Family planning leaders and implementers can draw from an established evidence base to integrate DMPA-SC in efforts to address unmet need and increase access to contraception through a range of delivery channels.
Based on growing demand among stakeholders, providers, and family planning clients, as well as increased investment from the donor community, countries across sub-Saharan Africa and Asia are pursuing introduction and scale-up of DMPA-SC and self-injection. Through these country experiences, partners have generated evidence and practical guidance for ministries of health, nongovernmental implementing partners, and policymakers working to introduce and scale up DMPA-SC or similar products.
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.
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.
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.
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.
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.
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
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.
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.
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.