De-mystifying Family Planning

Family planning allows people to attain their desired number of children and determine the spacing of pregnancies.

Source: WHO

Access to contraception supports the fundamental human right to decide freely and responsibly the number and spacing of children.

Source: WHO

In 2021 there were 1.9 billion women of reproductive age (15-49 years) worldwide. Of the 1.1 billion with a need for family planning, 874 million were using a modern contraceptive method and 164 million had an unmet need for contraception.

Source: WHO

WHO groups methods by how they are used. Implants, intrauterine devices (IUDs) and sterilization are highly effective and long-lasting. Pills, injections, patches and vaginal rings are used regularly and work well when taken correctly. Condoms are effective at preventing pregnancy if used correctly, and are the only method that also protects against sexually transmitted infections, including HIV. Fertility awareness-based methods and withdrawal are less reliable.

Source: WHO

In Kenya, hormonal contraception is available as oral pills, injectables (intramuscular or subcutaneous), implants, skin patches, hormone-releasing intrauterine systems and vaginal rings.

Source: Kenya Ministry of Health

Every method in WHO's guidelines has undergone rigorous testing for safety, efficacy and effectiveness.

Source: WHO

Hormonal contraceptives contain synthetic hormones - either a combination of oestrogen and progestin, or progestin alone. They work primarily by preventing ovulation and by thickening cervical mucus, which makes sperm movement difficult.

Source: Kenya Ministry of Health

Progestin-only pills, sometimes called the mini pill, contain no oestrogen. They thicken cervical mucus to interfere with sperm movement and they suppress ovulation. Brands in Kenya's public sector contain levonorgestrel 30 mcg.

Source: Kenya Ministry of Health

Implants keep cervical mucus thick so sperm cannot penetrate it, and suppress ovulation in many cycles. They become effective 24 hours after insertion.

Source: Kenya Ministry of Health

A copper IUCD works because copper ions decrease sperm motility and function by altering the fluid environment of the uterus and tubes. A hormonal IUCD releases progesterone, which thickens cervical mucus, suppresses ovulation in some cycles and thins the lining of the womb.

Source: Kenya Ministry of Health

The male condom is a thin sheath worn on the erect penis, most often made of latex, and also made from polyurethane, polyisoprene, lambskin or nitrile. It works as a barrier, keeping sperm from meeting an egg.

Source: Kenya Ministry of Health

Implants give 99.9 per cent protection against pregnancy. IUCDs are 99 per cent effective when used correctly and consistently, with fewer than one pregnancy per 100 women using a copper IUCD in the first year.

Source: Kenya Ministry of Health

Progestin-only pills are 99.5 per cent effective when used correctly and consistently during exclusive breastfeeding, and are most effective when taken at the same time every day. The risk of pregnancy is greatest if pills are taken late or missed.

Source: Kenya Ministry of Health

Male condoms are 87 per cent effective in typical use and 98 per cent effective when used correctly and consistently. They also prevent 80 to 95 per cent of HIV transmission that would otherwise have occurred.

Source: Kenya Ministry of Health

Among implants in common use in Kenya, Jadelle (two rods, levonorgestrel) lasts five years, while Implanon and Implanon NXT (one rod, etonogestrel) and Levoplant (two rods, levonorgestrel) last three years. Hormone-releasing IUDs release levonorgestrel over five years.

Source: Kenya Ministry of Health

Family planning is offered at service delivery points across the health system, from dispensaries and health centres up to sub-county and county facilities.

Source: Kenya Ministry of Health

Services are provided by nurses, doctors, pharmacists, pharmaceutical technologists and community health promoters. Some methods may only be provided by cadres specifically trained for them.

Source: Kenya Ministry of Health

Community-based family planning brings information and services to people where they live, including community-based distribution of injectables, condoms and pills, alongside a community pharmacy channel.

Source: Kenya Ministry of Health

Administration of injectable contraceptives by community-based distributors has been approved in 14 counties: Baringo, Garissa, Mandera, Marsabit, Narok, Samburu, Tana River, Turkana, Wajir, West Pokot, Kajiado, Kilifi, Isiolo and Tharaka Nithi.

Source: Kenya Ministry of Health

The Ministry of Health recommends universal access to age-appropriate information and services for all adolescents and young people, and providers are to offer adolescent- and youth-friendly services that are equitable, accessible, acceptable, appropriate and effective.

Source: Kenya Ministry of Health

Clients should be counselled on dual protection - protecting against both pregnancy and STIs including HIV.

Source: Kenya Ministry of Health

WHO identifies barriers including limited availability of certain methods, particularly in low-resource or rural settings, and restrictions related to age, income or marital status. Fear of side effects, misinformation and social or religious opposition discourage use, as do poor service quality and provider bias against particular methods.

Source: WHO

Gender inequality also plays a role, with some people needing a partner's consent or fearing stigma.

Source: WHO