The power to prevent pregnancy in women’s hands: DMPA-SC injectable contraception

September 12, 2018 by PATH

Woman holds subcutaneous DMPA (DMPA-SC, Sayana Press)

Photo: PATH/Gabe Bienczycki

Women want and need access to a variety of contraceptives to plan, space, and prevent pregnancies. PATH is expanding access and options with DMPA-SC (brand name Sayana® Press), an all-in-one contraceptive that puts women in charge of their reproductive health.

Simple. Revolutionary. Empowering.

It might be surprising based on the name, but DMPA-SC* has captured the imagination and attention of the global family planning community.

For decades, PATH has championed the development and delivery of DMPA-SC, a lower-dose, easy-to-use injectable contraceptive that protects against pregnancy for three months. Sayana Press, the DMPA-SC product available to Family Planning 2020 (FP2020) countries, is manufactured by Pfizer Inc. and combines the drug and needle in the prefilled BD Uniject™ injection system, which was originally developed by PATH. The product is now available in at least 20 FP2020 countries and is approved by regulatory agencies in more than 40 countries worldwide, including in the European Union.

Injectable contraception has been widely used around the world for decades, so why is this tiny device attracting so much attention?

First, it’s just a neat little device. When PATH worked with the ministry of health and other partners to begin introducing the product in the health system, women in Uganda started calling it the “all-in-one”. There is an intuitive appeal and common sense in the design for delivering an injection—a small plastic bubble prefilled with a single dose of medication and attached to a short needle.

Making injections available in more places

Another reason for the interest in DMPA-SC: it opens up more access possibilities for women. Before DMPA-SC, injectables could only be given using a separate vial and syringe, and were often only administered by highly trained health providers at facilities. But 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.

DMPA-SC is so small, light, and easy to use that any trained person can administer it, including community health workers, pharmacists, and even women themselves through self-injection. This unique design is helping make injectable contraception available in remote locations, closer to where women live.

In other words, this 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. PATH is leading the DMPA-SC Access Collaborative with our partners John Snow, Inc. to help make that happen in as many countries as possible.

Self-injection: putting health in women’s hands

What if we could give millions of women greater control over their health and their families’ health? We can.

Never before in history have women been able to give themselves a simple injection every few months to prevent pregnancy—the final, and possibly biggest, reason why DMPA-SC is so appealing. By putting the power of protection directly in women’s hands, self-injection with DMPA-SC has the potential to reduce access-related barriers for women, increase contraceptive continuation rates, and enhance women’s autonomy.

PATH has led research in Senegal and Uganda which found that women can self-administer DMPA-SC safely and effectively, that they like doing so, and that self-injection enables them to continue using the method longer than injections from providers.

Based on a robust evidence base compiled by PATH and partners, an increasing number of countries worldwide are adding DMPA-SC to their contraceptive method mix and scaling up self-injection along with provider-administered DMPA-SC. Countries such as Senegal and Uganda are already moving forward with scaling up self-injection. Several other countries are in the early stages of piloting or offering self-injection, including the Democratic Republic of the Congo, Ghana, Malawi, and Nigeria.

And in Uganda, as the Ministry of Health plans for national rollout of this new option for women, PATH’s Self-injection Best Practices initiative is gathering information about how the practice can be designed and implemented at scale. The team has applied user-centered design techniques to develop, implement, and evaluate self-injection program models across delivery channels. The first program data in mid-2018 showed that at least 3,000 women are self-injecting across four districts.

PATH works to expand access to DMPA-SC because we believe that all women, no matter where they live, should have access to a range of safe and effective contraceptive options that allows them to make an informed choice—for the sake of their own health and the health of their families and communities.

For more information check out the links below, sign up for our newsletter or email FPoptions@path.org.

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“I am in charge now. I inject myself from home, in the bathroom, or anywhere. If I ever have another child, it will be because I want one.”
— DMPA-SC self-injection client, Uganda

*DMPA-SC: Subcutaneous depot medroxyprogesterone acetate.
Sayana Press is a registered trademark of Pfizer Inc.
Uniject is a trademark of BD.

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