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Evidence to Action (E2A) Expanding Contraceptive Choice resources and tools

This web page features publications from Evidence to Action’s work to expand contraceptive method choice by strengthening services in facilities, advancing community-based family planning, and creating models for effective integration.

Institutional Author(s): Evidence to Action (E2A)
Publication date: December, 2020

Tool Web page

DMPA-SC country data dashboard

The country dashboard is a visual presentation of key data for a select list of priority countries; it provides a snapshot of the state and stage of DMPA-SC introduction/scale-up, allowing stakeholders to assess progress, identify roadblocks, guide course corrections, and inform decisions.

Institutional Author(s): PATH
Publication date: August, 2020

Costs and cost-effectiveness of subcutaneous DMPA through different delivery channels: What new evidence tells us

This brief summarizes recent evidence from African countries on the costs and cost-effectiveness of DMPA-SC. Key findings include that DMPA-SC may help reduce service delivery costs by catalyzing expansion of channels closest to women and that self-injected DMPA-SC is cost-saving as compared to clinic-administered DMPA-IM when accounting for costs to women and health systems.

Institutional Author(s): PATH
Publication date: October, 2019

A Next Generation Approach Introducing DMPA-SC Self-Injection Through Private Providers in Zambia

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.

Institutional Author(s): JSI, Inc., USAID
Individual Author(s): Tanvi Pandit-Rajani, Ariella Bock, Mika Bwembya, Lina Banda
Publication date: July, 2019

How to Introduce and Scale Up DMPA-SC: Practical Guidance from PATH Based on Lessons Learned During Pilot Introduction

This document was created to support ministry of health and nongovernmental partners as they develop strategies to introduce and scale up subcutaneous DMPA (DMPA-SC, brand name Sayana® Press) to increase contraceptive options and access. Available in English and French, the publication provides practical guidance based on results, evidence, and learning from the pilot introductions of DMPA-SC in four countries in Africa.

Institutional Author(s): PATH
Publication date: 2018

Introducing the subcutaneous depot medroxyprogesterone acetate injectable contraceptive via social marketing: lessons learned from Nigeria’s private sector

The subcutaneous depot medroxyprogesterone acetate (DMPA-SC) injectable contraceptive was introduced in South West Nigeria in 2015 through private sector channels. The introduction included community-based distribution and was supported by a social marketing approach. From program monitoring and evaluation, aimed at understanding performance, market reach and other process measures, we identify lessons learned to inform future scale-up efforts. We synthesized the findings from a core set of key performance indicators collected through different methods: (1) implementer performance indicators, (2) phone survey of DMPA-SC users (n=541) with a follow-up after 3 months (n=342) and (3) in-depth interviews with 57 providers and 42 users of DMPA-SC

Institutional Author(s): University of California San Francisco, Akena Associates, DKT Nigeria, American University of Beirut
Individual Author(s): Jenny Liu, Eric Schatzkin, Elizabeth Omoluabi, Morenike Fajemisin, Chidinma Onuoha, Temitope Erinfolami, Kazeem Ayodeji, Saliu Ogunmola, Jennifer Shen, Nadia Diamond-Smith, Maia Sieverding
Publication date: July, 2018

Journal Article Link to Journal Article

Rapid Uptake of the Subcutaneous Injectable in Burkina Faso: Evidence From PMA2020 Cross-Sectional Surveys

The subcutaneous (SC) injectable, widely known by its commercial name Sayana Press, has potential to improve access to contraceptive methods. In Burkina Faso, SC-injectables were first piloted in select regions in 2014 and introduced nationally in 2016. PMA2020 is the first national survey to track programmatic progress of SC-injectable introduction at both population and health facility levels in the country across 2 rounds of data collection: March–May 2016 and November 2016–January 2017. Over this 6-month period, SC-injectable availability at public service delivery points increased from 50% to 85%, largely driven by increases in availability among the non-pilot regions. In terms of use, while the modern contraceptive prevalence rate among all women remained constant at about 23%, SC-injectable prevalence nearly doubled from 1.1% to 2.0%, making up approximately 9% of all modern method users in Burkina Faso by late 2016, though the difference was not statistically significant. Increases were comparable between pilot and non-pilot regions. While the difference was not statistically significant, more rural women were using the method compared with their urban counterparts in the pilot regions, an interesting finding considering the opposite pattern is generally true for contraceptive prevalence nationally. In summary, following national scale-up, data show substantially improved availability of SC-injectables at service delivery points and potential for changes in the method mix in Burkina Faso. In order to further improve contraceptive access and choice, scale-up of community-based distribution of SC-injectables should be considered, especially among rural populations with higher unmet need for family planning.

Institutional Author(s): Institut Supérieur des Sciences de la Population, Bill & Melinda Gates Institute for Population and Reproductive Health
Individual Author(s): Georges Guiella, Shani Turke, Hamadou Coulibaly, Scott Radloff, Yoonjoung Choi
Publication date: March, 2018

Journal Article Link to Article

The Coming-of-Age of Subcutaneous Injectable Contraception

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.

Institutional Author(s): USAID
Individual Author(s): Kimberly Cole, Abdulmumin Saad
Publication date: March, 2018

Journal Article Link to Journal Article

DMPA-SC Introduction and Scale-Up in Nigeria: Future Benefits for Contraceptive Use and Savings

In Nigeria, DMPA-SC—an easy-to-use injectable contraceptive commercially branded as Sayana Press—has been approved for provider- and self-injection, and is being distributed in the public and private sectors. With technical support from the USAID-funded HP+ and the Gates-funded Technical Support Unit, Nigeria’s Federal Ministry of Health applied a new impact model to quantify the potential family planning programmatic impact and cost implications of DMPA-SC introduction and scale-up in Nigeria by 2021. This brief highlights the boost that DMPA-SC can provide to the country’s modern contraceptive prevalence rate, cost savings, and next steps.

Institutional Author(s): Health Policy Plus (HP+)
Publication date: February, 2018

Advancing Community-Based Access to Sayana Press: Expanding the Reach of the Formal Health System

Advancing Partners & Communities (APC) advances programs that improve the overall health of communities, especially family planning (FP). The project increases access to community-based family planning (CBFP) services, including Sayana Press, a progestin-only injectable contraceptive that provides three-months of coverage, similar to Depo-Provera. Sayana Press, however, it is unique in that it combines the needle and drug in a small, lightweight, easy-to-use single dose container. APC is working to introduce and scale up community-based distribution of this new commodity in Benin and Uganda. The project is also investigating community-based provision of injectables for home and self-injection in Malawi. Each of these efforts has the potential to dramatically increase the number of contraceptive users at country and global levels, reducing the percentage of women and couples who have an unmet need for contraception.

Institutional Author(s): Advancing Partners & Communities (APC)
Publication date: September, 2016

Brief Link to Brief