Shock over marriage certificate rule for IVF treatment under SHA
When the government announced that IVF treatment would be covered under the Social Health Authority (SHA), Anita* allowed herself to hope.
For years, the teacher had lived with blocked fallopian tubes and Polycystic Ovary Syndrome — conditions that had made natural conception impossible and left fertility treatment as her only realistic path to motherhood. SHA’s announcement felt, she says, like a door finally opening.
It took a single administrative requirement to shut it again.
To access IVF under SHA, she discovered, she would need to produce a marriage certificate — or, in its absence, an affidavit confirming a marital union. Without proof of marriage, her pre-authorisation request, submitted through Nairobi West Hospital on June 11, could not be approved. Her medical diagnosis did not matter. Her years of documented infertility did not matter. What mattered was her relationship 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 says.
The marriage certificate condition appears in a formal communication from SHA to Nairobi West Hospital, obtained by this reporter, setting out the requirements for IVF pre-authorisation approval. The communication instructs hospital staff to ask patients to present themselves physically at SHA headquarters on the eighth floor, office number 811, to Dr Liwa, with a marriage certificate or affidavit and a national identity card.
The clinical documents to be submitted online separately include case notes justifying the procedure, radiology and laboratory reports, and a certified medical report from a gynaecologist or fertility specialist.
The clinical bar and the administrative bar are being applied in parallel. A woman can clear every medical hurdle — documented infertility, specialist recommendation, age eligibility, no living child — and still be turned away at the administrative stage for lack of a marriage certificate.
SHA Mwalimu Comprehensive Cover
Anita has a partner who is willing to provide sperm for the procedure. The two are not married.
“Why should I be forced into marriage just to access healthcare? I simply want the opportunity to have a child,” she says.
The IVF benefit was activated under the SHA Mwalimu Comprehensive Cover — the scheme covering Teachers Service Commission (TSC) members — with effect from April 24, 2026, at Nairobi West Hospital, currently the only contracted and accredited facility for the service.
The TSC communication announcing the benefit spells out the eligibility criteria. Access is reserved for SHA-POMSF (Public Officers Medical Scheme Fund) beneficiaries, defined as “principal members and/or their lawfully declared spouses.” The clinical requirement is documented failure to conceive after 12 months of regular unprotected intercourse, or as clinically determined by a specialist. A maximum of two IVF attempts per beneficiary is permitted over a lifetime. The female partner must be 41 years or below at the start of treatment. Both primary and secondary infertility are eligible, with secondary infertility requiring that the couple have no living child at the time of treatment.
The IVF benefit sits within the existing inpatient benefit limit of the Mwalimu Comprehensive Cover, covering four independent IVF interventions: ovarian stimulation and monitoring; oocyte retrieval and fertilisation; embryo transfer and luteal support and confirmation; and a second IVF trial at a panelled IVF facility. Frozen embryo transfer cycles are included within that same overall limit.
Where a cycle is cancelled or fails — whether due to poor ovarian response, failure to retrieve viable oocytes, failed fertilisation, absence of viable embryos, or failed implantation — the costs incurred up to that point are applied against the member’s inpatient limit. Treatment can continue until the inpatient benefit limit is exhausted or until the member reaches the maximum of two lifetime IVF attempts, whichever comes first.
The IVF cover cap for teachers under the Mwalimu Cover POMSF scheme and SHA staff stands at Sh600,000. For all other POMSF schemes, the cap stands at Sh400,000. IVF claims are accepted only from four facilities: Afrihospital Holding Limited in Mombasa, NMC Fertility Kenya Limited (Fertility Point), Nairobi West Hospital IVF Unit, and Trinity IVF and Fertility Hospital.
IVF Scheme
Release notes from the IVF Scheme document under the SHA package further state that for a married couple to access IVF, they “must have been in a legally recognised, marital relationship for a continuous period of not less than three years.”
By defining the eligible unit as a principal member and their lawfully declared spouse, the policy structurally excludes single women regardless of their medical need, their contribution to the fund, or the availability of a willing sperm donor.
Anita’s frustration is not only personal. She sees in the policy a coercive logic that could push vulnerable women into legally and personally untenable positions.
“Some people may feel pressured to obtain documents they do not have just to qualify. That could have legal consequences. Why put people in such a situation? No law says a woman must be married to have a child. This is healthcare. If I meet the medical criteria, why should my relationship status determine whether I receive treatment?” she says.
Part of what makes the policy particularly painful for many of the women it affects is the way it intersects with pressures they are already navigating. Anita describes a community where infertility has ended relationships and marriages, where the inability to conceive carries social consequences far beyond the medical. Many women arrive at the point of seeking fertility treatment already carrying the weight of those pressures.
“For some of us, marriage itself has become a painful subject because of the pressure around fertility. Now we are being told we must go back to marriage before we can access treatment. It feels unfair,” she says.
She also notes she was not alone in her initial excitement. Groups of women who had been quietly navigating infertility, many of them teachers who had been contributing to the Mwalimu scheme for years, shared the news of the SHA announcement and began the application process together.
“We were all excited. For many of us, this was a dream come true. Then we started the application process and discovered these additional requirements. It felt like the door had been shut in our faces,” she says.
“The money is there. We contribute to this fund every month. If IVF is part of comprehensive healthcare, then it should be available to everyone who qualifies medically, not only those who are married. I hope the policy will be reviewed before more women find themselves where I am: medically eligible, financially contributing, but administratively excluded. I simply want the opportunity to have a child. That should not require a marriage certificate.”
Michael Wanyama, an advocate at Kipkorir & Wanyama Advocates LLP, offered an independent legal assessment, noting that the Constitution of Kenya does not permit the denial of healthcare based on marital status.
“The only requirement would be if you are using the cover of your spouse, and you have to provide evidence of your relationship to reduce issues of fraud. Where we sit, we think it is a reasonable limitation. However, if you are a principal SHA member, that should not be the case,” he explained.
On the question of sperm donation, he was equally direct.
“If somebody is willing to donate sperm, it means they are not related to you. So basically, there is no way you can prove a relationship between the donor and recipient. All you have to show is that under this cover, you are a principal member, and that should suffice. If SHA is asking for anything outside of that, they are asking out of their mandate,” he said.
On the concern Anita raised, that the policy could push women into marriages of convenience entered into solely to access fertility treatment, Wanyama acknowledged it as a real and foreseeable consequence, but noted that the law offered no mechanism to detect or prevent it.
“Under Kenyan law, the only requirements for a valid marriage are that both parties are adults above the age of 18 and that both consent to the marriage. Unfortunately, the reason for marrying is not provided for in law. Traditionally, people have been getting married because of love; if they were to get married for other purposes, there is no way to police that,” he said.
In response, SHA Chief Executive Officer Dr Mercy Mwangangi termed the situation an administrative error and stated that no principal member is required to present a marriage certificate to access the service.
“That was an administrative error that will be sorted immediately. We do not ask for a marriage certificate for you to access IVF. When you are registering, the standard procedure is for you to produce your identification documents. So, for a principal member, we only need the ID. Those who are affected should resubmit their pre-authorisation requests,” said Dr Mwangangi.
*Name withheld to protect identity
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