As elsewhere in Africa, a woman in rural Malawi often must walk for miles to reach the nearest health clinic. When she finally arrives, long queues await and a preferred contraceptive, Depo-Provera®, is often unavailable. Even if the barriers of distance, long waits and stock-outs did not exist, a busy clinic would not be an ideal venue for those who seek contraception in a private setting away from the prying eyes of neighbors and acquaintances. Many women use Depo-Provera because it is effective, requires only a single injection every three months and can be used without the knowledge of a sexual partner.
In many villages in Malawi, and other countries, an auxiliary nurse sells a wide variety of over-the-counter medicines, as well as condoms and oral contraceptives, in a small drug shop. Women in these villages wish that injectable contraceptives were as easily and discreetly available as the pills and condoms in the drug shop.
This situation may soon change with the arrival of a new, lower-dose formula of Depo-Provera called Sayana® Press. Sayana Press provides the same three months of safe, effective pregnancy prevention as Depo-Provera but comes in an easy-to-use, pre-filled injection device designed to allow low-level health workers, and even users themselves, to inject the product. To further simplify the injection, the long needle formerly required for deep muscle injections has been replaced by a much shorter needle for a simple injection just beneath the skin.
Several countries in Africa, such as Senegal and Uganda, are beginning to use Sayana Press in their family planning programs, especially those in which community health workers provide contraceptives. More importantly, a few countries will soon begin stocking Sayana Press in pharmacies and perhaps rural drug shops.
Self-injection of Sayana Press might be a game changer for family planning in Africa. Research by FHI 360 and PATH suggests that African women like the idea of self-administration of injectable contraceptives, and recent studies in industrialized countries have demonstrated the feasibility, safety and acceptability of the practice. However, self-injection and its potential to increase contraceptive acceptability and continuation have never been assessed in family planning programs in poorer countries. For this reason, FHI 360, in partnership with Malawi’s Ministry of Health, will soon begin a study in Malawi to assess the suitability of at-home and self-injection in a developing country context. This important new research is funded by the U.S. Agency of International Development (USAID) through the Advancing Partners & Communities (APC) project, which is implemented by JSI Research & Training Institute, Inc., in partnership with FHI 360.
Sayana Press is the result of a decades-long partnership between Pfizer, PATH and USAID. More recently, in 2011‒2013, researchers at FHI 360, with USAID funding, conducted the first studies of Sayana Press’s acceptability among health providers and clients. The research, conducted in Senegal and Uganda, showed that both users and providers strongly preferred Sayana Press to traditionally administered Depo-Provera. In addition, FHI 360’s Product Quality and Compliance division currently conducts analytical testing of Sayana Press for all lots procured by USAID.
In years to come, millions of women will have not only an improved, more acceptable injectable contraceptive, but also a new, more private way to use it. Such incremental improvements are vital to reaching women all over the world with lifesaving family planning services. More work remains before Sayana Press can be sold in drug shops for self-injection. But with a recently negotiated lower cost and introduction beginning in five countries — Bangladesh, Burkina Faso, Niger, Senegal and Uganda — it will soon start to have a greater impact in helping countries reach their family planning goals.
Read more about FHI 360’s work in family planning.