Most of us in wealthy countries know where we can go to find good family planning care. Unfortunately that is not always true in other parts of the world—unfortunately, even in the USA, 7% of women had trouble getting birth control according to a recent survey.
Alicia (name changed), the 23 year-old niece of a Kenyan friend, is an example. She had a boyfriend who took no responsibility when Alicia found she was pregnant. I helped pay for her prenatal care, then got an urgent text that she was at term and the baby was breech. I was able to pay for a cesarean at the best hospital in western Kenya. The baby weighed almost 9 pounds; I’m glad they didn’t attempt a vaginal birth!
Alicia thought she knew when she wasn’t fertile, but apparently she guessed wrong. To get effective contraception, she would have needed bus fare to travel to a city, plus the cost of the public clinic. Perhaps the clinic would have required an examination and tests (both common in some countries)—meaning more expense. These would have been insurmountable barriers to a young woman living in a subsistence economy. Perhaps the largest barrier Alicia faced was admitting that she needed birth control in her traditional society.
Here is my perception of what is needed to overcome barriers to successful use of family planning.
Start young: Sex ed starts in first grade in Finland and some other European countries. Teen sex is common there, but teen pregnancy is rare. It is interesting that the states in the US that have the least sex education have the most teen pregnancies.
Make Contraception Easily Available: Many school-based clinics can provide family planning. Colleges and universities have started stocking vending machines with condoms and emergency contraception, amongst other goodies, they are available anytime with the student’s identification card. Planned Parenthood has a very successful program. Women only need to fill out a questionnaire about their health and have their blood pressure checked to get birth control pills—and they can get up to a year’s supply at one visit.
Make Contraception Affordable: A study in Missouri has shown that when birth control is inexpensive or free, people choose the most effective methods. That has also been found true in Ceará state, Brazil and in British Columbia, Canada.
Reduce infant Mortality: “What,” you might think, “does this have to do with family planning?” Knowing that children will live to adulthood motivates people to decrease their fertility. This is especially true in countries without a social security system; children are the only security people have when they are injured and as they age.
Take away Stigma: There are many jokes about teens buying condoms—but often it is not so funny for the young man. A study done in the Midwest found that more guys would purchase “rubbers” if they knew that they would be supplied in a plain paper bag.
A small group of concerned people formed “Free the Pill” in order to get the FDA to approve an oral contraceptive available without prescription. OPill®?. A national study found that many of the people who used OPill®? had previously used no family planning or a less effective method.
Unfortunately, President Trump has destroyed USAID, the world’s largest funder of family planning. Although other countries and private foundations are stepping in to fill that needed aid, we can expect an increase in unintended pregnancies.
Back to Kenya. Alicia hopes for a university education. She was an excellent student in school, but her family doesn’t have the money for college. Now she has an infant to care for in addition to other challenges. Fortunately, her mother is willing to help with the baby, and I am able to help with finances.
©Richard Grossman MD, 2026