PSI launched our first social marketing programs for injectable contraception in Guinea and Nigeria in 1995. In 2016, we distributed 6,889,391 injectable contraceptives, averting 583,537 disability-adjusted life years (DALYs) and providing 1,586,039 couple years of protection (CYPs) across 28 countries.
- combined injectable contraceptives containing both progestin and estrogen, administered once a month;
- progestin-only injectable contraceptives containing norethisterone oenanthate (NET-EN), administered once every two months;
- progestin-only injectable contraceptives containing depot medroxyprogesterone acetate (DMPA), administered every three months.
The primary function of injectables are to stop monthly ovulation (release of eggs from ovaries). They also thicken cervical mucus, making it difficult for sperm to pass through to the uterus. Injectables do not disrupt existing pregnancy.
Sayana® Press, a new formulation and presentation of progestin-only injectable contraception, was designed to overcome many of the barriers women face in accessing family planning. The three-month, progestin-only injectable contraceptive is packaged in the Uniject™ injection system – a small, easy to use, all-in-one, pre-filled device. With its simplified delivery system and training, Sayana® Press can expand the geographic availability of injectable contraception and reach new users through pharmacists and community health workers, where authorized by local health authorities.
Our programs enable the use of voluntary family planning methods, including injectables, within the context of informed choice. 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 detailer staff visit service providers at their workplaces to learn what information and support they need to offer a broad range of contraceptive methods.
Making a Difference
In Madagascar, one in five women has an unmet need for contraception. A major obstacle is geographic access: 80% of the population lives in rural areas with few health centers. Community health workers (CHWs) 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% in 2003 to 2009, according to demographic and health surveys. During that time, the percentage of women using injectables nearly doubled from less than 8% to more than 14%. In 2003 to 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 to 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-acting reversible contraceptive methods such as implants and the IUD.
In 2016 we distributed more than 1.6 million injectables through community-based distribution in Madagascar, providing 406,632 CYPs. Results from the Madagascar Millennium Development Goals National Monitoring Survey in 2012 to 2013 show that modern contraceptive use continues to grow.
- Intensive Group Learning and On-Site Services to Improve Sexual and Reproductive Health Among Young Adults in Liberia: A Randomized Evaluation of Healthy Actions
- 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.