Elsevier

Contraception

Volume 89, Issue 5, May 2014, Pages 379-384
Contraception

Original research article
Perceptions of home and self-injection of Sayana® Press in Ethiopia: a qualitative study,☆☆

https://doi.org/10.1016/j.contraception.2013.12.010Get rights and content

Abstract

Objective

Sayana® Press,1 a new subcutaneous formulation and presentation of a popular injectable contraceptive, has the potential to expand non-clinic access to contraception, including home and self-injection (HSI). This study collected information from potential users and stakeholders on their perceptions and preferences, the feasibility of an HSI of Sayana Press program and key policy considerations.

Study design

PATH conducted 62 interviews and 7 focus groups with family planning users, non-users, physicians, other health care providers and key informants in the Oromia region of Ethiopia. Participants watched a demonstration and tested the device on a model mid-interview. The study did not involve product use in humans.

Results

Women found the product easy to use, liked the simple design and valued the time and expense that could be saved through HSI of Sayana Press (HSI-SP). Of those with inhibitions about their ability to self-inject, most shifted their opinion favorably after demonstration. The majority of other stakeholders also supported HSI-SP and thought it could increase contraceptive use in Ethiopia, and they suggested that any successful program must include proper training and supervision, particularly regarding product storage and waste management.

Conclusion

The data provide findings to stimulate further research and support future planning. They suggest that HSI-SP may meet the needs of many women if key requirements and challenges are met. It may also be necessary to revise policies and guidelines to integrate the approach with national family planning strategies.

Implications

This study provides the first available data on perceptions, feasibility and requirements for HSI of Sayana Press in a low-resource setting. Findings provide insights that may guide future implementation strategies, strengthen non-clinic family planning access programs and stimulate continued research.

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.

Sayana Press image.doc

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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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.

☆☆

Conflict of interest: None of the authors has a conflict of interest.

1

Sayana Press is a registered trademark of Pfizer Inc.

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