soon, for many of these women, the promise of contraception – of bodily autonomy, of pregnancy by choice – may be a promise broken.
Some women will turn to private sellers for their preferred method, but “when it's not available in the government facilities, these private pharmacies tend to hike” their prices, Mr. Nyabwari said.
UNFPA and partners are actively working to ramp up family planning procurement and delivery to meet the needs of women, including hundreds of thousands of doses of injectable contraceptives. Still, these deliveries will not fill all the gaps. And without more support, women will find themselves with fewer options.
