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Self-Injectable Gives Women More Power Over Family Planning

For women in much of the developing world, a lack of autonomy and privacy are just a couple of obstacles to accessing birth control. A small, self-injectable contraceptive trialed in Uganda could empower more women to make their own decisions regarding childbirth.

Written by Hannah McNeish Published on Read time Approx. 4 minutes
The portable, single-use Sayana Press contraceptive injection is designed to allow women to administer it to themselves, cutting down the number of visits they have to make to a doctor. PATH/Will Boase

GULU, Uganda – Two-headed babies, hemorrhaging, weight gain, lust-fueled adultery and infertility. Among Ugandans, especially men, these are just some of the side effects that female contraceptives are rumored to cause, and why so many women can’t access birth control, or don’t even try.

“You know, the husbands, they don’t allow family planning,” says Molly Warom, 26, a hairdresser in Gulu, northern Uganda. She hears about the struggles women have trying to convince their partners to let them use family planning methods like the pill or injections. “The men say their ancestors were not using those things and they were normal, so why are we women using them?”

Women who decide to use contraception – with or without the consent of their partners – then face the challenge of keeping their decision private. The lack of discretion in the country’s overcrowded and chaotic medical facilities puts many women off seeking out family planning methods. “When you go to the hospital, someone can peep at you and tell,” says Warom.

Autonomy and privacy are two of the issues that medical innovation charity PATH is hoping to tackle with a single-use, self-injectable contraceptive that is being trialed in Uganda. Manufactured by Pfizer, the Sayana Press combines one dose of the widely used contraceptive depot medroxyprogesterone acetate (DMPA-SC) and a single-use needle Uniject device. One dose lasts three months and, so far, women in the trials have found the drug easier to use than the separate vials and syringes of other makes.

“They like [Sayana Press] because it’s an all-in-one, so you can’t misplace either the vial or the needle, which has been the case with the traditional methods,” says Fiona Walugembe, PATH’s Sayana Press Uganda coordinator.

When the Sayana Press pilot introduction was launched in 2014, PATH, the Ugandan ministry of health, and partners trained over 2,000 community health workers on how to administer the device. About one year later, PATH and the Ugandan ministry of health launched a research study in which nurses taught 380 women how to self-inject. Walugembe says women have been reporting fewer side effects and less pain injecting with Sayana Press than a traditional injection, because the self-injectable has a lower dosage of DMPA-SC, a shorter needle and is injected into fatty tissues rather than muscles.

Warom and her boyfriend had been using condoms (which he could get for free from the local health clinic) because they wanted to wait until their baby was three years old before they had another child. “The baby has to feed well, study well, but if you produce frequently those things will not happen,” she says.

When Warom heard about free trials for the Sayana Press happening in Gulu, she worried about the side effects but also wanted to take control of her reproductive health. “With the depot [traditional injection], the needle is long. But this one, the needle is tiny,” she says, adding that she has shown many of her friends the all-in-one system that she can use at home every three months.

“I choose my own time to do it, when the day comes. It saves me time, you can keep it secret and it saves on transport,” she says.

In a country where one in three women have unmet family planning needs – one of the highest rates in sub-Saharan Africa – PATH’s Walugembe says the network of trained community health workers is key to the new device’s success. “One of the major hindrances in Uganda is access, whereby women have to walk very long distances to health facilities,” she says. “But the fact that we have the health workers who reach out to women, this has been instrumental.”

An October 2016 study of the trial results showed that 88 percent of the women could self-inject with competence and 98 percent wanted to continue. “This pioneering research is important, not only for the women of Uganda, but for all women,” said Dr. Anthony Mbonye, acting director general of health services at the Ministry of Health and a co-investigator of the study, in a press release. Around 225 million women in developing countries want to plan their pregnancies but don’t have access to a suitable method.

According to Walugembe, the Sayana Press, which requires the user to go to a doctor or the hospital for a checkup every nine months, has been found “highly acceptable among the women who are under 25, and for [women in] Uganda that’s a priority.” Over 40 percent of the women currently in the trial are 25 or younger, she says. “We are excited by the results we are seeing, that it’s making a difference in the lives of women.”

Research on self-injectable contraceptives has already been conducted in the U.K., where the Sayana Press has been approved, and in the U.S. The Uganda results are a significant step toward getting self-injectables onto the African market because health ministers have told PATH that they want more evidence the system will work before approving it for their family planning services. Burkina Faso, Niger and Senegal have also piloted Sayana Press since 2014 and are moving toward including it in their family planning programs.

As more young women start to use short-term contraceptives around the world, the myths about them – such as causing sickness, weight gain and bleeding – are slowly fading.

“I’m normal, I’m not fat, I’m just the same size I was before,” says Warom, whose experience has inspired around a dozen of her friends to use Sayana Press.

But for many women, the main reason for wanting to use self-injectables is privacy. Rosemary Lamwaka, a clinical officer at Gulu Hospital, says that injectables are the most popular form of contraception among women because they can easily hide them from men, unlike the daily pill.

For now, the women taking part in the trial have been getting Sayana Press for free and many are hoping the drug gets approved by Uganda’s Ministry of Health for free distribution nationwide.

“The only problem is that women are worried about where they will get Sayana after this study,” she says. “They want to continue with self-injections.”

CORRECTION: This story has been updated to correct the figures and timeline for the launch of the Sayana Press pilot.

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