Kenya’s new health policies are abandoning infertile Wanjiku

Imagine paying your monthly health insurance premium without fail, only to be told that your inability to conceive a child is a “lifestyle choice” not worth state funding. For millions of Kenyans, this is a punishing, daily reality. In our society, childlessness is a heavy, isolating burden that falls almost entirely on women, who face severe stigma, psychological torment, and marital rejection. Yet, this is no rare condition. One in four Kenyan couples struggles with subfertility, an overwhelming national crisis born primarily of untreated infections, severe endometriosis, and complex medical realities.

Reproductive health is a constitutional right under Article 43, not a selective privilege. Yet, our national healthcare system treats the inability to carry a child with cold indifference, driving desperate families into catastrophic debt. June is Infertility Awareness Month, and it is time to dismantle the bureaucratic barriers that treat the empty cradles of ordinary Kenyans as a luxury problem.

For a decade, the legal framework governing advanced fertility treatments was stuck in legislative limbo. Recently, the National Assembly finally passed the Assisted Reproductive Technology (ART) Bill, 2022, sending it to the Senate. This transitions Kenya from an unregulated, “wild-west” environment into a structured system. But beneath the parliamentary celebration sits an uncomfortable truth. This is a Private Member’s Bill, not a Ministry of Health-sponsored reform. Because it was driven by individual legislative goodwill rather than a ministerial mandate, it lacks the institutional backing of multi-year budgets. Paradoxically, as we debate expanding state financing, we must tread carefully. Over-regulating and flooding a highly sensitive medical sector with unbacked public money before establishing robust institutional maturity can backfire, inadvertently fueling a thriving black market and driving unethical practices deeper underground.

The immediate, glaring failure lies within the newly gazetted benefit packages of the Social Health Authority (SHA). The primary SHA tariff structures offer absolutely zero coverage for advanced fertility treatments. If an ordinary citizen, the everyday Wanjiku, walks into a public facility seeking IVF, they face absolute financial exclusion. To make matters worse, advanced infertility care is entirely absent from our public healthcare sector; there is not a single public hospital in the country equipped to offer comprehensive IVF. This exclusion would be easier to swallow if the private market offered a safety net, but it does not. Almost all private medical insurances in Kenya explicitly exclude infertility treatments from their standard covers, dismissing them as elective procedures.

Even when health policies pretend to offer solutions for structural infertility, such as blocked fallopian tubes caused by previous surgeries, infections, or endometriosis, the system is designed to fail the patient. To fix blocked tubes safely and preserve fertility, advanced laparoscopic and endoscopic keyhole surgeries are required. Yet, our health policy treats these minimally invasive options as a luxury. Under the SHA surgical tariffs, laparoscopic procedures are heavily underfunded, covering only a fraction of the actual cost of specialised theater equipment and consumables.

When the hospital bill outstrips the microscopic SHA tariff, the financial deficit is pushed directly onto the patient through massive out-of-pocket top-ups. Desperate, low-income women who cannot afford these upfront cash gaps are forced to undergo outdated, highly invasive open surgeries instead. This actively worsens their medical prognosis, as open pelvic surgeries create extensive new scar tissue and adhesions, permanently cementing the very infertility they are trying to cure.

This systemic cruelty stands in direct violation of the original spirit of Kenya’s health planning. The draft National Reproductive Health Policy initially intended to include general public coverage for at least one full IVF cycle under the state-funded essential benefits package. Somewhere along the bureaucratic conveyor belt, that promise was quietly erased, leaving only premium civil service schemes, like the heavily restricted Mwalimu Cover for teachers, with any semblance of fertility care.

To bridge the gap between legal rights and real-world access, Kenya must immediately overhaul its approach to reproductive health financing. First, the Ministry of Health must return to its original intent by introducing a basic, subsidised fertility package under SHA that covers at least one complete cycle of fertility treatment, ensuring that economic status does not dictate a family’s biological future. Second, the SHA board must realistically adjust its surgical tariffs for laparoscopic and endoscopic gynecological procedures. Categorising fertility-preserving keyhole surgeries as standard essential treatments rather than underfunded luxuries will prevent clinicians from being forced into open surgeries that permanently destroy a woman’s pelvic anatomy. Finally, the state must invest in building and equipping specialised public fertility centers within level 5 and level 6 county referral hospitals, subsidising the cost of medications and laboratory processing to make science accessible to the rural poor.

We cannot boast of achieving Universal Health Coverage when the state deliberately chooses to leave millions of infertile Kenyans behind in the dark. It is time to align our national budget with our constitutional promises, resource our public hospitals properly, and restore medical dignity to every Kenyan family trying to conceive.

Dr Mogaka is the Chairman of the Kenya Obstetrical and Gynaecological Society (KOGS) ,North Rift Branch.