Village health worker Ahmed Mawejje demonstrates a new contraceptive option—Sayana Press—in Kitalegerwa, Uganda. Photo: PATH/Will Boase.
An “all-in-one” injectable contraceptive increases access—and gets women and men talking about family planning
Ahmed Mawejje is doing show and tell. Some three dozen people have gathered in front of the lone shop in the village of Kitalegerwa, in the Mubende district of Uganda, to listen to Ahmed’s talk about family planning options.
A volunteer village health worker trained by PATH and a teacher by vocation, Ahmed is an enthusiastic presenter. He dispels myths (no, injectable contraceptives do not make women infertile) and gamely demonstrates the female condom when an attendee shouts out, “Show us!”
One contraceptive particularly interests the crowd: Sayana® Press.
Sayana Press 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—has earned the nickname “the all-in-one” in Uganda.
Sayana Press is injected subcutaneously, that is, under the skin instead of into muscle. It’s so small, light, and easy to use that it is uniquely suited for minimally trained community health workers and even for women to inject themselves. That’s made it a popular choice.
The number one choice of women
Since 2014, PATH has coordinated pilot introductions of Sayana Press in Burkina Faso, Niger, Senegal, and Uganda, working closely with ministries of health and local partners. By early 2016, all four countries were moving to include the product in their national family planning programs.
One of the attractions of Sayana Press is that it’s making it easier for women to access their preferred form of contraceptive. Injectable contraceptives are the number-one choice in Uganda and many other African countries. They are long-lasting, safe, and discreet, and there is almost no risk of unintended pregnancy. But due to the more complicated vial and syringe setup for methods like Depo-Provera, they typically need to be administered by clinic health workers. For many women, that means walking long distances and standing in lengthy clinic lines every three months—and that’s been a significant barrier to access.
Now village health workers like Ahmed can bring an injectable contraceptive directly to women.
Family planning creates love
In front of the Kitalegerwa store, an enthusiastic discussion is taking place.
A man asks about the effectiveness of Sayana Press. Ahmed holds the device above his head and pronounces, “Ninety-nine percent.” (Watch a video of Ahmed.)
It’s striking that this conversation is taking place in such a public setting and that the men are as eager to ask questions as the women. Not so long ago, it was taboo to talk about family planning. But Ahmed’s message resonates with many 21st century Ugandans who are experiencing modernization and diminishing resources at the same time.
“If there are many children crying for food, attacked by diseases, there is no room for love,” Ahmed says. “Family planning is about being able to support your children. Family planning creates love.”
Vincent Mawano is one of a small but growing number of Ugandan men embracing family planning. He suggested that his wife, Scovia, try Sayana Press, and she readily agreed. The couple were concerned about their ability to support their two children and the dwindling amount of farmland in Uganda as the population grows.
“My dream is to educate my children and build a good home for them,” Vincent says. “If I have few children, I can afford to feed them well, send them to school, and save money for land to farm and a house.”
Not every man, or community, is ready to accept family planning. Many women in the pilot introduction countries have described a conflict between the cultural demand to have many children and their own worries about the health consequences of one pregnancy after another. These women appreciate that Sayana Press is discreet.
An innovative contraceptive can change women’s lives. See how in this Sayana Press slideshow. Photo: PATH/Will Boase.
Making it easier for women to plan their pregnancies is an important part of improving their health. It’s estimated that about one-third of maternal deaths worldwide could be avoided by delaying motherhood, spacing births, preventing unintended pregnancy, and avoiding unsafely performed abortions.
Sayana Press is a welcome addition for countries trying to reduce high rates of maternal deaths. Marguerite Ndour, PATH’s Sayana Press coordinator in Senegal, says the ministry and partners there “warmly welcomed Sayana Press and decided to officially bring the introduction of Sayana Press to scale even before the end of the pilot phase.”
The ministries in Senegal and Uganda have also partnered with PATH on studying an approach that could give women even more autonomy—self-injection.
Self-injection for even more control
Sayana Press’ unique design lends itself to easy and safe self-injection. The United Kingdom and several European Union countries approved self-injection with Sayana Press in 2015. And the World Health Organization has recommended self-injection of subcutaneous injectable contraceptives in settings where women have access to training and support.
PATH is working closely with the governments of Senegal and Uganda to research self-injection in local settings and learn how to best support women to self-inject independently, safely, and effectively in the privacy of their own homes. Hundreds of women have taken part in the research, and early results indicate that women can successfully administer the contraceptive themselves and want to continue the practice.
Self-injection with Sayana Press “offers women the chance to take contraception into their own hands,” says Adja Ndao. Photo: PATH/Cedric Koffi.
“The study offers women the chance to take contraception into their own hands,” explains Adja Ndao, one of the nurses helping to implement the study in Senegal. “It’s a new way of empowering them to plan their families.” She adds, “I like that I am helping women to be healthy.”
We are also comparing the cost-effectiveness and long-term use of Sayana Press versus Depo-Provera. These studies are determining whether women who self-inject with Sayana Press use the method longer than women who access Depo-Provera from providers. Findings from all our research will help other countries make informed decisions on whether and how to include Sayana Press self-injection in their family planning programs.
“Self-delivery of Sayana Press and family planning in the hands of users is good progress,” says Dr. Dinah Nakiganda, the head of reproductive health for the Ugandan Ministry of Health. She particularly appreciates that self-injection could help women overcome barriers to access such as the cost and time of traveling to facilities or health workers who oppose family planning for certain groups, like young women.
A changing world
The first woman in Uganda to receive Sayana Press is happy with her choice—and the potential for self-injection. Annet Tumubweine, like Ahmed, is a village health worker whose clients are trying to figure out how to raise families in a changing world.
“We are having to adapt to a new life,” Annet says. “In the past, we had no access to health education or family planning, and people delivered as many children as they could. But these days, children aren’t just digging (farming). They need to be educated.”
She adds with a grin, “The dot-com era has so many demands for someone to cope with.”
Sayana Press is giving her and thousands of other women one less thing to worry about.
Sayana Press and Depo-Provera are registered trademarks of Pfizer Inc. Uniject is a trademark of BD.