A woman taking her dose of Sayana Press
Preferred methods of contraception vary from country to country, with various family planning procedures available worldwide for use.
Although there is no universally-recognised mixed method of contraception, uptake of the various family planning methods may reflect local cultural preferences or social norms.
Research findings have revealed that in Nigeria, the intrauterine contraceptive device (IUD), male condoms and injectable have been identified as the most patronised methods. In Canada, oral contraceptives, condoms and sterilisation have been found to be the preferred methods, while Ethiopia reports injectables as the most preferred choice among the mediums of contraception.
Injectables have also been identified as the method of contraception preferable among women in Ghana as against the IUD or oral contraceptives, while male condom is the preference for men.
The effectiveness of the method, recommendation from other users, low incidence of forgetfulness and the relatively longer intervals for administration were the commonest reasons for the use of injectables among Ghanaian women.
Findings of a study by Laryea et al. Contraception and Reproductive Medicine (2016), better explains the reasons for the choice of injectables by women in Ghana, particularly those in the Ashanti Region, the study population.
“With the pill, I sometimes forget but for the injection, I always remember when it is time for my next shot,” a respondent of the survey notes. “My sister told me it was a more reliable method compared with pills and I used it because I have a child although not married,” a respondent said.
Another participant of the survey stated, “I chose injections because I am an apprentice and can take the injection without anyone noticing.”
“I opted for injectables because my husband did not give his consent for me to take up family planning,” was another reason given for the use of injectable by women attending family planning clinic at the Komfo-Anokye Teaching Hospital (KATH) in the Ashanti Region of Ghana where the study was conducted.
“I chose injections so no one knows I am on a family planning method,” another respondent indicated.
The study showed majority of the total respondents (247 women) were satisfied with either method of the injectable contraception and will recommend it to other potential users.
“The majority of respondents (70 percent) were on the Depot Medroxyprogesterone Acetate injection (DMPA), sixty percent of respondents were on injectables as their first ever method of contraception and approximately 72.2 percent of respondents had shared their experience with relations and friends,” the research findings stated.
The research, therefore, concluded that there is a high level of satisfaction among current users of injectable contraceptives.
“Strategies to increase the uptake of injectables can go a long way to increase the contraceptive prevalence rate and reduce the unmet need for family planning in Ghana,” the research recommended.
This, notwithstanding, the respondents also explained that travelling long distance for the shot, especially those in the rural areas and other side effects like change in the menstrual cycle were well tolerated by the participants.
Injectables in Ghana
Family planning services have been available on a large scale in Ghana since the 1980s.
Contraceptive usage in Ghana is almost universal and their use has resulted in a decline in Ghana’s fertility rate from 6.4 percent in 1988 to 4.2 percent in 2014.
Since their introduction in Ghana in the early 1990s, injectable contraceptives have seen increasing patronage and are currently the most preferred method of contraception in the country.
Among the various contraceptives available in Ghana are two types of injectables – a progestin-only injectable contraceptive, Depot Medroxyprogesterone Acetate (DMPA) given once every three months and a combined-injectable contraceptive (CIC), NorethisteroneEnanthate / EstradiolValerate (NET-EN/EV), given monthly.
Recent data from the Ghana Health Service (GHS) indicates that injectables account for more than three out of ten contraceptive used by women in Ghana, with close to four out of every 10 prospective users of modern family planning methods likely to opt for injectables.
The high usage and satisfaction of injectable contraceptives, notwithstanding, Ghana still records high numbers of unmet need for family planning.
Family planning method is accessible or available to only 22 percent of the Ghanaian population who need a form of contraception method, according to the Demographic & Health Survey, Ghana.
This means that one out of every four Ghanaian woman wants to wait for some time to have a child, or do not want to have any more children, yet they are not using any contraceptive method.
The Chief Director of the Ministry of Health, Dr Afiza Zakariah, said the figure, although high as compared to other countries in the sub-region, puts Ghana in an unlikely position to meet the national target for contraceptive prevalence of 50 percent by 2020.
“Unless we scale up we will not be able to reach our target and that is what government is doing by not only making the different methods available, but training health workers to dispel the myths surrounding the use of family planning methods and highlighting the importance of family planning to the woman’s health, family and community at large,” she stated.
Dr Yaa Asante, Programme Manager, Family Planning, Ghana Health Service, could not agree more. “We are working with stakeholders like the National Population Council (NPC) to highlight the benefits of contraception to the development of Ghana because family planning alone can reduce maternal mortality by 30 percent, and when we add skilled delivery will prevent over 70 percent deaths among pregnant women in Ghana,” she added.
She also indicated that the family planning programme will ride on the back of the success stories of the various family planning methods while looking at more innovative ways to make the products more accessible.
“So we are also looking at things like self-injections by women in remote areas with little supervision as well as free products,” she added.
Sayana Press
Pfizer Inc., taking into consideration the challenges associated with the injectable contraceptive, developed a more convenient, easy to use and less expensive injectable contraceptive, Sayana Press.
Sayana Press is a self-injectable contraceptive that combines a lower-dose formulation of the widely used injectable contraceptive Depo-Provera® with the PATH-developed Uniject™ injection system.
The device—a small bubble of plastic prefilled with a single dose and attached to a short needle — is injected subcutaneously, that is, under the skin instead of into muscle like the DMPA.
The small, pre?lled syringe is easy to transport and use. It can be administered in remote locations by community health workers, or even by women in their homes.
Its small, light and easy to use features make it uniquely suited for minimally-trained community health workers to administer to clients and even for women to inject themselves with little or no supervision.
Each subcutaneous injection prevents ovulation for at least 13 weeks (or three months). Approved in more than 40 countries, Sayana can be stored without refrigeration.
Pilot introductions of Sayana Press have already been conducted in the African continent in countries like Uganda, Burkina Faso, Senegal and Niger with impressive results. Two years after the pilot, all four countries were moving to include the product in their national family planning programmes.
“One of the attractions of Sayana Press is that it’s making it easier for women to access their preferred form of contraceptive,” Fiona Walugembe, Project Manager of Sayana Press at PATH Uganda, said.
Lessons from Uganda
Depo-Provera (hormonal injection) has been the popular contraceptive method used by Ugandan women to plan their families but its associated challenges prevented more women from accessing the product, which accounted for about 20 percent of contraceptive usage in Uganda.
Unlike Sayana Press, Depo like the DMPA in Ghana, had to be administered by a trained health professional and must be stored under certain temperature although it provides the same three months protection.
Sayana Press, however, adds the element of discretion, in that it allows for women to self-administer it in the comfort of their homes.
This innovative approach has not only helped to expand the coverage of self-injectables to women, especially in rural areas, where lack of independence and privacy are some of the obstacles to accessing birth control but has also given Ugandan women the power to control their births.
Since its introduction stage in 2014, Uganda has scaled up the use of Sayana Press in rural areas, offering more women the opportunity to plan their families with very little supervision from health workers.
Walugembe added, “Fewer cases of side effects such as weight gain or irregular periods have been reported by providers and users of Sayana Press.”
Thirty-five-year-old resident of Kalagala village in Mubenda District, Betty Nabulesa, has three children from a previous marriage, and she does not plan to have more children in her second relationship, therefore, she has enrolled as a beneficiary of the Sayana Press project in Uganda.
After trained community health workers sensitised her and other women on the project, Nabulesa now administers her own contraceptive method at home.
“I do it myself in my house, I take the medicine, shake it, remove the tip and I inject myself under my skin on my abdomen, I don’t feel a lot of pain as well,” Nabulesa revealed.
The pilot study nurse in Mubende District, Winnie Kagwa, agreed that more women choose Sayana Press because they can hide it and use it when a man is not around. “Now they have the power in their hands,” she pointed out.
By Jamila Akweley Okertchiri