Her future, in her hands

UK aid helps transform lives with launch of world’s first self-injectable contraceptive

Amina, the midwife in charge of the Kanseera health centre II in Mubende, Uganda, displays the Sayana Press contraceptive.
“I’ve not used contraception before, this is the first time I’m using it.”

Mother-of-nine, Dina, 40, had heard about family planning but whenever she thought of coming to a health clinic for advice, she was discouraged by her family and friends.

“People in the community, people in my family, they all discouraged me. They said if I start using contraception I will fall sick.”

Dina, a mother of nine, started using contraception — Sayana Press — for the first time last year.

But the everyday pressures of feeding, clothing and educating her children — seven of whom were still at home — worried Dina and her husband, James. Making a living as farmers, they realised if Dina was continuing to get pregnant their income wouldn’t stretch to support more children.

When Dina came to the health centre, Amina, the midwife in charge, explained all the family planning methods that were available, along with their benefits and possible side effects. Dina chose Sayana Press and she was taught how to inject herself.

“My husband is very cooperative. I don’t know how to read so he is the one who helps me remember the dates for my next dose,” says Dina.
Dina and James decided to “give family planning a try” as they didn’t want to have more children.
“If I don’t do anything I will continue to have more children.”

James, Dina’s husband, goes on to explain: “In the past there used to be a cultural expectation to have a large family, but nowadays it’s not good because things are changing and there are limited resources available.”

A healthy family is a happy family

Viola didn’t know about contraception when she got married at 18. Now 30, and a mother-of-six, Viola is keen to avoid another pregnancy. Instead she wants to focus her energy on taking better care of her children and giving them a good education. She too chose Sayana Press.

Viola is using contraception for the first time with Sayana Press.
“I feel stronger and I have more time to look after my children. I’m energetic and able to do my work because, right now, I don’t have a very young baby,” says Viola.

“With a small number of children you can take better care of them,” says Benon,55, Viola’s husband.

“There were men who tried to discourage me — get me to change my mind — but now they have come to understand the benefits of family planning and are encouraging their partners to get advice.”

Viola and Benon wants to focus on educating their six children.

Family planning enables couples to choose whether and when to have children. For couples like Dina and James, and Viola and Benon — who already have large families — that’s mainly about avoiding unintended pregnancy.

Expanding access to contraception and family planning programmes is one of the most cost-effective ways to break the cycle of poverty. It empowers people to plan their futures and reach their fullest potential.

What is Sayana Press?

Both Dina and Viola chose Sayana Press — a simple all-in-one injectable contraceptive. It’s small, compact and easy to use, so anyone can inject themselves once they have been trained. To administer it, the user just needs to shake it and inject.

One of the main benefits of Sayana Press and a reason for its increasing popularity — in Uganda and several other countries — is that once a woman is trained she can administer it herself, in her own free time. In addition, the women are given a booklet with explanatory images — so even if they’re illiterate they can follow the simple steps that are set out.

Dreaming of a better future

Single mother Rachel works in a salon where she is getting trained as a hairdresser.

Nineteen-year-old Rachel is a single mum. She got pregnant while she was still in school so had to drop out to have her baby. Rachel lives at home with her mother, who supports her financially while she gets trained as a hairdresser.

“I like Sayana Press because you can inject yourself and you can do it in secret. Only my mother knows that I’m using contraception. If other people find out that I’m using contraception they will start saying that I won’t be able to have more children.”

Preventing unintended pregnancies remains a challenge for many girls and women. To help inform communities about family planning, and break down misconceptions around contraception that stops women from accessing family planning, PATH has trained community health workers in villages.

Harriet trained as a community health worker and she educates people in her community on the different contraceptives that are available to them.

These community health workers talk to men and women about the various contraception methods, their benefits and side effects. Most often these health workers are nominated from within the community, so are considered approachable and trustworthy.

Helping others, and herself

Mum-of-five Harriet, 35, is a community health worker. Having used contraception to space her pregnancies, she feels confident talking to women in the community about the benefits of family planning. Since last year, along with other family planning methods, Harriet has been telling women about Sayana Press.

Harriet with the other community health workers — both men and women are trained to do this voluntary work.
“I feel strong, I feel well, I have put on some weight, so I love Sayana Press.”

Harriet switched to Sayana Press as she found it simple and easy to use and she talks about her experience with other women in the community.

Sauda is the midwife in charge of Gayaza health centre II in Mubende. As a trained health care worker, she educates women about the different family planning methods that are available to them.

Sauda, a midwife, trains women on how to administer Sayana Press by themselves.
“Family planning helps a woman to plan better for her family. It gives her time to relax and it also helps to recover from the stress of pregnancy all the time.”

“Many clients are choosing to self-inject, so that reduces the time they come here. There’s also the issue of confidentiality. Some of them, they don’t want their parents or partners to know that they are using family planning. So when we teach them they opt to go for Sayana Press and inject themselves,” says Sauda.

Confident and empowered

Sauda trained Florence, 30, on how to use Sayana Press. Florence, a single mother of four, faces many hardships bringing up her children, so wanted to ensure she wouldn’t get pregnant.

Using Sayana Press has helped Florence, giving her confidence and peace of mind.
“Sayana Press has helped me a lot because I feel free, I don’t have to worry that I will become pregnant — I feel that I am ok. I feel confident.”

Florence is a primary school teacher so she would need to take time off to come to the clinic.

“When I come and collect Sayana Press from the health clinic, I take three at a go. That covers me for nine months, so that saves me my time. Injecting myself helps me because even if I’m not near the nurse I can still do it myself to protect my body.”

The introduction of Sayana Press in Uganda was supported by UK aid as well as the Bill & Melinda Gates Foundation, Children’s Investment Fund Foundation, United Nations Population Fund (UNFPA), and USAID — led by the Ministry of Health and coordinated by PATH.

Why is family planning important?

Investing in family planning provides long term benefits for whole families, communities and countries, helping to stop the cycle of poverty and improving lives now and in the future.

It’s essential to act now to help the world’s poorest countries grow safer, healthier and more resilient by ensuring that family planning — and future planning — is an option for every woman.

On 11 July the UK will co-host an international summit on family planning in London with the Bill & Melinda Gates Foundation and UNFPA. The summit will bring together partners from around the world and aims to boost global commitments to increase access to family planning services for women and girls in the world’s poorest countries.

For more information visit the summit website: http://summit2017.familyplanning2020.org

Facts & stats

  • During the pilot period of 2015–2016 in Uganda, 130,673 doses of Sayana Press were administered by community health workers and 29% of those doses went to new users of modern contraception.
  • Sayana Press is a new three-month injectable contraceptive, uniquely suited for administration by community-level health workers and even the users themselves. It presents a new opportunity to expand the method mix available outside of clinic settings, and to dramatically increase access to injectables for women living in rural, hard-to-reach areas.
  • The UK played an important role in supporting Sayana Press as part of a donor consortium, supporting the introduction of Sayana Press and building up an evidence base for it in four priority countries, as well as supporting the scale up to the next stage of the product’s journey.
  • At the summit, the UK will be coming together with partners to commit to make Sayana Press widely available at scale across the world’s poorest countries. This is the first time in more than a decade that a new contraceptive method is being introduced and scaled up globally.

Words, photos and interviews: Sheena Ariyapala/DFID