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Self-injectable contraceptive empowering African women

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Thirty-year-old Elina could not manage to walk for five hours with a baby on her back to access contraceptives at a health facility near Kawali district in Uganda.

“I really wanted to practise child spacing but I failed. I was not on any contraceptive method. I found myself pregnant with no plan. I had many children in a few years,” says Elina who had her first child at 18 years.

She recalls: “Sometimes, I realised that I was pregnant even before the other child’s first birthday. It has not been easy to take care of many children [of] the same age group.”

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She was mostly stressed taking care of the children as she did not have the luxury of having a nanny to help her out. Elina was also supposed to help her husband in the garden.

Now 30 years old, she has six children. She would have had more if she had not moved from where she previously lived to her current location. When Elina’s family moved to a village near Kansaeeta Health Centre, she finally had the chance to access contraceptives and attain her peace of mind.

She was offered an opportunity to enroll on a study to see the effectiveness of Sayana Press.

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PATH reproductive health global programme says Sayana Press is a new, lower-dose, easy-to-use injectable contraceptive that is administered every three months under the skin rather than into the muscle.

PATH is conducting research in several African countries on the use of Sayana Press and Elina happened to be one of the 35 women that were enrolled to use Sayana Press as a contraceptive for a period of one year at Kansaeeta health centre in Uganda.

Sayana Press is an injectable contraceptive that is different from Depo- Provera. Sayana Press offers an opportunity for a trained woman to inject herself.

“The product’s user-friendly design means that any trained person can administer it, including community health workers, pharmacists and even women themselves, through self-injection,” reads part of the information on PATH’s website.

Study Nurse for Path (Uganda), Sarah Coutinho, says the country piloted Sayana Press from April 2016 and 77 women were enrolled for the study at Kansaeeta health centre.

“Thirty-five were enrolled on self-inject (Sayana Press) 32 were on Depo. All of them have been followed up at three times intervals. Those on Depo go to the clinics to have their injectable. Those on Sayana are also followed up,” she explains.

She, however, reveals that more than 10 women discontinued for various reasons including their husbands’ disapproval.

“Most women around here are subjected to domestic violence. They are not able to make decisions without their husband’s approval; they are not even supposed to question their husbands’ decision. So they were told to discontinue,” Coutinho says.

The Uganda situation is not different from that of Malawi as many women also have unplanned children due to same reasons.

Uluby Nkholera of Traditional Authority Nkanda in Mulanje says she would love to have a self-injecting contraceptive because it would offer privacy.

“Even though health workers were trained to keep patients’ issues confidential, I still feel shy to visit a health facility to have my injunction contraception… I’m human. So if Malawi is to have a national wide self-injectable contraceptive, I would very much appreciate,” she says.

Group Village Head Namakhu of Mulanje says the major challenge that rural women face in accessing contraceptives of their choice is the distance to health facilities.

“I have three children but two of them were unplanned. They are too close to each other because I was not using any contraceptive. I only had it six weeks after the birth of my child and I could not go back after three months. I was discouraged because of distance, and there came another child,” she admits.

Malawi Demographic and Health Survey (MDHS) of 2015-2016 says 30 out of 100 married women prefer using injectable contraceptives to using other forms.

It also says contraceptive prevalence rate is 59 per cent among married women aged between 15 and 49.

“The contraceptive prevalence rate among currently married women is highest among women aged 35-39 (67 per every 100 women). Among sexually active, unmarried women aged 15-49 (44 per every 100 women) use a contraceptive method and 43 per every 100 women use a modern contraceptive,” reads the MDHS.

It also highlights that much as the total demand for family planning among married women aged 15- 49 has increased over time, the total demand for family planning among sexually active single women exceeds that of currently married women at 84 per cent versus 78 per cent.

“This is the case although the percentage of demand satisfied is much lower for sexually active unmarried women than for married women. 53 unmarried women out of every 100 have their demand satisfied while 76 out of every 100 married women have their demands satisfied,” reads part of the MDHS.

It adds that 19 out of every 100 women have an unmet need of contraceptives.

In early May, Pfizer Inc., the Bill & Melinda Gates Foundation and the Children’s Investment Fund Foundation (CIFF) announced that Pfizer’s injectable contraceptive, Sayana® Press, will now be available to qualified purchasers for $0.85 per dose, a reduction from the previous price of $1.00 per dose.

A press statement indicates that a consortium of organisations from the public and private sector first collaborated in 2014 to assess demand for Sayana Press.

“Initial pilots conducted in Niger, Senegal and Uganda demonstrated strong demand for Sayana Press among younger women; up to 34 per cent of doses administered across these three countries were to women between the ages of 20 and 24,” reads part of the statement.

It adds that Sayana Press is also attracting the attention of women who have never used contraceptives.

In Malawi, Sayana Press was piloted in Mangochi District and 834 women aged 18 to 40 were recruited to participate in the study.

Doctor Bagley Ngwira of College of Medicine who was heading the research says the research team is now analysing the data collected and more issues will be known afterwards.

“Of course, we had some drop outs along the way but the reasons and other issues will be fully explained in the final report,” he said.

Sayana Press is approved by regulatory authorities in more than 40 countries across the European Union and in a number of Family Planning 2020 focus countries. These countries include Bangladesh, Burkina Faso, Kenya, Niger, Nigeria, Senegal and Uganda, as well as additional markets in Latin America and within Asia Pacific. Additional regulatory submissions are being pursued. Sayana Press is not approved or available for use in the United States.

Sayana Press is also approved for administration by self-injection in 17 countries in both the developed and developing worlds.

Modern Contraception (usage) method mix

Injections 56. 3 percent

Pill 3.8 percent

Implants 16.4 percent

Intrauterine device (IUD) 1.7 percent

Female Sterilisation 17.8 percent

Male Sterilisation 0.2 percent

Condom 3.8 percent

Source: Malawi Indicator Cluster Survey (Mics) 2014

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