The Family Planning Financing Roadmap is a resource for USAID Mission staff and others working on family planning issues in developing countries. The website is designed to support sustainable family planning approaches for a wide range of users, from those who have very limited knowledge of health financing concepts to those who have some knowledge or experience and are looking to develop a deeper understanding of specific issues. The website has three main sections: learning materials, an interactive roadmap, and a community of practice.
This toolkit contains resources designed to help pharmacy associations become effective advocates and begin working to change policies in their countries. The toolkit can be adapted to advocate for any injectable contraceptive. The toolkit includes a Resource for Considering DMPA-SC.
This is a practical reference for global health practitioners working to introduce or scale up medical devices, diagnostics, or other consumer products. Its four-stage model uses case studies to highlight lessons and factors for consideration. Includes a practitioner’s workbook and a toolkit.
This report presents an in-depth analysis of Burkina Faso’s policies, regulations, and guidelines, based on an extensive document review followed by key informant interviews. The findings are organized by select family planning methods, including voluntary surgical contraception, implants, injectables, and pills. The report also includes a section describing COVID-19’s effect on task sharing and self-care policies. The authors recommend policy and regulatory revisions and actions to further improve the country’s family planning and regulatory environment and scale implementation of the World Health Organization (WHO) guidelines and note that the Burkina Faso experience may serve as evidence when the WHO next updates its task sharing guidance.
In 2018, Zambia initiated a strategy development process to introduce and scale up DMPA-SC, which called for private sector engagement. The purpose of this activity was to generate
experience from a DMPA-SC self-injection pilot in the private sector to inform country and global learning, and to provide the Zambian MOH with operational recommendations for policy and program planning. In partnership with the Zambian Ministry of Health (MOH), we designed and applied a client centered approach that reflected the specific needs and desires of private health sector clients and providers. We adapted and tailored globally available DMPA-SC training materials and methodologies designed largely for a public sector context to a private sector setting. The private sector pilot demonstrated that a shorter training format, that incorporated an e-learning video and individual consultation, was effective for training clients in DMPA-SC self-injection. Based on stakeholder interviews and a highly participatory HCD workshop, we developed and provided the Zambian MOH with recommendations for a phased, targeted DMPA-SC self-injection scale-up based on a total market approach. This activity demonstrated that a shorter DMPA-SC training format was effective for training private providers and their clients in self-injection, and that most women who participated in the pilot are willing to pay a price similar to or higher than the negotiated donor price of $.85 per unit. With only one DMPA-SC product available in the global market, the authors strongly encourage Zambia and other countries committed to engaging the private sector to consider a phased, targeted approach using market segmentation to strengthen public and private sector coordination, minimize product leakage, and ensure quality standardization across all service delivery channels.
Thirty-one years ago, Uniject—a prefilled, single dose syringe and needle package that features a collapsible blister—was conceptualized. Seventeen years later Uniject was approved to administer 104 mg of the contraceptive depot medroxyprogesterone acetate subcutaneously (DMPA-SC). DMPA-SC is still nascent in many countries, but in others it has transitioned to prominence even where there is already an intramuscular DMPA (DMPA-IM) product on the market. DMPASC is now coming of age, and offering it alongside a broad range of other contraceptive options, including fertility awareness methods, long-acting reversible methods, and permanent methods, increases choice and access to voluntary family planning.
Progestin-only contraceptive injectables and implants are highly effective, longer-acting contraceptive methods that can be used by most women in most circumstances. Globally, 6% of women using modern contraception use injectables and 1% use implants. Injectables are the predominant contraceptive method used in sub-Saharan Africa, and account for 43% of modern contraceptive methods used. A lower-dose, subcutaneous formulation of the most widely used injectable, depot-medroxyprogesterone acetate, has been developed. Implants have the highest effectiveness of any contraceptive method. Commodity cost, which historically limited implant availability in low-resource countries, was markedly lowered between 2012 and 2013. Changes in menstrual bleeding patterns are extremely common with both methods, and a main cause of discontinuation. Advice from normative bodies differs on progestin-only contraceptive use by breastfeeding women 0–6 weeks postpartum. Whether these methods are associated with HIV acquisition is a controversial issue, with important implications for sub-Saharan Africa, which has a disproportionate burden of both human immunodeficiency virus (HIV) and maternal mortality.
Sayana® Press (SP) is a 104-mg single dose of medroxyprogesterone acetate (MPA) in 0.65-mL volume, sterilely packaged in the Uniject device. Uniject is a pre-filled, non-reusable blister injection system consisting of a bubble reservoir with an integral, ultra-thin needle. In this issue of Contraception, a group of papers address the acceptability of Sayana® Press (also known as Depo subQ Provera 104™ in Uniject) and other research related to this new product. These papers also identify some of the challenges to SP reaching its full potential as a new contraceptive option in low-resource settings, especially in sub-Saharan Africa and South and Central Asia, where unmet need for family planning is the greatest. SP could be a “game changer,” in part, due to its potential for in-home or self-injection. In addition, given the safety and ease of subcutaneous injections with SP, some Ministries of Health may be more likely to enact policy change to permit community health workers (CHWs) and other community-level workers (e.g., drug shop keepers) to provide injectables in countries that currently only permit higher level providers to do so. At a reasonable price, this new product has the potential to expand contraceptive choice and use in underserved communities that otherwise might not have access to injectable contraceptives.
Institutional Author(s): USAID
Individual Author(s): Jeff Spieler
Publication date: March, 2014