“Looking after these children is very hard. We don’t have money for treating them, feeding them or providing basic necessities …We can’t afford to add more children.”
According to recent figures from the World Health Organisation, over 200 million women and girls in developing countries have an unmet need for modern contraception. Throughout Africa and Asia, socio-cultural factors and family planning myths can deter women from having a choice in their birth control methods or prevent them from using any at all. Whilst for others living in remote, hard to reach regions, a lack of availability or limited access to preventative options acts as a barrier to contraceptive use.
The Children’s Investment Fund (CIFF) is a philanthropic fund which seeks to overcome challenges facing adolescent girls in developing countries, and it’s $50 million ‘Making Self-Injectables a Reality’ programme is a response to the absence of contraceptive services available to them in 8 countries across Africa and Asia. Since 2017, Crown Agents has worked as CIFF’s fund manager, supporting the scale up of the distribution and administration of Sayana Press, a self-injectable contraceptive. Crown Agents’ role is to manage the relationship with local implementing partners, who make up the programme’s backbone and drive change on the ground.
To mark International Women’s Day, we wanted to highlight three ways this programme is empowering women and adolescent girls.
Way number one: No one is left behind. The programme reaches a wide demographic of women and empowers them with the choice of the self-injection
The ‘Making Self-Injectables a Reality’ programme adheres to the Sustainable Development Goal’s pledge to leave no one behind and endeavour to reach the furthest behind first. The initiative understands that age, location, vulnerability to shocks and socio-economic status should never be a barrier in meeting women’s needs. It makes contraception widely available not just for married women, but for any girl of reproductive age that wants to be protected against unintended pregnancy. Being user-controlled, easy to use, and only needing to be self-injected once every 3 months, Sayana Press is a discrete, convenient option for all ages. Adolescent girls are given the right to make their own family planning choices, free from age discrimination cultural bias.
The distribution and awareness programmes of Sayana Press are not just based in well-established clinics where residents have regular access to health services, but also in remote, conflict-affected areas. To date 3,111 providers have been trained in Sayana Press administration, including in facilities where there has traditionally been low family planning awareness and limited contraceptive options for girls. In Uganda for example, partner UNFPA is providing knowledge, support and distribution for those wanting to use the injectable in refugee settlements, where the risks of pregnancy are significant and contextually unique.
Way number two: Careful monitoring and evaluation, driven by women’s experience within their cultural contexts, ensures continuous improvement in contraceptive distribution and use
The Sayana Press programme seeks to continuously improve, understanding that women’s contraceptive needs are individual and unique, and that it needs to adapt accordingly. Before initiating programming in a region, grantees have commissioned pilot studies to learn about the challenges women and girls face in using self-injectables in their community. Studies by Marie Stopes International Madagascar produced recommendations to introduce youth-friendly tools, including timely reminders for when to inject doses at home. Learnings come directly from the women voicing their own realities, which shape recommendations on how to scale up the self-injectable programme in that area. For example, in Malawi, qualitative evidence on the issue of waste management in the Mangochi district led to FHI360 considering new actions to avoid issues with the disposal of needles once self-injected.
Grantees also work with local partners who train health workers to consistently improve the quality of care. To ensure Sayana Press is the right option, individual counselling and community demonstrations are offered. Women are shown the correct way to self-inject, ensuring they feel comfortable using the product. This is about empowering women to administer the drug themselves by taking into consideration their cultural context, instructing them on safe usage and supporting them throughout the process.
Way number three: Men, the new female advocate
Adolescent girls often encounter barriers to accessing contraception as the result of stigmas associated with sex outside of marriage, myths about the injectables themselves or deep-rooted socio-cultural factors that discourage family planning. Overcoming these stigmas takes community effort and, in particular, requires the engagement of men to support progress. The CIFF programme in Uganda organises educational activities in culturally sensitive areas to help address rumours that prevent women from taking contraceptives. These include male action groups which seek to educate other men on family planning misconceptions and encourage behavioural change. Over 258 male champions, young and old, were engaged to mobilise their community and champion the use of contraception.
‘Making Self-Injectables a Reality’ also attempts to influence male and community views towards self-injectables by working with national governments as part of wider family planning advocacy. Our partners engage policymakers to help advocate use of the drug across various means of communication, such as radio and social media. In 2019, over half a million people in Madagascar were reached through educational messaging on Sayana Press, contributing to over 11,000 unintended pregnancies being averted.
Considering the programme’s numerous achievements and efforts to empower girls, Crown Agents Programme Manager, Sanum Jain, commented,
“On a human level, deciding on your contraception is a difficult and nerve-wracking process for any woman or girl, regardless of your country’s quality of healthcare. Adding the complexities of humanitarian settings, cultural barriers and reaching remote communities, makes this even harder. We are proud to work alongside CIFF to make the lives of these women and girls that little bit easier.”
 Samuel Okiror, ‘We’re not baby factories’ the refugees trying injectable contraceptives’ <https://www.theguardian.com/global-development/2020/feb/25/the-sel-injectable-contraceptive-helping-refugees-in-uganda-plan-their-families-south-sudan>
 Guttmacher Institute Fact Sheet, 2017