Original research articlePerceptions of home and self-injection of Sayana® Press in Ethiopia: a qualitative study☆,☆☆
Introduction
Injectable contraceptives (“injectables”) are among the world's most popular family planning methods. In sub-Saharan Africa, more than 43% of women using modern contraception choose the method [1]. Injectables are typically administered by facility-based health workers, although many programs allow community health workers to administer in non-clinic access points or users' homes. Sayana® Press,1 a new 3-month formulation of a widely used injectable, depot medroxyprogesterone acetate (DMPA), is a subcutaneous formulation packaged in a single dose in the Uniject™ injection system.2 The easy-to-use, auto-disable syringe eliminates the need to measure doses or perform intramuscular injections (Fig. 1).
PATH is currently leading efforts to introduce and evaluate Sayana Press for administration by multiple cadres of health care providers in selected countries. However, the product also presents a potential opportunity to expand women's access to family planning by making it possible for them to self-administer the injectable in their homes. To explore perceptions, feasibility and policy issues related to home and self-injection (HSI) of Sayana Press (HSI-SP), PATH conducted a qualitative study of potential users, health providers and key informants in Ethiopia in July 2012. Sayana Press is not currently labeled for HSI, and the study did not include product use in humans. However, findings provide useful insights to stimulate further research, strengthen non-clinic family planning programs and, if appropriate, guide implementation in resource-limited settings worldwide.
Section snippets
Materials and methods
The study team collected qualitative data at two rural and peri-urban3 sites in the Oromia region of Ethiopia. Ethiopia was chosen because it has policies that may support a successful HSI-SP program and because injectable contraception is widely used in the country.
The team conducted in-depth interviews with women who were and were not using modern family planning methods (“FP Users” and “Non-users”),
Background characteristics of respondents
The age of FP Users and Non-users ranged from 20 to 41 years with an average age of 29 years; all but two were married. The majority had not finished secondary school and all lived in rural areas. Nearly all were housewives or farmers, of Oromo ethnicity and Orthodox Christian. Among the providers interviewed, the majority were female and located in peri-urban areas.
Acceptability of HSI of Sayana Press
HSI as a delivery option was attractive to many study respondents. Most thought the smaller subcutaneous needle would minimize
Context
Although there is no published research on the feasibility and acceptability of HSI of Sayana Press, previous studies suggest that women can successfully self-administer injectable contraception via the Uniject system [3] and can self-inject a similar product, Sayana®6 [5], [6], [7], and that many would prefer this option [8], [9].
Acceptability and potential of HSI of Sayana Press
This study,
Supplementary Materials
The following is the Supplementary data to this article.
Acknowledgments
PATH would like to thank the Oromia Regional Health Bureau for approving the study. Critical support was provided by Dwan Dixon, Addisu Getachew, Barbara Crook, Colleen Kuehl, Laura Anderson, Dr. Tekle-Ab Mekbib and the team of data collectors: Adanesh Dutu, Ararsitu Mesele, Bizuayehu Ayele, Jalle Teferi, Mashalit Tilahun, Mebrat Bacha, Tsion Assefa, Yodit Mekonnen and Zinash Dewo.
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Cited by (18)
Health workers’ values and preferences regarding contraceptive methods globally: A systematic review
2022, ContraceptionCitation Excerpt :Through our systematic database search, we identified 15,349 potential articles; we found an additional 132 articles through other methods like secondary reference searching (Fig. 1). Of these, we included 41 articles reporting on values and preferences around contraceptive methods from the perspective of health workers in this review (Table 1) [17–57]. The 41 articles capture values and preferences of 12,643 health workers from 27 countries.
A prospective cohort study to assess the acceptability of Sayana Press among 18–49-year-old women in Nepal
2021, ContraceptionCitation Excerpt :The method can also be self-injected by women themselves. Sayana Press can be provided in low-resource, non-clinic settings because of its unique method with alternative route of delivery requiring less trained providers and the product being compact, discreet, and easily transportable [4–6], potentially transforming the way in which women can access and receive their preferred method of contraception [7]. Sayana Press is approved by regulatory authorities in more than 40 countries across the world [8].
DMPA-SC: an emerging option to increase women's contraceptive choices
2018, ContraceptionClient and provider experiences with self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in Malawi
2018, ContraceptionCitation Excerpt :Detailed quantitative information from the main trial about women's experiences self-injecting, remembering when to reinject, and where they stored and disposed of DMPA-SC is consistent with these findings and presented elsewhere [10]. Our findings contribute to the growing body of evidence of the feasibility [5,6] of DMPA-SC self-injection and acceptability of the practice [3,4,7] in LMIC settings. Specifically, we found that clients in Malawi had similar positive experiences with self-injection as those who participated in studies in Uganda and Senegal; like the women in Malawi, they also felt that self-injecting DMPA-SC was easy and preferable compared to DMPA IM [5,6].
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Funding: This study was implemented by PATH with funding from the Bill & Melinda Gates Foundation, the U.S. Agency for International Development DELIVER PROJECT, Task Order 4 under U.S. Agency for International Development contract no. GPO-I-00-06-00007-00 and PATH individual donor Stephanie Evans. The views expressed herein are solely those of the authors and do not necessarily reflect the views of the donors.
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Conflict of interest: None of the authors has a conflict of interest.
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Sayana Press is a registered trademark of Pfizer Inc.