The WHO defines reproductive health as “a responsible, satisfying, and safe sex life [with] capability to reproduce and the freedom to decide if, when and how often to do so”. Access to RMNCH is a determinant of maternal and child mortality, as well as many economic and social development indicators. Family planning, for example, prevents adverse outcomes and maternal and newborn deaths by reducing women’s exposure to high-risk pregnancies and helps to avoid unintended and closely spaced pregnancies.
Each year, nearly half a million women worldwide die as a result of complications in pregnancy and childbirth. Almost all (99%) of these deaths occur in developing countries, where pregnancy-related complications remain a leading cause of death for women in their reproductive years. Yet, most of these deaths are avoidable. Over the last 30 years, the global RMNCH burden has decreased significantly, but many countries are far from achieving the national-level goals for maternal and child health – particularly in sub-Saharan Africa. Approximately 300,000 women die from pregnancy-related causes every year – 74% from complications during delivery.
In low- and middle-income countries (LMICs), 218mn women have unmet need for modern contraception, contributing to 111mn unwanted pregnancies every year. This need is greatest among adolescents 15-19 years-old, who face increased socio-cultural barriers to access. As of 2019, 314mn women within the FP2020 countries (a group of LMICs committed to improving access to family planning services) used modern contraception methods. This is a significant increase from 53mn in 2012. However, estimates suggest that 230mn women and girls in LMICs still have unmet need for modern contraceptive methods.
Many of the countries with the highest maternal mortality rates, and child mortality rates are also those with the lowest use of family planning methods, such as Chad, South Sudan, Somalia, and Nigeria. Sub-Saharan Africa has the lowest modern contraception prevalence rates (mCPR) globally. However, sub-Saharan Africa is also the region that has experienced the highest recent growth in mCPR. Between 2012 and 2019, mCPR growth in East and Southern Africa was 1% per year on average, and 0.7% and 0.6% in West Africa and Central Africa, respectively. These rates are greater than all other regions, and at least double the growth of the next highest of Latin America and the Caribbean, and South Asia.
Kenya is no exception. While use of modern methods of family planning in Kenya has increased over the last decade, from 32% in 2003 to 60.7% in 2018, 13.8% of currently married women still have an unmet need for family planning services, and 31% of family planning users discontinue use of a method within 12 months. The most popular modern contraceptive methods used among all women are injectables (19%), implants (7%), and the pill (6%). Use of the intrauterine contraceptive device (IUCD) is low (2.3%). The public sector remains the major provider of contraceptive methods, with 60% of modern contraceptive users obtaining their contraception from a government source, 38% from the private sector, and 2% from other sources.
While the RMNCH landscape is complex and highly fragmented, including many health priorities, commodities, and key players, many organisations in collaboration with governments have demonstrated efforts to prioritise and improve RMNCH. Gaps in access are driven by numerous factors including issues with product quality and appropriateness, weak forecasting and procurement systems, and inconsistent political will and financing for products.
Overall, there is a need for greater market shaping and coordination support. In the family planning space, efforts are underway to explore how a market coordination mechanism could address commodity access issues in LMICs, but broader support across the RMNCH landscape is needed as well. There is also limited opportunities for scaling new RMNCH tools and interventions. RMNCH lacks global bodies that provide scale-up at the volume of other disease areas. Despite these complexities, governments in partnership with the private sector are empowering women through prioritising RMNCH strengthening.