Countries across Africa are running out of contraceptives, with some methods already out of stock and others weeks away from no supplies because of US cuts to foreign aid.
At least three countries have already run out of at least one form of contraception – with UN supply chain data, seen exclusively by The Independent, showing another 13 countries also at high risk of running out. Another 21 countries face a moderate risk of shortages.
The lack of contraception will leave women and girls vulnerable to unwanted pregnancy and lead to potentially millions of unsafe abortions, charities have warned.
In Tanzania, central medical stores reported being completely out of stock of certain contraceptive implants by the end of July. In Kenya and Zambia, facilities have essentially run out of key brands of implants and injections, among the most popular methods of contraception.
As patients struggle to access family planning, much-needed supplies – including pills, condoms and intrauterine devices (IUDs) – are currently stuck in warehouses in those countries and face expiring before they can be used because of aid cuts.
The revelation comes after it emerged that $9.7m (£7.2m) worth of contraceptives – much of which was destined for the three countries identified by The Independent – are being held in Belgium and France, earmarked to be burnt rather than used.
A US State Department spokesperson said a rule re-introduced by Trump prohibited providing assistance, “directly or indirectly to foreign nongovernmental organisations that perform or actively promote abortion as a method of family planning”. This includes centres that hand out contraceptives, the spokesperson added.
The United States Agency for International Development (USAID) used to be the backbone of the world’s contraception supply chain. It funded global family planning to the tune of $608m (£453m) as well as playing a key role in forecasting need, purchasing products and transporting them around the globe.
When Trump took office for a second time in January and scrapped virtually all foreign aid spending, he pulled the US out of funding and running this system almost overnight. That included cancelling its contribution to the UN’s sexual and reproductive health agency, the United Nations Population Fund (UNFPA), which is the other key player in getting contraceptives to developing countries.
“We are seeing an alarming rise in stock-outs of essential contraceptives in some of the world’s most vulnerable communities,” said Karen Hong, chief of the supply chain management unit at UNFPA. “Recent funding cuts have severely disrupted supply chains but UNFPA is working tirelessly to ensure it remains open and flowing. This means we are doing all in our power to redirect resources and prevent catastrophic gaps, but we urgently need more support to meet the growing demand.”
The products most commonly out of stock across surveyed countries supported by the UNFPA included contraceptive injections, implants, pills and copper IUDs. Supplies of condoms were stuck in warehouses and were at high risk of going out of stock in many countries.
Kenya has experienced particular shortages of the long-acting contraceptive injections Sayana Press and Depo-Provera, as well as of Implanon NXT – a type of implant that is inserted under the skin of the arm –The Independent understands. These were some of the most popular contraceptive methods in the country, according to Lawreen Sakini, an adolescent and youth coordinator for Reproductive Health Network Kenya (RHNK). IUDs were also near to running out.
“If we don’t take action, by the end of the year we’ll be looking at dire situations,” said Sakini.
The shortages are limiting people’s choices. “The injections are really hard to come by,” she said. “And if we are having a hard time for the communities that are in urban areas, for the marginalised and low income [or] rural areas, it’s even harder for them to get the injection.”
Injections and implants are particularly favoured because it’s “hard for anyone to register you have a contraceptive method in you,” Sakini said. That meant it was more private, giving women some control in a culture where contraception can be taboo. For some, keeping pills in the home is risky and sexual partners won’t always agree to using condoms.
“Women are not always in a position to negotiate for safe sex,” she explained, particularly for those in abusive relationships.
Sakini’s team has been running an advice helpline. Since the cuts, clients have already come in seeking referrals for abortion services, or having initiated unsafe abortions, because of unintended pregnancies after they were unable to access contraception. She feared the cuts would not only drive up maternal deaths, but would also increase partner violence against women who experienced unwanted pregnancies.
She said she expected the situation to worsen by the end of the year as more products run out – with no clear plan to replace them – and for scarcity to drive up prices.
National supply plan data shared by the International Planned Parenthood Federation (IPPF) showed that, of 13 contraceptive methods used in Kenya, only two had new supplies already on order for the rest of this year and into next.
In Tanzania, implants were also in short supply. When data was last reported by the Medical Stores Department in May, one brand, Jadelle, had already gone out of stock in the country’s central warehouses with a second, Implanon, projected to have run out by the end of July. Another shipment is not expected until October.
Without action from governments and other donors to boost supplies, the lack of contraceptives could cause a projected one million extra unsafe abortions and 3.7 million unintended pregnancies in the country by next June, according to Patrick Kinemo, the country director for MSI Reproductive Choices.
“When our teams go to those remote villages, there’s been instances where the commodities are not there,” said Kinemo. “So then women are left with less choice.
“It’s central to our work that a woman should be shown all available methods, and they should then be able to make an informed choice based on the perceived benefits – limiting choice is unfortunate.”
While products have run out of stock at a central level, some items remained in health facilities dotted around the country. Kinemo has been working with the government to redistribute the supplies where possible. “But at some point, if they’re not replenished, they will run out,” he said.
Following Trump’s cuts, Tanzania had an order of around $6.3m dollars worth of commodities cancelled. “If you project until next year [in] June, there is a gap of about $20m [worth of contraception],” Kinemo said. And his organisation has already seen an 11 per cent drop in clients accessing its services this May compared with the same month last year.
Zambia has also reported shortages of contraceptive injections in health facilities, according to Amos Mwale, executive director of the Centre for Reproductive Health and Education (CRHE) in Lusaka.
“A number of people we have spoken to have given us an indication that right now when you go to public facilities, they do not have their preferred method,” he said. Instead, these facilities are handing out whatever they have available, including shorter-acting options.
This can cause particular problems for those who live in remote areas and have to plan ahead when it comes to contraception. With limited supplies of short-term methods like the pill and condoms on offer, “it becomes a challenge for them to consistently be visiting the facility,” said Mwale.
Responding to The Independent’s findings, chair of the UK Parliament’s International Development Committee Sarah Champion said: “Around the world, women and girls are bearing the brunt of aid cuts and political decisions.
“I am hugely alarmed that, at the same time the US is burning contraception bought for low-income countries, the likely recipients are running out of stock. I urge the [UK] development minister to think again about not ring fencing funding for women and girls; sexual and reproductive health needs protection.”
Former development minister Andrew Mitchell added: “The grossly irresponsible – and self-defeating – decisions by the British and American governments to slash development spending will destroy years of progress in making life significantly better for girls and women.
“In particular USAID and Britain have done totally brilliant work supporting women’s ability to decide for themselves whether and when they have children. All of this progress is now at risk. It is heartbreaking – above all for those most directly affected by these short-sighted decisions.”
Kinemo said his team in Tanzania was working to counsel people about other contraceptive options that are available if they’re not able to access their first choice. But this took time, he said, which meant those who couldn’t get their usual contraception were likely to either use less effective methods or no protection at all in the meantime.
The government was scrambling for resources, he added. But “the cuts came too [suddenly] for anyone to plan that quickly, the needs are many across the health sector and in some instances family planning is not seen as life-saving,”
If an order was put in today, it could still take around three months to get those stocks into health facilities, he said. With high demand in a number of countries, and a limited number of manufacturers in the market, lead times could be even longer.
National governments were primarily responsible for ensuring their people’s health, said Mwale, but the short notice had made it difficult for them to fill these gaps.
“Once you are running a budget, it’s very difficult to find sufficient allocation for resources, especially contraceptives,” he said. The Zambian government had already planned around the US government’s commitment to provide these supplies when portioning out resources.
In the meantime, Sakini said, the people who would lose out were those who faced a choice between spending $1 dollar, “either to drink water or to take a pill that will prevent you from getting pregnant because you did not have a choice.
“I just need people to understand how much of a privilege it is to access that one contraceptive, that one pill … that long acting method that can cover her for five years or six years while she tries to figure out how she’s going to survive,” she said.
“People think of it as a choice or think of it as cosmetic; it is someone else’s lifeline”.
This article is part of The Independent’s Rethinking Global Aid project
