In 2013, we distributed 9,056,318 injectable contraceptives, averting 821,083 DALYs and providing 2,095,144 CYPs. We launched our first social marketing programs for injectables in Guinea and Nigeria in 1995. Currently, we provide injectable contraception in 29 countries.
Injectable contraceptives are hormones delivered to a woman through an inter-muscular or subcutaneous injection to prevent unintended pregnancy. Depending on the type, injectables last for one, two or three months before a new injection is needed to maintain efficacy as a contraceptive. They are highly effective, reversible, safe, private and convenient. Injectable contraceptives are rapidly increasing in popularity, particularly in sub-Saharan Africa.
The types of injectables include:
- Combined injectable contraceptives contain both progestin and estrogen. They are administered once a month.
- Progestin-only injectable contraceptives containing norethisterone oenanthate (NET-EN) are administered once every 2 months.
- Progestin-only injectable contraceptives containing depot medroxyprogesterone acetate (DMPA) are administered every 3 months and are reversible.
The primary function of injectables are to stop monthly ovulation (release of eggs from ovaries). Injectables also thicken cervical mucus, making it difficult for sperm to pass through to the uterus. Injectables do not work by disrupting existing pregnancy.
Sayana® Press, a new formulation and presentation of progestin-only injectable contraception, was designed to overcome many of the barriers for women to access family planning. The three-month, progestin-only injectable contraceptive is packaged in the Uniject™ injection system–a small, all-in-one, pre-filled device. The simplified delivery and training to use Sayana® Press means it can expand geographic access and reach new users through pharmacists and community health workers, where authorized by local health authorities.
Our solutions enable the use of family planning methods, including injectables, within the context of informed choice. In addition to marketing contraceptives to consumers, we train service providers in family planning counseling and method administration, including community-based distribution of injectables and other short-acting methods as authorized by local health authorities. Our medical detailers visit service providers at their workplaces to learn what information and support they need to offer a broad method mix.
Making a Difference
In Madagascar, one in five women has an unmet need for contraception. A major obstacle is geographic access: 80 percent of the population lives in rural areas with few health centers. Community health workers () play an important role in bringing contraception and other health services to rural and underserved areas.
In 2006, Madagascar became the first country in sub-Saharan Africa to authorize CHWs to administer injectable contraception. This policy contributed to a rapid increase in the contraceptive prevalence rate, from 14 to 23 percent in 2003-2009, according to Demographic and Health Surveys. During that time, the percentage of women using injectables nearly doubled from less than 8 percent to more than 14 percent. In 2003-2004, before the policy change, the rate of injectable use was higher for women in the capital than for those in rural areas; by 2008-2009, the rate was the same.
Since 2011, with funding from USAID, we’ve teamed up with partner organizations to provide CHWs the training, tools and supplies they need to safely offer contraceptive services in rural Madagascar. Using our checklists and communication tools for counseling, the CHWs share information about the full range of family planning methods with women, men and youth. They offer short-term contraceptive methods such as male condoms, CycleBeads® (for the Standard Days Method), oral contraception and injectables. CHWs refer clients to higher-level providers for long-term methods such as implants and the IUD.
In 2013, we distributed more than one million injectables through community-based distribution in Madagascar, providing 279,646 CYPs. Results from the Madagascar Millennium Development Goals National Monitoring Survey in 2012-2013 show that modern contraceptive use continues to grow.
- Women’s Limited Choice and Availability of Modern Contraception at Retail Outlets and Public-Sector Facilities in Luanda, Angola, 2012–2015
Despite high rates of unintended pregnancy, access to a wide range of contraceptive methods, especially injectables and long-acting reversible contraceptives (LARCs), is severely limited in both public and private facilities. Knowledge of contraceptive choices is likewise limited, yet a substantial proportion of women are not using their preferred method among the methods they know of.