Paving Pathways to Contraceptive Self-Injection

Dr. Fannie Kachale, Director of the Reproductive Health Department the Ministry of Health and Population of Malawi 

In recent years, Malawi has seen significant improvements in increasing access to, and use of, modern contraception for girls and women. The modern contraceptive prevalence rate (mCPR) among married girls and women aged 15-49 reached 58 percent by 2016, up from 42 percent in 2010.

But despite these gains, one in five married Malawian girls and women of reproductive age wants but still does not have access to modern contraception. Unmet need is highest among 15-19-year-olds, with one in two unmarried girls confronting gaps in access. In contrast, one in five married girls aged 15-19 have an unmet need for contraception. In 2016, three in 10 girls aged 15-19—most of whom live in rural areas—were bearing children.

Paving new ways for girls and women to access the services and tools they need—to plan for the families and lives they want— remains the priority.

The Malawi Costed Implementation Plan for Family Planning sets forth an ambitious plan for reaching the country’s Family Planning 2020 (FP2020) commitment, namely ensuring that three in five Malawian girls and women have access to modern contraception by 2020. It’s a bold pledge, and one that focuses heavily on our country’s largest demographic: adolescents and youth.

Driving change requires overcoming long-standing challenges. The number of Malawian health facilities providing sexual and reproductive health services remains low; even more, the proportion of the population living within a five-mile radius of a health facility declined from 81 percent in 2011 to 76 percent in 2016.

We understand that closing gaps in unmet needs mandates that we not only bring care closer to girls and women, but also place the decision-making directly into their hands.

Learning lessons from previous years, the biggest increase in Malawi’s mCPR coincided with the expansion of community-based disruption of injectable contraceptives. In 2016, three in 10 Malawian girls and women aged 15-49 used injectables. The evidence suggests that the discrete nature of injectables, as well as the ease in access through community-based distribution, fueled the uptake rates. This was an opportunity.

That’s why in May 2018, the Malawi Ministry of Health and Population (MOHP) agreed to roll out contraceptive self-injections across the country through a phased approach for the next three years.

After a pilot project was conducted in the southern region of Malawi, evidence showed that women, when properly trained, were able to self-administer the injections. Self-injection was also likely to increase continuation of contraception. Introducing self-injections in Malawi was an effective intervention the MOHP identified to bring services to some of the hardest-to-reach consumers, while delivering a sustainable workaround from the low numbers of community health workers trained to administer injectables. It’s part of our collective approach to drive toward our FP2020 goals.

As a country, we see these efforts as a core part of how we are giving girls and women the tools to make healthy choices about their bodies and for their lives. For girls and women alike, self-injection puts power into their hands. Girls and women can easily access the method in their communities and administer self-injections in privacy, at a time and place convenient for them.

Photo credit: © PSI/Emma Beck

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