Headquartered in Seattle, WA, and with offices in San Francisco, Washington DC, and Paris, France, Camber Collective is a boutique social impact consulting firm that partners with foundations, NGOs, governments, and the private sector to address today’s most urgent challenges—systemically, sustainably, and equitably. Camber Collective works globally across various sectors but engages in a significant portion of its work in global health specifically, the sexual and reproductive health (SRH) and family planning (FP) space. Camber has been working on projects in the Global South-related to SRH, FP, and self-care for more than 10 years.
A pericoital (i.e., before or after sex) pill is a potentially innovative family planning method (using Levonorgestrel (LNG) 1.5mg) for women who have infrequent sex, need a discreet method, and/or simply have not found the right method for themselves. Currently, there is no method available that women can use only when they need it (i.e. on demand) that does not interrupt intercourse, and is discreet. LNG 1.5.mg is a well-tolerated progestin used in many forms of contraception including emergency contraceptive pills (ECP). Extensive research on LNG, including repeat use, dates to the beginning of the 1970s. LNG pills were originally labeled in Eastern Europe and Asia in the 1980s and 1990s as a contraceptive to be taken either before or after sex, as needed. Recent research has been conducted specifically on pericotial (i.e., pre- and post-coital) use of LNG as a primary means of contraception. Camber Collective, as part of the Plan A project, built on that recent research by conducting two 12-month prospective, single-arm, interventional studies in Ghana and Kenya to test the feasibility and acceptability of a pericoital pill. The study results were positive, with participants using as instructed, satisfied, and willing to use in the future if the product was made available.
The mode of providing the study product to women in the Kenya study was via Kasha’s digital platform. There were many advantages to using Kasha’s platform, especially during the COVID pandemic. This platform and direct-to-consumer model allowed the product and use instructions to be provided to customers in a calm setting and when convenient to the customer but with limited face-to-face contact. This was key during the pandemic. Women who desired the product because of its discreet properties were not required to visit a pharmacy, and the product was delivered in nondescript packaging within a timeframe that was convenient for the woman. A digital platform is a new avenue to shop for a portion of Kenyan women and required these customers to adapt to a new system. Additionally, many customers did not have smartphones nor a computer to access the digital platforms website or app, so providing USSD capable purchasing was key. Furthermore, direct-to-consumer delivery proved logistically challenging at times (e.g., difficult to find the residence, client does not answer their phone, delivery is slower than anticipated by the client) and thus robust logistical infrastructure and oversight was also important.
Digital platforms have the ability to revolutionize the way women interface with the health care system and obtain self-care products. At the same time, in countries with limited smart phone and computer usage, it will take time to familiarize clients with this new shopping system and USSD (or other lower tech options) should be made available for segments of the population less likely to have smart phones or computers. Furthermore, while direct-to consumer delivery has many advantages (e.g., allowing the client to choose the time and place to purchase, and discuss method use and ask questions) strong back-office and organization resources and support will be needed to identify and mitigate logistical challenges that will likely occur.