Family Planning and Women’s Health in Kenya

The Impacts of U.S. Investments

EXECUTIVE SUMMARY

Voluntary family planning is one of the most transformative interventions in global health, critical to improving women’s health and to saving the lives of women and children in some of the world’s most vulnerable communities. Beyond the direct health benefits, family planning is essential for women’s empowerment and sustainable development, contributing to improvements in education, economic growth, and the prevention of mother-to-child transmission of HIV. As the global leader in supporting family planning, the United States has a vital role to play in helping countries improve the lives of women and families.

To understand the impact of U.S. investments, this report examines U.S. support for family planning in Kenya at a pivotal moment for these issues globally. As a regional leader in family planning and a priority country for U.S. family planning and maternal-child health assistance, and the President’s Emergency Plan for AIDS Relief (PEPFAR), Kenya provides a lens through which to assess the opportunities and challenges in expanding access and transitioning to greater sustainability.

Kenya has made significant progress in family planning, with one of the highest contraceptive prevalence rates in the region at 58 percent, yet faces important challenges in maintaining momentum.

In the polarized U.S. political environment, funding for family planning programs faces persistent challenges. There is a risk that without clear U.S. commitment, these critical interventions could be derailed. Strong, bipartisan leadership is required to depoliticize these issues and to highlight the importance of voluntary family planning and healthy timing and spacing of pregnancies to improve women’s health, prevent unintended pregnancies, increase child survival, avert millions of abortions, and improve economic and social development. U.S. policy toward Kenya is in many ways a laboratory for the region with lessons for other countries.

This report focuses on three key questions:

  • How will changes in PEPFAR strategy present challenges for the scale and sustainability of family planning-HIV integration? The impact of PEPFAR 3.0 on family planning and maternal-child health services highlights the need for more ample, secure, and dedicated funding for these services. U.S. investments in voluntary family planning and in integrated service platforms with maternal-child health and HIV/AIDS have had a significant positive impact in Kenya, helping improve health outcomes for women and children. While U.S. funding for family planning and maternal-child health in Kenya has remained fairly steady in recent years, integration with HIV/AIDS is highly dependent on PEPFAR funding and strategy. PEPFAR’s refocused approach, which will target resources to 20 of Kenya’s 47 counties with high HIV burden, will present challenges for integrated services.

  • How can the United States assist Kenya to address ongoing challenges in family planning access and quality, especially in the context of decentralized health services? Kenya has shown leadership in developing policies supportive of family planning and integration of health services, propelled by advocacy from international partners and domestic civil society. To move implementation forward and to overcome key challenges, Kenya will need increased domestic resources for and commitment to family planning. This takes on new urgency in the midst of the extensive political decentralization in Kenya known as devolution, which has meant that responsibility for family planning services now rests with county governments. The Kenyan national and county governments will have to develop adequately funded budgets to ensure the availability of the full range of family planning methods (including long-acting methods such as implants and IUDs) and quality services. This may require returning authority for procurement of contraceptive commodities to the national level to avoid stock outs and to ensure efficiencies of scale and equity.

  • How can U.S. investments in family planning and maternal-child health yield the greatest impact, at a time when the international financing frameworks are shifting to include greater roles for the private sector and domestic resources? Now a lower-middle-income country, Kenya is also a front-runner country for the new Global Financing Facility (GFF) for reproductive, maternal, neonatal, child and adolescent Health (RMNCAH). However, the government’s continued reliance on its external donors to finance family planning services and commodities—especially USAID— underscores the challenges of transitioning to sustainable financing.

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About the Authors

Janet Fleischman
Janet Fleischman
Janet Fleischman is a senior associate with the Global Health Policy Center at CSIS, where she focuses on women’s global health and U.S. policy. She is also an independent consultant who has worked for many organizations addressing the health and rights of women and girls, gender-based violence, family planning/reproductive health, and HIV/AIDS. Read full bio here.
Katey Peck
Katey Peck
Katey Peck is a program manager and research associate at the CSIS Global Health Policy Center, where she focuses on family planning and reproductive health, as well as maternal, newborn, and child survival. Previously, Ms. Peck worked as a research analyst and writer at the Center for High Impact Philanthropy, where she contributed to donor guidance for global investments in child health. Read full bio here.