BY MELISSA HIGBIE, DISC PROJECT DIRECTOR, PSI
As a woman, deciding whether to use contraceptives, and which ones to use, has always been a deeply personal and ideally, a private decision. I distinctly remember the pharmacist who loudly verified my age as I pointed, blushing, at the “Plan B” emergency contraceptive in his locked cabinet. I remember the sting of shame that came with that request and the flood of relief when I walked out with product in hand. I was a graduate student in public health at the time, armed with a comprehensive understanding of contraceptive methods and access to a range of options, yet the experience was emotionally challenging and intense.
Too often when we’re planning large-scale sexual and reproductive health programs, we seem to forget about the user’s emotional journey and the complexities of her decision-making process. Through the DISC program, our goal is to do things differently, recognizing that when you’re trying to encourage a woman, or anyone for that matter, to try new things—including contraceptive self-injection—you can’t ignore her own needs, desires and preferences.
By now, we know that self-injection of DMPA-SC, often better known as Sayana Press, is safe and effective, and that it’s desirable and acceptable. Time and time again, those who have tried self-injection before—what we call ‘early adopters’—have mentioned discretion as their biggest motivation for using the product. By giving a woman the power to inject where and when she feels the most safe and comfortable, self-injection helps reduce the wide array of barriers that can stop her from being the decision-maker in her own fertility. It can help reduce the amount of contact required between women and medical professionals, saving precious time for both, as well as improving women’s ability to protect themselves from what can be significant public scrutiny.
By giving women the option to inject in the privacy of their own homes, self-injection helps reduce the amount of contact required with medical professionals, and limits the time a woman spends waiting outside a health facility or pharmacy, where she might be exposed to public scrutiny.
But even though the supply of self-injectable contraceptives has increased dramatically over the past few years, self-injection is still rarely practiced outside of research settings—contributing to a significant global unmet need for modern contraceptives. That’s what we’re aiming to change with this project. We believe women should have more options—which research shows leads to increased use—so they are better equipped to take control of their own sexual and reproductive health. This means not only more options of contraceptive products, but also more options as to how to access these—whether that’s in a clinic, at a pharmacy, via a mobile phone or through community-based distribution agents.
Ultimately, our work is about increasing women’s voice, choice and agency, and the only way to do that is to engage her in the process from the very start, and to be guided by her along the way. We’re spending time understanding what motivates women and health providers, and how contraception fits into their lives. For example, our teams in Nigeria and Uganda are working with a broad group of women, including those who have tried self-injection before and those who have not, to understand the drivers and barriers they face in learning about and accessing contraception, as well as sustaining its use. As our future consumers, these findings will help us build out a series of solutions for self-injection and ensure their voices inform our rapidly evolving ideas until they are ready to be launched in local markets. We’re using the same process with health workers, understanding their motivations for offering self-injection and engaging them to co-design solutions.
Helping women use their power to take more control over their own sexual and reproductive health is the right thing to do. Not to be overlooked, an added advantage is that it can also relieve some of the burden on health systems that were overstretched even before the COVID-19 pandemic. By shifting simple tasks to consumers, we’re allowing health workers to spend their precious time tending to other more complex aspects of health. When you look at it this way, self-care offers a win-win solution for women and health systems, as emphasized by the recently released WHO self-care guidelines. We’re seeing governments around the world increasingly interested in self-care as a way to efficiently and cost-effectively extend the reach of quality health services.
We’re starting with self-injection, but our ambition is larger. We’re aiming to expand consumers’ power to manage their own care through an array of interventions and demonstrate how self-care can not only help accelerate the pace of change toward improved sexual and reproductive outcomes, but ultimately help us achieve Universal Health Coverage—during a pandemic, and beyond. We’re privileged to be working with so many likeminded partners, who share our ambition of a world where women are taking many aspects of their health into their own hands and accessing a robust array of support to help them in this ambition.
There are no easy answers when we’re dealing with issues as complex as this one, but I firmly believe that putting more power and choice in the hands of women is a step in the right direction.
