As part of its strategy to reduce maternal mortality, Kenya selected four counties to intensify family planning for women who have already delivered or lost their children after an abortion.
Data from the counties show that the country is already reporting an increase, six years before the 2030 deadline. Exclusive data from the Kenya Health Information System showed early successes with Isiolo, Makueni, Kwale, and Kakamega Counties.
The uptake of immediate postpartum family planning—the contraceptives offered to women within 48 hours after they deliver—increased fourfold on average, from 3.8% in January 2023 to 13.9% at the end of 2023. Kakamega (19%) and Makueni (17%) Counties recorded the highest uptake.
Isiolo, Makueni, Kwale, Kakamega, and other nine counties were once ranked as having the highest burden of maternal mortality, accounting for 98.7% of maternal deaths in Kenya. The counties have maintained their overall modern contraceptive uptake despite the COVID-19 pandemic interruption.
The Kenya Demographic Health Survey showed Isiolo’s modern contraceptive uptake increased from 26% in 2014 to 29% in 2022, and Kakamega from 60% to 63% in the same period. Kwale’s stagnated at 35%, while Kakamega declined slightly from 65% to 63%.
The statistics indicate that Kenya is moving closer to achieving one of its eight global commitments: to increase the modern contraceptive rate for married women from 58% to 64% by 2030.
In the strategy, the National Council for Population and Development (NCPD)—the government body coordinating all population activities in the country—targeted counties where family planning use was below 35%. In the commitment document, Dr. Mohamed Sheikh, NCPD Director General said family planning is much more than women delaying childbirth.
“The counties with the low mCPR also are among the counties contributing to the highest maternal and neonatal mortalities, hence will contribute to the improvement of maternal and child survival,” Dr Sheikh said.
Study
A 2012 study published in the medical journal Lancet showed that family planning prevented 44% of maternal deaths in the world. The World Health Organization (WHO) recommends spacing pregnancies by two years or more following childbirth, and at least six months following an abortion, to allow the woman’s body to heal and prevent future complications. Yet, studies have shown that half of all pregnancies in Kenya occur within short intervals of less than two years after the preceding birth. 15% occur within very short intervals of less than 12 months.
Isiolo, a county that recorded an increase in postpartum family planning from 0% to 6.3%, has taken unconventional methods such as including men in family planning discussions in health facilities and community gatherings. However, inadequate expertise and finances are often a stumbling block to counties’ efforts in providing postpartum family planning.
Efforts
The Council of Governors has encouraged counties to set up offices to look for and work with partners. One of the partners that responded was the John Hopkins Affiliate, Jhpiego, through the project Accelerating PPFP Integration into Primary Healthcare in Kenya (APIP) to work in Isiolo, Makueni, Kakamega, and Kwale counties to train healthcare workers on how to give patients a wide array of family planning methods. The projects also purchased the latest tools for healthcare workers.
Dr Njeri Nyamu, a public health specialist and the director of one of the projects that have supported the counties, Accelerating PPFP Integration into Primary Healthcare in Kenya (APIP), stated that successful family planning uptake is much more than clinical services. It also involves working with the community to explore the cultural mores that bar family planning uptake.
“Counties are making all the effort to follow the WHO recommendations for family planning, but they need support for resources for training healthcare workers to enable them to provide adequate and comprehensive counselling to mothers and couples on the contraceptive options available, so they can make a choice that best fits their needs and intention for family size,” Dr Njeri said.
She continued “This is not a healthcare workers’ affair alone; we work with community leaders and groups to address socio-cultural constructs, myths, and misconceptions that often negatively influence family planning uptake,”
