Limited access to contraception now threatens to lock out 72% of users -#formnigani report
Kenyan youth have identified a combination of COVID-19 containment measures and prevailing disparities in access to health services and contraception as detrimental to family planning and by extension, crucial health and development outcomes for Kenya, according to the report titled Kenyan Voices: COVID-19 and Contraception. The report launched on 30th June 2020 by #formnigani captures Kenyan youth’s perceptions of the state of the family planning during the pandemic, and identifies contraception access as central to achieving key social and economic outcomes for sustainable and equitable development for Kenyans.
According to the report by #formnigani, a creative platform for Kenyans to express themselves and have discussions about the critical issues and decisions surrounding contraception, as a result of the various factors affecting contraception access, 93% of young Kenyans predicted a surge in pregnancies and a sharp increase in population. These factors, triggered by the COVID-19 pandemic include alterations to sexual and reproductive healthcare seeking behavior as the pandemic affects virtually every aspect of society.
“A set of new drivers are now more influential in driving access to preferred methods, including loss or reduction of income, closure of colleges and universities which offer free access to contraceptives, and shortages owing to interruptions to local and global supply chains,” said Dr. Katindi Sivi, leading Kenyan futures expert, who formulated and facilitated the development of the COVID-19 and Contraception report.
Resultantly, young Kenyans are finding it much more difficult to access contraception during the COVID-19 pandemic. A key concern identified by the #formnigani report contributing to challenges in access is the omission of various forms of contraception by guidelines put in place to sustain contraception efforts. Despite contraception being identified as an essential service, there is a glaring lack in mapping policy enactments to the needs and behavior of users. This is visible in the Ministry of Health’s Kenya COVID-19 RMNH Guidelines, which despite classifying contraception as an essential services limited community based distribution to condoms and oral pills which comprise just 22% of the contraception uptake by Kenyans.
“A majority of contraception methods, most of which are long-term, are left out such as injectables, implants, IUDs. Looking at these three methods alone, disproportional access to contraception threatens to lock out 72% of users. While it is reasonable to prioritize certain aspects of public health, classifying some forms of contraception as non-essential potentially cuts the public off from accessing them in the short-term and expose the country to long-term social and economic consequences,” said Andy Awiti, strategy consultant and a participant of the #formnigani Think Tanks.
In addition to undermining the policy’s intent, the restrictions on available methods deepens disparities in access by reducing choice at a time when healthcare, and sexual and reproductive healthcare, is primarily accessed through public facilities.
Furthermore, existing disparities in access to family planning methods and information may combine with new barriers to contraception access, the report notes, with outcomes further detrimental to Kenya now and in the years to come. In some counties that have experienced lockdowns, access to contraception has been concerningly low – Mandera has a contraception prevalence rate of less than 10%, Kilifi just under 35%, while Kwale and Mombasa range between 35% and 45%. This, coupled with prevailing conditions may see an increase in nationwide teenage pregnancies and maternal deaths from unplanned pregnancies, currently at 13,000 and 6,500 respectively, with long term strain on Kenya’s social fabric and economic resources.
In the COVID-19 and Contraception report, young Kenyans explore future outcomes for the country based on key drivers of contraception most influential in shaping contraception in Kenya during the pandemic and beyond, including global influence, innovation, and the state of the health system. This culminates in a picture of the state of Kenya in the near and long term in three scenarios – worst case, moderate case and best case scenarios.
In the best case scenario, an understanding of the crucial role that a robust contraception system plays in economic policies guides people-centric family planning reforms that deliver on socio-economic goals. These reforms are explored in the report’s minimum quality standard (MQS) framework, including a community based, population approach to contraception policy and financing that seeks to include the most vulnerable, a contraception supply chain anchored on offering expanded choice of methods, and an SRH system that benefits from the synchrony between health facilities and outreach initiatives. For young Kenyans, the role of contraception in achieving individual and national goals cannot be understated. “Even as we fight the pandemic, there is a chance to review the systemic gaps including the ones that contribute to unmet contraception needs to be able to adequately get future solutions to our challenges,” said Dr. Katindi Sivi.