By Kendal Danna, PSI Technical Advisor, Reproductive Health
In 2017, with USAID support, PSI began piloting the introduction of the hormonal Intrauterine System (IUS), also known as the LNG-IUS, a highly effective long-acting reversible contraceptive (LARC) method that offers a rapid return to fertility after removal, non-contraceptive benefits such as reduced menstrual bleeding, and the potential for milder side effects than with other hormonal methods. PSI supported providers to add the IUS to the broad range of voluntary family planning methods offered in four African countries: Nigeria, Madagascar, Zambia, and Zimbabwe. Our pilots have provided evidence for the acceptability of the IUS among potential clients and providers, and have helped the global community of practice to understand the potential for this method in new markets, within the context of informed choice and access to a variety of methods.
PSI has contributed both operational learning and research evidence to the IUS community of practice. This was possible in Nigeria and Zimbabwe through the USAID-funded Support for International Family Planning and Health Organizations 2 (SIFPO2) project, and in Madagascar and Zambia through the USAID-funded Expanding Effective Contraceptive Options (EECO) project led by WCG Cares. We carried out research in these pilot settings to understand client and provider perspectives on the IUS. We are also partnering with FHI 360 under the ongoing Learning About Expanded Access and Potential of the LNG-IUS (LEAP) Initiative to understand the demand for this method and its potential effect on contraceptive markets. Click here to learn more about our research findings and to access other resources on the new IUS Access Portal.
Based on our pilot introductions, we have identified five market indicators that suggest the hormonal IUS access will take off this decade, becoming a standard part of the contraceptive method mix in the many countries where it has previously been out of reach for women:
1. New studies show that women want the IUS
When we listen to clients who have chosen the IUS, the evidence is clear. Women are highly satisfied with the method. Contraceptive continuation among users in pilot settings is consistently high. Across all four countries, more than 90% of adopters continued to use the IUS three months after adoption 2. Furthermore, the diversity of IUS adopters in our studies shows that the unique attributes of the method are broadly appealing for women across demographic profiles. Women deserve a wide range of contraceptive options that can satisfy their individual needs. For clients, the IUS offers something new and different from other method options.
“My flow has become lighter… I was told at the facility that some people experience such side effects, so I received it well… Now even when I am on my period I am still comfortable enough to wear what I want because of the lighter flow and shorter days… [My husband] is happy because it gives us more time to be intimate… Even at the farm this has helped me because my energy levels are not so high when I am on my period, so with shorter days [of menstrual bleeding] I work better even through my period days… [With] the extra money for pads I am able to buy a few extra baby clothes for my little girl.” — IUS user in Zambia responding to LEAP follow-up survey about her experience with the IUS
2. Ministries of Health and national stakeholders are developing plans for broader access
In late 2019, the Ministries of Health in Zambia and Nigeria, through the coordination of PSI, FHI 360, the Clinton Health Access Initiative (CHAI) and other partners, convened in-country meetings to examine evidence from IUS studies in their countries and explore the potential for national scale-up of the method. These stakeholders’ meetings were critical early milestones, and both Ministries have set off on the road to broaden family planning method options nationwide. They are developing national strategies to lay the groundwork for an intentional and phased approach to scale-up. Nigeria and Zambia may become “first movers,” but more Ministries of Health are joining in this progress and showing their enthusiasm to make the method more widely available in their own countries.
“We are on the road to increasing access to the hormonal IUS and I invite the global community to join us…Let’s move forward together” — Dr. Kayode Afolabi, Director of the Reproductive Health Division, MOH Nigeria, speaking at the Hormonal IUS Technical Consultaion
3. Donors are investing in IUS scale-up
In 2015, under the leadership of USAID, a Technical Working Group was created to better understand the potential of the IUS. Comprised of donors, implementers, manufacturers and suppliers, this group developed a global learning agenda and committed to coordinating efforts to learn from early introductions of the method.
Five years later, the technical working group has evolved to become the much larger Hormonal IUS Access Group. This global consortium—consisting of a Steering Committee of donors and a Partners Group of implementing organizations—is exploring concrete opportunities to sustainably increase access to the hormonal IUS. USAID and UNFPA are working to add the IUS to their global product procurement catalogs. Thanks to the catalytic support of donors like USAID, there is growing interest in supporting intentional and phased scale-up of this method.
4. Suppliers are increasingly making the product more affordable for low-and middle-income countries (LMICs)
PSI’s introductions began with IUS product donated by the International Contraceptive Access (ICA) Foundation, a partnership between Bayer Pharmaceuticals and the Population Council that has made the IUS available in 36 countries free of charge. Since 2005, over 150,000 units have been donated. This commitment from the foundation has been invaluable in markets where the cost of the other IUS products has often put the method out of reach for the majority of the population.
Several commercial suppliers have committed to making the IUS a more affordable option for LMICs as well. In Madagascar and Zambia, the EECO project led the first introductions in Africa of the IUS product from the non-profit pharmaceutical company Medicines360. Other suppliers, such as Bayer and Pregna, have also signaled a strong interest in expanding access to their IUS products in LMICs.
5. Family planning providers and organizations are committed to adding the IUS to the basket of available contraceptive methods
PSI’s research with public and private health care providers shows that they too support improving access to the IUS at their health facilities. Providers see the value of adding this method to their offering and appreciate that the IUS can offer their clients unique contraceptive and therapeutic benefits as well as milder side effects.
In June 2020, the Access Group, in partnership with the Method Choice Community of Practice, convened the virtual meeting Hormonal IUS Updates: New Insights and Steps Toward Scale to help expand global awareness of current evidence about the method to new members and to new audiences. Following the meeting, we are energized; participating organizations like PSI see the potential of this method to improve the global family planning landscape and we are ready to get to work to make this method available to more women.
PSI is committed to helping grow and shape the IUS market at the global and national levels. We aim to meet the call for improved contraceptive choice by supporting expanded access to this method. For the IUS, this is just the beginning.
Banner image credit PSI/Benjamin Shilling.