According to Family Planning 2030, just 30 percent of women in Uganda use modern contraception. The country has made great strides in the past decade, with that figure up from 21 percent in 2012. But barriers to family planning—including limited and hard-to-reach services—persist.
“Difficulty accessing family planning services makes it challenging for women to avoid unintended pregnancies,” explains PATH’s Allen Namagembe. “It’s also difficult for them to space births as they would like.” The statistics bear her out: Performance Monitoring for Action’s fall 2020 survey revealed that some 44 percent of Ugandan births were unintended.
As Deputy Director of the Access Collaborative for Uganda, Allen is determined to put the power of reproductive choice in women’s hands. In 2013, she joined the pioneering work to introduce a new family planning option: a self-injectable, all-in-one contraceptive called DMPA-SC*. The product—a small plastic bubble prefilled with a single dose of medication that’s attached to a short needle—protects against pregnancy for up to three months.
DMPA-SC (brand name Sayana® Press) combines drug and needle in the prefilled BD Uniject™ injection system originally developed by PATH. Uganda was the first country in sub-Saharan Africa to offer contraceptive self-injection outside a research setting.
Allen was enthusiastic from the start. “It’s a great innovation,” she says of DMPA-SC. “It gave me hope that the practice would equip women to be in charge of their reproductive health.” Small and light, easy to inject, and protecting against pregnancy for three months, the product reduces the demands on busy health workers and makes it easier for women who don’t live near a health facility or clinic to use a contraceptive of their choice.
Building evidence, delivering results
In 2014, the Ugandan government first introduced DMPA-SC to be administered by community health workers. The success of these efforts opened the door for the country to pursue additional avenues of access through self-injection. Yet government officials and other decision-makers, including health care providers and civil society organizations, had questions about DMPA-SC self-injection. Would it be acceptable to Ugandan women and their partners? Would it add value to existing programs? What about costs?
Because self-injection was a new approach in family planning, there was limited data for Allen and her team to rely on. By working closely with local partners, including the Ministry of Health, they set up the parameters and generated evidence of self-injection’s acceptability, feasibility, and effectiveness (measured in terms of contraceptive continuation), and identified the key steps to securing government approval for self-injection in Uganda.
“It was very exciting,” says Allen of the introductory phase. “Injections are normally the province of the health care provider—so it marked a real shift to equip women with a safe and effective tool for self-injection.”
“All women, no matter where they live, should have access to quality family planning services.”— Allen Namagembe, Deputy Director, DMPA-SC Access Collaborative, Uganda
A carefully designed rollout included community consultations for human-centered design approaches to offering the new option, resulted in a step-by-step process for safe and effective self-injection by thousands of Ugandan women.
Throughout the COVID-19 pandemic, the Access Collaborative has continued its partnership with the Ministry of Health, district leaders, and many implementing partners to advance scale-up efforts, which are still in process. Ensuring all women in a country can access a new contraceptive option in the context of informed choice takes time. Today, women who choose DMPA-SC self-injection receive: training and supervision as they give themselves their first self-injection, illustrated instructions, three additional doses of DMPA-SC (to be self-injected over nine months), instructions on storage and disposal, and a calendar on which to calculate their next injection dates.
Allen’s work is also supporting the expansion of DMPA-SC self-injection in other countries; the data and program implementation experience from Uganda is now informing self-injection projects in the Democratic Republic of the Congo, Madagascar, Nigeria, Zambia, Senegal, and beyond.
For this biostatistician, it all comes back to her passion to help women and girls reach their potential. “All women, no matter where they live, should have access to quality family planning services,” she says.
*DMPA-SC: Subcutaneous depot medroxyprogesterone acetate.
Sayana Press is a registered trademark of Pfizer Inc. Uniject is a trademark of BD.
