Self-injection: A revolution in family planning

By Professor Dr. Anthony K. Mbonye

In Uganda, about 32.2% of women use modern contraception. Another 30.5% want to plan their pregnancies but can't access a method that meets the reality of their lives. New family planning options that put control in women's hands can expand access dramatically. 

Injectable contraceptives like the well-known Injectaplan or the recently introduced lower-dose, "all-in-one" Sayana Press, are among Uganda's most widely-used contraceptive methods. These methods offer safe and effective protection, convenience, and privacy. Due to its ease of use, the all-in-one injectable is ideal for administration by community health workers—like Uganda's Village Health Teams (VHTs)—and even for women to inject themselves. 

Over the past few years, VHTs have mobilized to offer injectable contraceptives and other methods, reaching women in their villages. As of June 2016, more than 2,000 VHTs in 28 districts conducted 200,000 family planning visits and administered more than 130,000 doses of the all-in-one injectable. Nearly 40,000 women choosing the all-in-one were using modern family planning for the first time. Women and VHTs have reported they like the short needle. 

Now, self-injection of contraception could further revolutionize women's ability to manage their health. And Uganda is leading the way. In June 2015, nearly 400 Ugandan women became the first to self-administer injectable contraception in sub-Saharan Africa as part of a feasibility study conducted by the Ministry of Health (MOH) and the NGO PATH. Newly published results from the study indicate that the practice is feasible and highly acceptable—and, based on those results, the MOH is starting to roll out self-injection in routine service delivery.  

Just imagine how much easier self-injection will be for a woman instead of traveling to a clinic or finding a VHT. She can just give herself a shot when she has a few precious minutes free—then she doesn't have to worry about getting pregnant for another three months. 

The first woman to enroll in the MOH-PATH self-injection study is a case in point. "Grace" lives in rural Uganda, kilometers from the closest health center. She had four children by the time she was in her twenties. Grace decided it was time to delay having another baby for a few years, so she traveled to the health center, where she was invited to participate in the study. Grace gladly accepted because self-injection would save her a trip to the clinic. She said she liked self-injection "Because the first time I did it from the clinic and did not experience any pain, and the second injection [on my own] was even easier." 

Six months after Grace enrolled, the study found that 87% of participants successfully self-injected after a single one-on-one training session—even three months later, when reinjecting on their own. Most women thought self-injection was easy and 98% of them wanted to keep doing it. As another study participant described: "I don't need to travel a long distance. It is easy, safe, and gives me the freedom to manage it myself." 

For self-injection, this is only the beginning. Uganda's study provides powerful insights for other countries who will consider making self-injection available in their family planning programs. 

There is strong evidence supporting self-injection in other countries including in Europe and the United States. The United Kingdom's lead drug regulatory authority has already approved self-injection of Sayana Press in that country. In Uganda, the MOH and PATH conducted the feasibility study to understand whether women like this method, and how best to train and support them to self-inject.

Now that we have answers, what's next? The Uganda MOH has worked with PATH and other family planning experts in Uganda to design a pilot program for self-injection. This November, we trained nearly 100 family planning providers in Mubende district to offer self-injection alongside other methods. Our hope is that, in 2017, we can roll out the program in more parts of the country. 

Again, Ugandan women will be leaders—the first to self-inject contraception outside of a research study, through a program based on evidence generated right here. They are helping to revolutionize family planning in our country and around the world.

Writer is the acting Director General, Health Services, Ministry of Health