Why Women in Rift Valley and Nyanza Have More Children Despite Contraceptives

Kenya’s progress in expanding access to modern contraceptives has hit a plateau, leaving women in parts of the Rift Valley and Nyanza having more children than they desire despite high rates of birth control use.

Data from the Kenya Demographic and Health Survey 2025–26 shows that modern contraceptive use among married women nationally has stalled at 56.1 per cent, down slightly from 56.9 per cent in 2022. The trend puts Kenya at risk of missing its 2030 national target of 64 per cent.

At the same time, unmet need for family planning among married women has crept up to 16 per cent from 14 per cent in 2022, missing the national target of 10 per cent. The gap is most pronounced in counties like Nyamira, Nandi and Bomet, where women end up having an average of 1.1 more children than they say they want. In nearby Kisii, women have 1.0 more child than desired, even though modern contraceptive use in these regions ranges between 51 and 69 per cent.

The national total fertility rate now stands at 3.1 children per woman, down from 3.4 in 2022 and 6.7 in 1988–89. However, when asked about their ideal family size, the majority of Kenyan women expressed a desire for just two children.

Geographic disparities explain much of the national picture. In West Pokot, unmet family planning need among married women reaches 42 per cent, followed by Turkana at 34 per cent and Tana River at 29 per cent. Makueni recorded the lowest unmet need at 4 per cent.

In contrast to Nyanza and the Rift Valley, women in parts of northern Kenya report almost no use of modern methods but are generally having the exact number of children they want. In Mandera, where modern contraceptive use among married women is below 1 per cent, the desired fertility is 6.7 children per woman compared to an actual rate of 6.8. In Garissa, where modern use is 5 per cent, desired fertility is 5.2 against an actual rate of 5.3.

Overall fertility rates vary widely across the country, ranging from 2.2 children per woman in Embu to nearly seven in Mandera. Seven counties recorded fertility rates of 5 or more: Mandera (6.8), Wajir (5.8), Tana River (5.7), Turkana (5.6), Garissa (5.3), West Pokot (5.1) and Samburu (5.0). Marsabit recorded 4.9.

In total, 31 out of Kenya’s 47 counties have fertility rates above the national average of 3.1. The lowest rates were recorded in Embu (2.2), Kiambu (2.3), Mombasa (2.3), Kericho (2.6), Nairobi (2.6), Kirinyaga (2.7) and Tharaka-Nithi (2.7).

Compared to 2022, several arid and semi-arid counties saw significant declines in fertility. West Pokot dropped from 6.9 to 5.1, Wajir from 6.8 to 5.8, Samburu from 5.8 to 5.0, Marsabit from 6.3 to 4.9, and Mandera from 7.7 to 6.8. Rates in Tana River (5.7), Garissa (5.3) and Nairobi (2.6) remained unchanged.

The survey shows that modern contraceptive preferences have shifted over the last decade. Implants have overtaken injectables as the most popular method, rising from 9.9 per cent in 2014 to 22.8 per cent today. Injectables fell from 26.4 per cent to 18.7 per cent over the same period.

Education and household wealth remain decisive factors in family size. Women with no formal education have an average of 5.4 children, compared to 3.6 for those with primary education, 3.0 for secondary, and 2.7 for post-secondary education.

Looking at older generations aged 40 to 49, women with no education have had 6.2 children on average, while those with post-secondary education have had 2.8. In Mandera, women in this age group have had an average of 7.7 children, followed by Wajir at 7.5 and Garissa at 6.8.

Among women in the poorest fifth of households, the average fertility rate is 4.5, compared to 2.3 among the richest fifth. Modern method use stands at just 21 per cent among married women with no schooling, compared to between 58 and 60 per cent for all other education levels. Unmet need among uneducated women is 29 per cent, compared to 13 per cent for those with higher education.

Kenyan women are also giving birth later in life. The peak age for giving birth has shifted from 20–24 years in earlier surveys to 25–29 years, currently at 161 births per 1,000 women. Among women aged 20 to 24, birth rates plummeted from 324 per 1,000 in 1988–89 to 157 today.

Teenage fertility has also dropped markedly. Births among girls aged 15 to 19 fell from 153 per 1,000 in 1988–89 to 63. The percentage of women aged 15 to 19 who have ever been pregnant dropped from 14.8 per cent in 2022 to 11.9 per cent.

Rural areas have seen a steeper decline in fertility than urban centres over the past two decades. Rural women had 5.4 children in 2003 compared to 3.6 today, a fall of 1.8. Urban fertility dropped by 0.7 over the same period, moving from 3.3 to 2.6.

Across all women aged 15 to 49, the average number of children ever born is 2.1, with 2.0 still living. For married women, the average is 3.0 born and 2.9 living. For women aged 45 to 49 who have completed childbearing, the average is 4.5 born and 4.2 living.

About 1 per cent of women aged 45 to 49 have never given birth, while 42 per cent have had five or more children.

High rates of modern contraceptive use are recorded in Murang’a (76 per cent), Makueni (72 per cent), Meru (72 per cent) and Kirinyaga (71 per cent), where fertility rates stand at 3.4, 3.3, 2.8 and 2.7 respectively.

However, with national total demand for family planning plateauing at 76 per cent, the rising unmet need in high-use regions underscores the challenge Kenya faces in reaching its 2030 reproductive health targets.