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Family Planning and Reproductive Health Access and Utilization in East Africa

From June to August 2022, 38 family planning and reproductive health (FP/RH) workforce members from Ethiopia, Kenya, Malawi, Nigeria, Rwanda, Tanzania, and Uganda came together during the 2022 East Africa Learning Circles cohort. Through structured group dialogues over four sessions, they shared and learned from each other’s practical experiences, on what works and what doesn’t in improving FP/RH access and use.


Expanding access to contraception and satisfying the need for family planning are essential elements for achieving universal access to reproductive healthcare services, as called for in the 2030 Agenda for Sustainable Development.

According to the World Health Organization (WHO), the number of women who want to use family planning has increased markedly over the past two decades, from 900 million in 2000 to nearly 1.1 billion in 2020. Consequently, the number of women using a modern contraceptive method increased from 663 million to 851 million, and the contraceptive prevalence rate increased from 47.7% to 49.0%. The UN projects that an additional 70 million women will be using modern contraception by 2030.

The proportion of women of reproductive age whose need for family planning is satisfied by modern contraceptive methods (SDG indicator 3.7.1) has increased gradually in recent decades, rising from 73.6% in 2000 to 76.8% in 2020. Reasons for this slow increase include limited method choice s; insufficient access to services, particularly among young, poorer, and unmarried people; side effects (whether feared or experienced); cultural or religious opposition; poor quality of available services; user’ and provider bias against certain methods; and gender-based barriers to access.

State and non-state actors both have roles to play in ensuring that barriers to access and uptake of family planning and reproductive health (FP/RH) services are addressed. A number of different elements need to be in place for successful FP/RH programs, from strategic planning, program development, and implementation to monitoring and evaluation (M&E) and accountability.


To ensure that everyone is equipped with the knowledge and best practices to address the factors hindering access to and use of FP/RH services, the Knowledge SUCCESS East Africa team hosted a Learning Circles cohort on Family Planning and Reproductive Health Access and Utilization in East Africa. This topic was identified as a regional priority according to surveys and interviews among FP/RH professionals and organizations based in East Africa.

The weekly Learning Circles sessions and discussions were anchored by the FP2030 Rights-Based FP Program Framework, which depicts essential elements that should be in place at various levels in the healthcare system, including empowered and satisfied clients, quality information and services, an enabling legal and policy environment, and supportive culture and community.

Graphic with four quadrants that describe supportive culture & community; enabling legal & policy environment; quality information & services; and empowered & satisfied clients.
This graphic framework is a vision of what an ideal human rights-based voluntary family planning program looks like.

The Learning Circles cohort participants also considered the 10 human rights-related principles and standards pertaining to contraceptive information and services upon which the framework is based. These principles, agreed on by WHO, UNFPA, FP2030, and others, include:

  • Availability
  • Accessibility
  • Acceptability
  • Quality
  • Non-discrimination and equality
  • Informed decision-making
  • Privacy and confidentiality
  • Participation
  • Accountability
  • Agency/autonomy/empowerment


Success Factors

Through small group discussions, cohort participants used Google Jamboard to brainstorm a wide range of ideas around successful strategies for improving FP/RH access and utilization.

Screenshot of a Google Jamboard with family planning and reproductive health access and utilization success factors.
An example of a group's completed virtual brainstorming board with ideas on how to successfully improve family planning and reproductive health access and utilization in East Africa based on participants' programmatic experiences.

They then grouped their top success factors to align with the key elements of the FP2030 framework:

  • Quality information and services: Continuously train and mentor service providers to avoid method bias, ensure availability of a wide range of method choices, improve client information sharing and counseling
  • Advocacy and resource mobilization: Advocate for FP budget allocation and spending, develop of Costed Implementation Plans, ensure resources to buy commodities
  • Stakeholder engagement: Engage stakeholders at all levels (including community/youth, government structures, and public-private sector partners) to provide ideas, promote collaboration, ensure ownership and sustainability
  • Enabling environment: Establish and enforce legal and policy frameworks that facilitate access to and use of FP/RH services, as well as prioritizing data use for decision-making
  • Socio-cultural factors: Address barriers to FP/RH access, promote gender norms that support FP access, create awareness and demand for FP/RH services, encourage male involvement, correct myths and misconceptions
    Project management and coordination: Create and adhere to plans for implementation, research/surveys, M&E


Using a knowledge management approach called Troika Consulting, cohort participants identified a number of challenges to FP/RH access and utilization:

  • Project handovers: Lack of clarity regarding roles and responsibilities between international and Africa regional offices causes delays in capacity strengthening
  • Limited FP/RH services on national health insurance schemes: Clients end up paying for services, making it difficult to achieve all visits
  • Provider bias hampers integration of FP/RH services: Clients sometimes opt to use oral contraceptive pills instead of considering other available methods due to provider bias.
  • Health facilities do not have specific youth services. Where FP services are available for adolescents, they are often provided in Care and Treatment Centers—which often cater to women who have given birth, excluding not nulliparous girls and women. When adolescent and youth sexual and reproductive health (AYSRH) is not a priority for policymakers and implementers, adolescents face age-related stigma when trying to access FP.
  • Poor consultations with key stakeholders can lead to poor health outcomes. For example, in one of three counties in Kenya, poor coordination with the Ministry of Health led to delays in training health workers on the provision of adolescent-responsive services, resulting in increased rates of teenage pregnancy and gender-based violence (GBV).
  • Lack of support from schools, who cite limited time during the school day, for a menstrual hygiene management project.
  • Low male engagement in uptake of FP services, given the power issues and social constructs surrounding consent for FP.
  • Negative social norms that prohibit young people from accessing FP despite high teenage pregnancy rates.
  • Commodity security issues, especially facility stock-outs of some commodities.
  • Fear of side effects of contraceptive methods and/or a lack of accurate knowledge prevents many women and adolescents from accessing FP.


The Learning Circles series culminated in participants developing commitment statements towards improved implementation of their programs while taking into account what they had learned from each other. Participant commitments included engaging faith leaders from Christian and Islamic centers to champion FP/RH, partnering with facility-based health care providers to address youth FP/RH needs, and creating a WhatsApp group for all members of the MOH Technical Working Group for GBV and AYSRH to discuss FP-related issues.


Through Learning Circles, FP/RH workforce members from East Africa were able to grow their knowledge and strengthen their understanding of how to improve FP/RH access and utilization, network and build relationships with colleagues facing similar challenges, and generate new ideas and practical solutions for improving FP/RH program implementation. Simultaneously, they learned new knowledge management tools and techniques that they can use in their organizations to facilitate creative ways of exchanging knowledge and effective practices.

Learn more about Learning Circles and read insights from a previous sub-Saharan Africa Learning Circle on family planning programming in the context of COVID-19.

Do you want to know more about the KM tools and techniques used in Learning Circles and how to use them in your own work? Check out this resource!

Irene Alenga

Knowledge Management and Community Engagement Lead, Amref Health Africa

Irene is an established social economist with over 13 years’ experience in research, policy analysis, knowledge management, and partnership engagement. As a researcher, she has been involved in the coordination and implementation of over 20 social economic research projects in various disciplines within the Eastern African Region. In her work as a Knowledge Management Consultant, Irene has been involved in health-related studies through work with public health and technology-focused institutions in Tanzania, Kenya, Uganda and Malawi where she has successfully teased out impact stories and increased visibility of project interventions. Her expertise in developing and supporting management processes, lessons learned, and best practices is exemplified in the three-year organizational change management and project closure process of the USAID| DELIVER and Supply Chain Management Systems (SCMS) 10-year project in Tanzania. In the emerging practice of Human Centered Design, Irene has successfully facilitated a positive end to end product experience through conducting user experience studies while implementing the USAID| DREAMS Project amongst adolescent girls and young women (AGYWs) in Kenya, Uganda, and Tanzania. Irene is well-versed in resource mobilization and donor management, especially with USAID, DFID, and EU.

Alex Omari

Country Engagement Lead, East & Southern Africa Regional Hub, FP2030

Alex is the Country Engagement Lead (Eastern Africa) at FP2030's East and Southern Africa Regional Hub. He oversees and manages the engagement of focal points, regional partners and other stakeholders to advance the FP2030 goals within the East and Southern Africa Regional Hub. Alex has over 10 years’ experience in family planning, adolescent and youth sexual and reproductive health (AYSRH) and he has previously served as a task force and technical working group member for the AYSRH program at the Ministry of Health in Kenya. Prior to joining FP2030, Alex worked as the Technical Family Planning/ Reproductive Health (FP/RH) Officer at Amref Health Africa and doubled in as the East Africa regional Knowledge Management (KM) Officer for the Knowledge SUCCESS global flagship USAID KM project collaborating with regional bodies, FP/RH technical working groups and Ministries of Health in Kenya, Rwanda, Tanzania and Uganda. Alex , previously worked at Amref's Health System Strengthening program and was seconded to the former First Lady of Kenya’s Maternal Health Program (Beyond Zero) to provide strategic and technical support . He served as the Country Coordinator for the International Youth Alliance for Family Planning (IYAFP) in Kenya . His other previous roles were while at Marie Stopes International, International Centre for Reproductive Health in Kenya (ICRHK), Center for Reproductive Rights (CRR) , Kenya Medical Association- Reproductive Health and Rights Alliance (KMA/RHRA) and Family Health Options Kenya (FHOK). Alex is an elected Fellow of the Royal Society for Public Health (FRSPH), he holds a Bachelor of Science degree in Population Health and a Master of Public Health (Reproductive Health) from Kenyatta University, Kenya and a Master of Public Policy from the School of Government and Public Policy (SGPP) in Indonesia where he is also a public health and health policy writer and website contributor for the Strategic Review Journal.