Could do-it-yourself birth control injections take off in South Africa?
Regular visits to clinics for injectable contraception could soon be a thing of the past as new research may pave the way for take-home jabs.
In South Africa, an estimated 60% of women in their reproductive years use hormonal contraceptives. Most opt for the three-monthly, long-acting injectable contraceptive depot medroxyprogesterone acetate, more commonly known by the brand name Depo-Provera or “the shot”.
Tlaleng Mofokeng is a doctor and vice-chairperson of the civil society Sexual & Reproductive Justice Coalition. Mofokeng says the idea of a take-home injectable contraceptive could make life easier for thousands of women in South Africa.
“A self-administered contraceptive is a fantastic idea. It means women don’t have to take time off work to queue in clinics,” she says.
In some European countries like the United Kingdom, a take-home, do-it-yourself version of the shot known as Sayana Press has already been approved for use. Now, a first-of-its-kind study in sub-Saharan Africa could help bolster the case for similar moves in the region.
Published recently in the journal Contraception, the study was conducted among 380 women between the ages of 18 and 45 in Uganda. As part of the research, nurses trained the women on how to inject themselves with Sayana Press at home. After three months, the study found that almost 90% of women were able to use the pre-filled lancets of Depo-Provera correctly and on time. Nearly all (98%) of the women involved in the trial said they would like to continue using the take-home contraception, according to the research carried out by the international reproductive health nonprofit organisation PATH and the Ugandan ministry of health.
Following the study’s results, Uganda has become the latest country in Africa to begin piloting Sayana Press in public health facilities in the country’s Mubende District about 140 kilometres west of the country’s capital Kampala. Sayana Press has also been piloted among 120 000 women in Burkina Faso, Senegal and Niger.
Mofokeng says Sayana Press could be particularly helpful for women in rural areas that lack nearby health facilities as well as young women in need of birth control but who fear being chastised by health workers. Multiple studies, including 2012 research published in the Journal of Community Health, have cited health workers’ poor attitudes towards young people as a major barrier to contraception access.
Women need a choice about what comes home with them
But Mofokeng says more needs to be done to ensure that women have access to a broad range of non-hormonal contraception.
Depo-Provera and Sayana Press rely on the hormone progestogen to thicken the mucus in a women’s cervix and prevent sperm from reaching a woman’s eggs. In some women, the hormone also prevents ovulation, according to the UK National Health Service.
“I am concerned with the hormones that are in the self-administering contraception — Depo-Provera, which causes the vaginal walls to thin which makes it easier for women to contract HIV,” Mofokeng explains.
For more than two decades, research has suggested that there is a link between the use of Depo-Provera and increased HIV risk among women. A large-scale study is currently seeking to provide a definitive answer as to whether “the shot” raises women’s HIV risks in 2018.
Although researchers in Uganda are confident that self-injecting contraceptives will give women more control over their reproductive choices, the recent study warns that the training process for self-administering may be “difficult to replicate on a daily basis”. It adds countries will need to create simpler and cheaper methods of training for Sayana Press to be used widely by women.
Until then, the do-it-yourself birth control option could help some Ugandan women reclaim their reproductive rights.
PATH’s Sayana Press co-ordinator in Uganda, Fiona Walugembe, says: “Many women don’t have the power to plan their families because health centres are far away or partners refuse to support them to use contraceptives. Self-injection gives women an additional option that increases both convenience and privacy.”