Local leaders drive progress in contraceptive self-care

March 8, 2022 by Bonnie Keith, Beth Balderston, and Megan Shawcross

How “Self-Injection Ambassadors” across Africa are expanding contraceptive access and choice for women and girls.

Dr. Mareme Mady Ndiaye, Senegal's Head of Family Planning and a proud Self-Injection Ambassador, speaks as a panelist during a meeting on contraceptive access and choice.

Self-Injection Ambassador Dr. Marème Mady Dia Ndiaye, Head of the Family Planning Division, Department of Maternal and Child Health, Senegal, speaks at a PATH-supported contraceptive workshop in Dakar, Senegal. Photo: PATH.

Introducing and scaling up any new health product can take years, and many roadblocks can be encountered along the way. The introduction and scale-up of DMPA-SC* has been no exception.

Often known by its brand name, Sayana® Press (Pfizer Inc.), DMPA-SC makes contraceptive injections simpler and more accessible—any trained person can administer it, including clients themselves. Self-care options like self-injection are key components of a holistic primary health care system that is responsive to the needs of women and girls. With these systems under strain due to COVID-19, support for expanded self-care options is growing to alleviate burdens on traditional health service delivery outlets and providers. However, it still takes considerable advocacy to institutionalize self-care approaches in health systems.

Advancing regulatory and policy approval of contraceptive self-injection requires a host of partners and collaborators. Government officials, implementing partners, health workers, and communities all must reach consensus and commit to offering DMPA-SC self-injection as part of a full range of contraceptive options. And that’s where local champions have an essential role to play.

Contraceptive choice

By putting the power of protection directly in people's hands, contraceptive self-injection has the potential to reduce access barriers, increase contraceptive continuation rates, and enhance autonomy. Photo: PATH/Will Boase.

Champions for contraceptive self-care access

In 2020, the DMPA-SC Access Collaborative, led by PATH in partnership with JSI, launched the Self-Injection Ambassadors Initiative to mobilize influential champions for contraceptive self-injection—and for sexual and reproductive health self-care more broadly.

The Ambassadors—who range from ministry of health officials and university lecturers to pharmaceutical society executives—are invited to join the initiative based on their expertise, influence, and passion for expanding women’s and girl’s access to self-injection.

“Ambassadors leverage their reach and relationships to unlock opportunities to advance self-injection. They also champion self-care for sexual and reproductive health more broadly,” says Fiona Walugembe, Director of the PATH Uganda Access Collaborative Market Test. “Ambassadors make the most of their insider knowledge to identify and overcome local barriers to self-injection, advocating for policy and program advancements, using tactics tailored for their communities.”

Beginning with 14 Ambassadors from seven countries, the initiative has grown to include 24 Ambassadors from Burkina Faso, the Democratic Republic of the Congo, Kenya, Madagascar, Nigeria, Senegal, Togo, Uganda, and Zambia. The Ambassadors are all experts in their respective fields, who are strategically positioned to influence the scale-up of self-injection in their communities. The Access Collaborative equips them with the latest evidence and advocacy tools, and convenes the group regularly for collaborative learning exchange.

How champions advance contraceptive self-injection

In the two years since the initiative began, Ambassadors have facilitated notable progress in advancing self-injection and self-care options for women, girls, and people of all genders across the African continent. In their countries, many Ambassadors have pushed self-injection into the national spotlight, while simultaneously furthering broader self-care policy priorities. For example:

  • In Madagascar, the Ambassadors built up a cadre of supporters within the Ministry of Health, comprising individuals who could either make or influence decisions around sexual and reproductive health policy and programming, including expanding the availability of self-injection at the community level.
  • In Nigeria, Senegal, and Uganda, the Ambassadors have directly influenced government inclusion of self-injection in Family Planning 2030 commitments and national self-care guidelines.

Ambassadors are also helping to roll out policies as they are finalized. For example:

  • In Uganda, Ambassadors helped disseminate the country’s new self-injection policy and related guidance among district health teams and then facilitated training of 24 district health staff, rapidly expanding the availability of self-injection across the country.

Ambassadors are also working to illuminate the advantages of self-care overall, shining a light on the importance of self-care options as their countries grapple with overburdened health systems during the COVID-19 pandemic. For example:

  • In Senegal, Ambassadors helped advance the development of national self-care guidelines by helping to establish a local technical and advocacy group.
  • Similarly, in Uganda, an Ambassador chairs the national Self-Care Expert Group, influencing inclusion of self-injection and broader self-care on the national agenda, including the country’s family planning costed implementation plan.
  • In Madagascar, Ambassadors were profiled on radio and television programs, advocating for the importance of maintaining family planning services during the pandemic, including access to self-injection and other self-care options.
  • At a global level, multiple Ambassadors have made their voice heard through the Self-Care Trailblazer Group, lending their expertise to global calls to action on self-care.
“The inclusion of self-care and self-injection [in national policy] is a high-impact practice aimed at addressing inequities to family planning...”
— Dr. Charles Olaro, Health Services Director, Uganda Ministry of Health

The Ambassadors have also leveraged the wide-ranging resources and tools on self-injection to train providers, disseminate evidence, and expand self-injection options into the private sector—broadening the possibilities for women and girls to access this contraceptive option. For example:

  • In Kenya, Ambassadors worked with Advance Family Planning and Jhpiego to expedite government approval of a training curriculum for pharmacy staff, enabling them to provide self-injection services to clients.
  • In Kenya and Zambia, Ambassadors briefed pharmaceutical society members on the availability of self-injection training curricula and the benefits of offering self-injection, generating enthusiasm among these private-sector providers. Zambia’s Ambassador is a consistent presence in discussions with the private sector, helping to secure their support for pharmacy provision of self-injection and related training curricula.

What’s next for self-injection advocacy

Self-injection can put reproductive health care into the hands of women and girls. However, moving from concept to practice requires leaders from multiple areas of expertise and influence.

Through the power of their wisdom and the reach of their influence, the Self-Injection Ambassadors are catalysts for change—increasing the family planning methods and service delivery options available to women and girls, ensuring they can choose which options work best for them.

Fiona remarks, “We are grateful for the leadership of these self-care champions—they are helping to set new standards in reproductive health, making progress toward a world in which women, girls, and people of all genders have equitable access to essential primary health care.”

*DMPA-SC: Subcutaneous depot medroxyprogesterone acetate.