Private sector dominates family planning purchases as public stockouts persist

Women of reproductive age (15-49) prefer to buy family planning products from the private sector rather than the public sector, a new report shows.

The latest report from Exemplars in Global Health shows that between 2003 and 2014, more than 90 per cent of women in the age group purchased these products from the private sector. The private sector in this context refers to private pharmacies, hospitals, clinics, drug shops, churches, and friends.

“The use of the private sector remains consistent across age groups, with adolescents more likely to obtain these products from shops, churches or friends,” the report read.

The shift to the private sector has been attributed to frequent stock-outs of contraceptives in public facilities due to lack of funding as the country lost key donors following its transition from a low-income to a lower-middle-income country, as well as easy access to drug shops, pharmacies and private hospitals, which also rarely experience stock-outs.

According to Dr Vincent Nyangweso, a gynaecologist in Nairobi, stock-outs, defined as the lack of contraceptives available at health facilities or pharmacies, can deny women access to their method of choice, ultimately increasing the risk of contraceptive discontinuation and unintended pregnancy.

“Contraceptive stockouts occur for a variety of reasons, including supply chain challenges such as inefficient planning, procurement and distribution of family planning commodities,” he says.

Studies have shown that stock-outs are more common in public sector facilities than in private or non-profit facilities.

The Sustaining Health Outcomes through the Private Sector (SHOPS) Plus study highlights the significant role of the private sector in driving the growth of modern contraceptives (mCPR) such as injectables, implants and condoms in Kenya.

While more women accessed injectables from the public sector, the private sector saw a greater increase in the number of users.

Between 1993 and 2014, the analysis shows that the number of users accessing injectables from private clinics and pharmacies increased from about 36,000 to 765,000, highlighting the important contribution of the private sector to the growth in injecting drug use in Kenya.

While the government currently provides free family planning commodities to public facilities and selected private facilities, access to free commodities is expected to end as donor funding declines and the Ministry of Health plans to fully fund its purchase of family planning commodities by 2025. Kenya has a higher prevalence of modern contraceptive use than most countries in sub-Saharan Africa.

However, the percentage of married women using modern contraceptives has steadily increased over time, from 32 per cent in 2003 to 57 per cent in 2022. Over the same period, the unmet need for family planning declined from 27 per cent to 14 per cent. The country aims to achieve 64 per cent mCPR by 2030.

Meanwhile, recent estimates suggest that out of the 923 million women of reproductive age in low- and middle-income countries, 218 million have an unmet need for modern contraception, meaning they do not want to become pregnant but are not using contraception.

According to the Kenya Demographic and Health Survey (KDHS) 2022 report, the unmet need for family planning in Kenya is about 14 per cent, meaning that they are sexually active and want to space or limit their childbearing but are not using contraception for family planning.