By Sophie Nyongesa and Dorothy Okemo
World Contraception Day is celebrated annually on 26th September. The annual worldwide campaign centers around a vision where every pregnancy is wanted. Launched in 2007, World Contraception Day mission is to improve awareness of contraception and to enable young people to make informed choices on their Sexual and Reproductive Health. Although there are various contraceptive methods available in Kenya, the Kenya National Commission on Human Rights (KNCHR) report on public inquiry into violations of Sexual and Reproductive Health shows that Kenyans who desire to plan their families still do not have access to family planning services due to unavailability of essential sexual and reproductive health services and difficulties in accessing these services owing to distance or cost.
According to the Health Action International led research on the availability, affordability and stock-outs of Sexual and Reproductive Health Commodities done in 10 counties in Kenya conducted between 2017-2019, the findings show a general improvement in the availability of contraceptives over the years except for ethinylestradiol and norethisterone (Norimin), a birth control pill which remained around 5% availability each year. For instance, the availability of male condoms (84%) were higher than the female condoms (56%) in the public sector in 2019. The diaphragm was rarely available; only in 4% mission health facilities and unavailable in both the private and public health facilities. Moreover, the diaphragms were only available in Kisumu County at 6% among the ten counties that were researched. The availability of the Emergency Contraceptive Pill was 47% in the public sector compared to 71% in the private sector. The total average availability of contraceptives per county was low, ranging from 43% in Kakamega, Kisumu, Meru and Kwale counties, 41% in Narok and Nakuru Counties, 38% in Mombasa County, 35% in Nairobi County, 31% in Isiolo County and 30% in Makueni County. These findings confirm that availability of contraceptives was below average in the country.
Statistics by the Guttmacher Institute shows that 63% of pregnancies among adolescents in Kenya are unintended. Studies have shown that early and unintended pregnancies among the adolescents lead to unsafe abortions and miscarriages, school dropouts and increased risk of birth related complications. The Guttmacher institute shows that satisfying the unmet need for modern contraceptives among adolescent women in Kenya would result in a 73 %drop in unintended pregnancies as they account for an estimated 86% of all unintended pregnancies in the country.
The Kenya National Family Planning Costed Implementation Program (FP-CIP) 2017-2020, details the country’s plans to achieve the family planning vision and goals to improve the health and wellbeing of its population through providing high quality, right-based family planning information and services. To address the existing challenges and opportunities for scaling up right-based family planning in the country, the FP-CIP 2017-20 focuses on six thematic areas. These include; family planning commodity security, family planning financing and sustainability, information management, stewardship, governance and partnerships, demand creation and service delivery. Addressing of the different challenges in these thematic areas would help reach the national family planning goal of increasing contraceptive prevalence rate from 53.7% in 2016 to 58% in 2020.
According to the United Nations Population Fund (UNFPA), the current COVID-19 pandemic has impacted the supply, availability and accessibility of Sexual and Reproductive Health commodities such as the contraceptives for the young people especially the young women. The pandemic has disrupted the health systems, health commodity supply chains and therefore more women and girls are unable to access the family planning information and services they need.
The COVID-19 measures put in place such as the curfew restrictions, social distancing and having some health facilities set aside solely for COVID-19 cases management has made the accessibility of reproductive health information and services difficult. The shift of attention, resources and funds to cater for prevention and management of the Covid-19 has reversed the gains made in the Sexual and Reproductive Health sector.
In the wake of the current pandemic and beyond, various strategies have to be put in place in to mitigate the unmet family planning needs for the youth. The Health Action International led research on the availability, affordability and stock-outs of Sexual and Reproductive Health Commodities in ten counties, made a number of recommendations in improving access to contraceptives including;
- Sensitization and community education on myths and superstition around the use of contraceptives to allay the fears on the perceived side effects of contraceptives.
- Involvement of male partners in access, provision and education around use of contraceptives.
- Improving the supply chain by ensuring timely supply of commodities and supply of ordered quantities to ensure live-saving Sexual and Reproductive Health commodities are always available all public health facilities.
- Setting aside of functional youth friendly centers or designated youth friendly corners in health facilities for provision of Sexual and Reproductive Health information and services for the young people.
- Improving the general infrastructure to ensure access of Sexual and Reproductive Health services especially in hard to reach areas and particularly where the health facilities are located in very remote and inaccessible areas.
- Providing adequate budgets for Sexual and Reproductive Health and also ring fencing these funds to guarantee their provision.
- Training of both stock management and quantification to ensure seamless supply and availability of commodities. Health care providers should be able to adequately forecast when a commodity is likely to run out and ensure a new supply is ordered for, in anticipation of any delays in supply to avoid undue stock-outs.
According to the Global Health Science and Practice journal, contraception is a lifesaving and an essential component of reproductive healthcare, lowering maternal mortality and improving newborn and child health especially in Low and Middle Income Countries like Kenya. The national and county governments should incorporate a multi-sectoral approach in dealing with Sexual and Reproductive Health in the quest to ensure accessibility and availability of family planning information and services for ultimate improvement of maternal and child health outcomes.