NAIROBI, Kenya — When the government announced that In vitro fertilisation (IVF) would be covered under the Social Health Authority (SHA), Jessica* allowed herself to hope.
For years, the teacher had lived with blocked fallopian tubes and polycystic ovary syndrome (PCOS), conditions that made natural conception impossible and left assisted reproduction as her only viable path to motherhood. The SHA announcement, she says, felt like a long-awaited opening.
But that hope quickly collided with an administrative requirement she had not anticipated.
To access IVF under the scheme, Jessica discovered she would need to present a marriage certificate — or an affidavit confirming a legal marital union. Without it, her pre-authorisation request submitted through Nairobi West Hospital on June 11 could not proceed.
Her medical condition was not in question. Her eligibility, based on clinical diagnosis, was not disputed. What mattered, she says, was her marital status.
“As someone who has struggled with infertility for years, I medically qualify for IVF. But now I am being told that I must be legally married to access the treatment. I find that discriminatory,” she said.
Administrative barrier at the centre of dispute
A SHA communication seen by this publication sets out the requirements for IVF pre-authorisation, instructing patients to present themselves physically at SHA headquarters in Nairobi, accompanied by a marriage certificate or affidavit and a national identity card.
Clinical documents — including specialist reports, laboratory results and radiology findings — are submitted separately through hospitals.
This creates a dual approval pathway: one medical, one administrative. While clinicians may confirm infertility and recommend IVF, approval can still be halted if administrative criteria are not met.
“Principal member and spouse” rule
The IVF benefit, introduced under the SHA Mwalimu Comprehensive Cover for Teachers Service Commission (TSC) members, came into effect on April 24, 2026, with Nairobi West Hospital designated as a contracted provider.
Eligibility is defined under the Public Officers Medical Scheme Fund (POMSF) structure, which limits coverage to “principal members and/or their lawfully declared spouses”.
Under the framework, applicants must show documented infertility after at least 12 months of regular unprotected intercourse (or clinical determination), and female partners must be aged 41 years or below. The scheme allows a maximum of two IVF attempts per lifetime.
The benefit is also capped at Sh600,000 for teachers under the Mwalimu cover and Sh400,000 for other POMSF beneficiaries, and is currently available only at selected accredited facilities, including Nairobi West Hospital, NMC Fertility Kenya Limited, Afrihospital Holdings (Mombasa), and Trinity IVF and Fertility Hospital.
Structural exclusion concerns
For Jessica, who has a partner willing to provide sperm but is not married, the policy creates a structural exclusion from care.
“Why should I be forced into marriage just to access healthcare? I simply want the opportunity to have a child,” she said.
She is among a growing number of women raising concerns that the requirement effectively locks unmarried but medically eligible patients out of fertility treatment.
Legal interpretation and policy tension
Legal experts say the issue sits at the intersection of healthcare rights and benefit eligibility rules.
Advocate Michael Wanyama of Kipkorir & Wanyama Advocates LLP said that while verification for spouses under insurance cover is reasonable, restricting access for principal members raises constitutional questions.
“Where we sit, we think it is a reasonable limitation for spouses to prove relationship. However, if you are a principal SHA member, that should not be the case,” he said.
On sperm donation, he added that the absence of a legally recognised relationship should not automatically disqualify a patient.
“All you have to show is that you are a principal member under the cover. Anything beyond that may be outside mandate,” he said.
He also acknowledged that the requirement could unintentionally incentivise marriages of convenience, though he noted that Kenyan law does not regulate motivations for marriage as long as legal consent is present.
SHA response: “administrative error”
Following public concern, SHA Chief Executive Officer Dr Mercy Mwangangi said the marriage certificate requirement was not part of the intended policy framework.
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“That was an administrative error that will be sorted immediately. We do not ask for a marriage certificate for you to access IVF. For a principal member, we only need the ID,” she said.
She added that affected applicants should resubmit their pre-authorisation requests.
A broader question on access
For Jessica, the clarification comes after weeks of uncertainty — but the episode has already raised wider questions about how fertility care is structured within public insurance systems.
Beyond individual eligibility, critics argue the debate exposes a policy tension between traditional definitions of family and evolving reproductive realities.
“If I meet the medical criteria, why should my relationship status determine whether I receive treatment?” Jessica said.
“I simply want the opportunity to have a child. That should not require a marriage certificate.”
*Name withheld to protect identity
