Global aid cuts, particularly from the United States, have hit several sub-Saharan African countries hard. In Kenya, family planning commodity shortages and reduced access to services have left many women unable to obtain contraception, raising concerns about a rise in unplanned pregnancies.
Pascalia (not her real name) is a 21-year-old woman from an underserved rural community in Kenya. She carries a weight that would crush adults twice her age. Living in a single, cramped room, she is the primary breadwinner for an entire household – her two young children, aged four and two, her parents, and four younger siblings. Her husband is a fisherman who recently moved in with her at her parents’ homestead, drawn together by shared poverty. Now Pascalia sits outside her home, nine months pregnant, awaiting a birth she has no financial or physical means to prepare for.
I was forced to go to a private hospital, and I was asked to pay 50 shillings for the services, which I did not have. I pleaded with the nurse to help me, but she refused. When I came back, I got this pregnancy. I also tried to take local herbs for the pregnancy to come out, but it did not work. Now, here I am.
Pascalia’s current pregnancy is not the result of personal neglect. It is a direct consequence of a systemic failure – the devastating ripple effect of disruptions to family planning service delivery. With limited access to her preferred method of contraception, Pascalia became pregnant. Her experience shows the deeply personal toll that disruptions to the health system can take on women and families, particularly in underserved communities. For Pascalia, the loss of reliable access to contraception was never simply a supply-chain problem. It had a direct impact on her reproductive choices, adding another layer of uncertainty to an already difficult journey.
Pascalia’s experience reflects a broader pattern among women in underserved communities: when commodity stockouts and service disruptions reduce access to family planning, women face increased costs, unmet need, and in some cases turn to unsafe methods to end unwanted pregnancies. Her story underscores the urgency of sustained investment in resilient, accessible family planning systems to prevent these downstream consequences.
The Challenge Initiative (TCI) is currently documenting and analyzing the impact of global aid cuts on contraceptive access across the 15 countries it supports. Early findings show five of those countries experiencing a decline in the number of women using a modern contraceptive method, with Kenya among them, alongside Tanzania, Senegal, Burkina Faso, and Uganda. The full report will be shared widely once completed later in 2026.
