Uptake of self-injectable contraceptive soars among young women

An injectable contraceptive for self-use is increasingly becoming the preferred family planning method for girls and young women below 24 years.

Known as subcutaneous Depo-Medroxyprogesterone Acetate (DMPA-SC), it is injected under the skin - into the back of the upper arm, buttocks and in the thigh. 

The campaign dubbed ‘Chaguo Mkononi’, a Swahili phrase that translates into "the choice is in your hands”, has empowered women to self-administer the contraceptive in the comfort of their homes.

According to data released by the Reproductive Health Network, the organisation championing the uptake of DMPA-SC, more than 55,000 women have taken up the method since its rollout. This is an increase from last year by 4,000. 

Women aged 24 years and below are leading in the uptake, with 39,600 on the method this year. Some 15, 400 women aged 25 years and above are also using the birth control method.

The endeavour is grounded in the principles of reproductive health autonomy.This reflects this year's World Contraceptive Day theme: “Contraception Choices: The Power is in My Hands,” highlighting the importance of empowering individuals and families to make informed decisions about their reproductive health.

DMPA-SC offers the same level of effectiveness as other hormonal birth control methods but stands out for its ease of use. After being trained by healthcare workers, women can manage their contraceptive needs at their convenience, without relying on healthcare providers for every dose.

For women in rural areas or those with limited access to healthcare facilities, this method is revolutionising family planning. Many women who have switched to DMPA-SC talk about the newfound freedom and autonomy it gives them over their reproductive choices.

“The method is 99 per cent effective at preventing unintended pregnancies when administered correctly and on time every three months,” says the World Health Organization.

Already, Kenya has received 450,000 doses of a self-injectable contraceptive donated by the United Nations Population Fund with funding from the United Kingdom government to make family planning more accessible to women. 

The organisation's target is to reach five million women with the method, especially in arid and semi-arid regions with high unmet needs for family planning.

Dr Edward Serem, head of the Division of Reproductive and Maternal Health, highlighted the availability of a wide range of contraceptive methods at both health facilities and community levels.

However, he underscored the significant unmet need for family planning among young women especially in counties like Narok, Homa Bay, Lamu, and Kajiado, where the distance to health facilities remains a major barrier.

“We need to present several choices to women for them to make decisions on what they want and what is good for them,” Dr Serem said. 

Director General of Health Patrick Amoth said the self-injectable contraceptive is designed to be user-friendly and can be administered by trained individuals, including community health workers and women themselves upon training. 

“The integration of the method into Kenya’s reproductive health landscape is part of broader reproductive health self-care initiatives aimed at improving service delivery. These will support the government’s efforts to increase access to family planning in line with global trends toward self-care interventions,” said Dr Amoth

He added: “Chaguo Mkononi is proving to be a transformative force in family planning, ensuring that every woman, regardless of where she lives, has access to safe and convenient options for her reproductive health.”

Kenya has made significant strides in making contraceptives accessible particularly in hard-to-reach communities, with access to modern contraceptives increasing rapidly (57 per cent).

However, busy work engagement has been one of the barriers to the usage of modern methods in underserved areas, but following the introduction of the self-injectable contraceptive, the women are now using the methods at the comfort of their homes. 

Despite efforts to improve family planning access, Kenya continues to grapple with high rates of unmet need for family planning and contraception, particularly among marginalised populations. 

According to the Kenya Demographic Health Survey 2022, the modern contraceptive prevalence rate among married women aged 15-49 years was 63 per cent, while the unmet need for family planning stood at 14 per cent, which limits women's ability to prevent unintended pregnancies and plan their families.

“Our target is to see more women having control over their family planning. Self-injection puts the power of contraception in women’s hands,” said Ms Nelly Munyasia, Kenya’s ambassador for Chaguo Mkononi. 

In a remote village in Machakos County, Esther Mwende cradles her infant as she reflects on her recent decision to switch to the injectable contraceptive.
 
"I used to dread the long queues at the clinic, especially with a small baby to take care of. At times I would travel all the way to the hospital only to find that my preferred family product was not available. In public hospitals where we get them for free, they are always out of stock,” she said.

But that is now in the past.
“With Chaguo Mkononi, it is available in my local chemist at only Sh60 and even without the money, the contraceptive is free in public hospitals. You can be given many injections so you don’t need to make more trips to the facility.

"Previously, I would go to the clinic every three months for the injection. It wasn’t always easy. Now I don’t have to even leave my home. I do it within seconds. I feel empowered. It’s my choice, and it’s in my hands.” 

Ms Munyasia noted that Chaguo Mkononi allows for autonomy and gives women the opportunity to self-eject from the comfort of their homes. “This is especially convinient for adolescent girls and young women because their healthy-seeking behaviours are weird. They do not like going to facilities,” says Ms Munyasia.

 “This method is becoming more popular among  women. We are seeing an increase in the number of women taking it given that it has minimal side effects.”

For Chaguo Mkononi, according to the guidance by the Ministry of Health, a client is supposed to make four visits to a health facility for the service before they are allowed to go do it at home by themselves. 

“The women are given the commodities to go with them at home and are advised to notify the healthcare provider in case of any side effects,” notes the ministry.

During the first visit, the healthcare provider will take the history of the client and do a physical examination to ensure that the woman is eligible for the method. 

For eligibility, one needs to not have any pre-existing conditions because the method triggers the condition. 

The client is evaluated based on her responses and placed on the right method. They are trained over and over on how to use it. After their fourth visit, the healthcare provider is confident enough that the client can self-inject.

The product costs between Sh60 to Sh100 and is easily accessible in pharmacies. It is free in public hospitals.

The challenge that comes with the method is the disposal after use. But the government has since provided small containers where after self-injecting, the women put the waste in the containers after which the health providers collect them.

Alternatively, the women drop off the waste in health facilities, where they are disposed of.

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