Betty holding an illustration and speaking to group.

The community health worker

A game changer for family planning

Betty Laruni works 15-hour days to take care of her family. In her spare time, she gives women access to a revolutionary new form of contraceptive.

Betty Laruni is on her bicycle by 6 a.m., “Sunday to Sunday,” as she says. Her children, aged 2 and 6, are still sleeping. When they wake, her husband—who farms their village plot—will feed them the porridge Betty made before she left.

It takes Betty 45 minutes to ride to the hospital in Gulu, where she spends each day cleaning the maternity ward. In the afternoon, she’ll ride back to her village and care for the two children she missed all day.

As if that isn’t enough, in her spare time Betty volunteers as a community health worker—helping women keep themselves and their families healthy through family planning.

The “millionaires”

If wealth was the inevitable result of hard work and enterprise, every woman in Africa would be a millionaire. These words, by the writer George Monbiot, are a popular saying in Uganda, where women like Betty—who toil for their families and their communities—are remarkably common.

Betty is one of more than 2,000 village health workers in Uganda trained by PATH and our partners to educate women about family planning. These volunteers (or VHTs, for village health teams as they’re called in Uganda) are selected because they’re respected by their communities. They also need to be trustworthy, because confidentiality is crucial.

Betty and her peers are trained to counsel individuals about the range of available contraceptive options, and they can dispense some short-term methods like condoms and the pill. But with stigma still surrounding family planning, they need to use discretion when helping women who don’t want their partners, family members, or neighbors to know.

That’s one reason the new injectable contraceptive Sayana® Press is a popular choice.

Making it easier to plan a family

“Injectable contraceptives are popular in Uganda because they are discreet. At times, some male partners do not support their wives using family planning,” says Fiona Walugembe, coordinator of PATH’s Sayana Press project in Uganda. “The fact that injectables last about three months also makes them popular. And they are effective.”

Before Sayana Press, injectables could only be given using the standard vial and syringe setup and were most often administered by medical workers. Long distances to clinics, long waits for service, and occasional stockouts of syringes meant too many women went home without receiving the family planning method of their choice.

Sayana Press, on the other hand, is delivered in an all-in-one device and extremely easy to use. Trained lay health workers like Betty can inject their neighbors whenever and wherever it is convenient, even in the privacy of their homes.

Easy makes for better access

PATH coordinated the first pilot introductions of Sayana Press in sub-Saharan Africa—in Burkina Faso, Niger, Senegal, and Uganda. As project coordinator, Fiona has overseen every step of the process in Uganda, beginning by getting input and approval for the pilot introduction plan from Uganda’s Ministry of Health.

Introducing Sayana Press in Uganda.
Map showing districts in Uganda where Sayana Press has been introduced and where self-injection research has been done.

She’s also witnessed the excitement surrounding this new contraceptive option—from the Ministry to health workers to women using the device.

PATH has a long history of developing and improving access to contraceptives. “But the reason why we think Sayana Press is a game changer,” Fiona says, “is the fact that it’s very easy to administer, as we’ve seen from the evidence of the village health teams.”

She adds, “Many women don’t have the power to plan their families, because health centers are far away or partners refuse to use contraceptives. With Sayana Press, we are giving women additional choices and access to a form of contraception that meets their needs.”

How will they eat?

“Betty was always smiling.” That’s how George Barigye, one of PATH’s Sayana Press health officers, remembers the 26-year-old. “She even brought her new baby to the practice sessions.”

George led the seven-day training on family planning that Betty attended. He taught her and 29 others not only about family planning techniques, but how to give engaging group presentations and sensitive one-on-one counseling sessions.

Betty was highly motivated thanks to her innate desire to help others. But she was also motivated by her belief in family planning. She was one of six children, two of whom died young. She says, “Before, people reproduced without planning how their children will be in the future. How will they eat? How will they study?”

Like many African women, she made the choice to use family planning to space her children, so she could better support them. Fortunately for Betty, her husband supported her decision.

Betty injecting the upper arm of a woman holding her baby on her lap.

Irene Ocwee (right) brought her four-month-old to the clinic for a checkup and vaccinations. After hearing Betty Laruni (left) talk about family planning options, the 24-year-old mother of two decided to get Sayana Press there and then. Photo: PATH/Will Boase.

Helping others—and herself

During her breaks at the hospital, Betty now gives health talks to women waiting to get their children immunized. Babies cry and fidget, but the women who crowd the benches listen closely as Betty discusses such topics as hygiene, the importance of immunization, and the various contraceptive options available in Uganda.

“Doing this work gives me self-confidence. I’m helping people a lot.”

If a woman decides to use Sayana Press, Betty can administer it in the privacy of the hospital’s family planning room, in her own home, or even in the woman’s home.

Women are grateful for the ease of Sayana Press, she says. “It has a small syringe, it’s not painful, and it’s quick.”

She also has firsthand experience: she decided to use it herself. She had been getting the injectable contraceptive Depo-Provera® from the hospital nurse, but signed on to a study on the feasibility of self-injecting Sayana Press. “I’m better at giving Sayana Press to other women,” she says, “because I inject it myself.”

She adds, “Doing this work gives me self-confidence. I’m helping people a lot.”

A deep need

Wherever it’s been introduced, Sayana Press has helped increase access for women and adolescents, including new family planning users.

In Burkina Faso, where Sayana Press was introduced at all health facility levels in four pilot regions, nearly 200,000 doses were administered in just two years. In Niger, 70 percent of women who chose Sayana Press in the first quarter of introduction had never used modern family planning—showing the depth of need. And in Senegal, the contraceptive accounts for 72 percent of injectable use in community settings, demonstrating the popularity of this method in semirural areas.

Sayana Press doses administered in Uganda pilot introduction, per quarter, for a total of 130,673 over two years.
Chart showing number of Sayana Press injections given from the 3rd quarter of 2014 to the 2nd quarter of 2016.

Sayana Press is being progressively scaled up throughout Uganda. PATH has begun training health workers to administer Sayana Press in clinics and hospitals in 12 districts. That way, women can get the contraceptive wherever works best for them.

Sayana Press is also being introduced in more countries in Africa. PATH, for example, is helping to introduce it in 85 health facilities in the Democratic Republic of the Congo.

PATH has developed deep expertise by trying different introduction approaches across the countries. Fiona has become an unofficial ambassador for the potential of products like Sayana Press to increase women’s contraceptive access. She speaks at conferences and events around the world and advises health officials from other countries.

Dreaming of better futures

Data from the pilot introduction also suggest that young women are enthusiastic about a new, more accessible contraceptive option—45 percent of Sayana Press doses administered in Uganda were to women and adolescents younger than 25.

Their generation realizes that planning their families is one of the keys to success. “These days, family planning helps a lot,” says Betty.

Family planning—and Sayana Press in particular—is helping teenagers like Irene, whose boyfriend refuses to use contraceptives, and young women like Joyce, who sells used clothes in the market to feed her four children. It’s helping couples like Scovia and Vincent, who dream of a better future for their two small children.

“There are lots of women interested,” Betty says.

And there’s more good news for them. In the fall of 2016, Uganda is piloting self-injection of Sayana Press. That means women are about to have even easier access.

—Written by Lesley Reed