Why Nandi women are opting for the self-injectable contraceptive
Mercy Rono, a resident of Police Line, Emgwen in Nandi County demonstrates how she uses subcutaneous Depo-Medroxyprogesterone Acetate (DMPA-SC), a self-injectable contraceptive, at her home on September 26, 2024.
What you need to know:
- More than 55, 000 women countrywide have utilised DMPA-SC since its roll-out.
We are on the outskirts of Kapsabet town, a tranquil upcountry setting. Mercy Rono is our host at her one-bedroom rented house in Police Line, Emgwen Sub-county.
When she is done with her chores, she announces that it’s time for her morning ritual- self-administer an injectable contraceptive known as DMPA-SC (subcutaneous Depo-Medroxyprogesterone Acetate).
After washing her hands, she opens a pouch and removes an injectable device, shaking it hard to even the solution in its reservoir.
She then slightly lifts up her skirt and proceeds to pinch her skin, gently pressing the needle into the mound formed by the skin. Mercy drains out the reservoir in about six seconds and then removes the needle. She lets go of the pressed skin area and safely disposes of the needle in a pit latrine. All the above actions take less than three minutes.
Mercy marks a calendar on her wall, making note of the next injection date in three months’ time.
She has just administered a contraceptive shot into her body, an action that previously would have required her to visit a health facility, forcing her to spare time and money to facilitate the process. On a normal day, she would have made a trip to Kapsabet County Hospital for the medical procedure.
The subcutaneous Depo-Medroxyprogesterone Acetate (DMPA-SC), a self-injectable family planning commodity.
Mercy tells Healthy Nation that until August 2023, she had been visiting the health facility to receive the family planning method every three months.
This, however, is no longer the case since the mother of one currently injects herself in the comfort of her home.
“The procedure is such a game changer for us women. I no longer have to wait for the long queues to access my monthly contraceptive," says a smiling Mercy, adding that sometimes she would end up missing the commodity after spending hours at the facility.
She adds that she saves the money that would have been used to facilitate movement to the hospital.
“The injectable method makes family planning way much easier for women. During the biannual visits to a health facility, I always leave with a package, which I administer after every three months in the comfort of my home.”
Mercy is among hundreds of Women in Nandi County currently enrolled under DMPA-SC, a family planning commodity administered by injection into the thighs, upper arm or abdomen.
The injectable contraceptive is also approved for self-use by clients with supervision from a qualified health practitioner.
Anastacia Chepkoech, a nurse at the contraceptive clinic in Kapsabet County Hospital, says more women have been visiting the facility to access the new commodity inspired by the fact that it can be self-administered.
Ms Chepkoech says that on a single day, the health facility receives between 30 to 50 clients.
“We always take our clients through all the available family planning options. We have however realised that most young people aged between 20 to 30 years prefer DMPA-SC,” says Ms Chepkoech.
Mercy says she was first introduced to the self-injectable family planning commodity late last year during her routine clinic visits.
At the facility, she was informed that the hospital had run out of Depo-Provera, a commodity that she had grown used to.
The health worker had also been kind enough to explain to Mercy that the hospital had been supplied with the self-injectable commodity and took her through its administration and use.
"I was impressed by the fact that I could administer the dose on my own. I then decided to get my first shot and was asked to go back to the facility after three months," says Mercy.
During her second hospital visit, the nurse asked if Mercy had experienced any side effects and her thoughts about the new commodity.
Mercy reveals that unlike Depo-Provera, the new commodity has minimal side effects.
During her second visit, the health worker took Mercy through the self-administration process. Mercy was then allowed to self-administer the injection on her thigh under the supervision of the nurse.
Convinced that she could handle the commodity on her own, the nurse allowed her to leave the facility with a six-month package.
“Since then, I have been visiting the hospital after every six months to pick my bi-annual supply,” says Mercy.
Margaret Chepchirchir, a resident of Kiropket in Emgwen, is yet another happy client who has been utilising the new commodity.
Ms Margaret Chepchirchir, a resident of Kiropket, Emgwen, displays a package of the DMPA-SC that she recently received at Kapsabet County Hospital.
The mother of three says initially, she would be forced to make trips from Kiropket to Kapsabet County Hospital every three months, a journey that would cost her at least Sh150.
Margaret, then working on a tea farm to provide for her three children, says raising the amount was never easy.
She notes that she would be paid Sh6 for picking one kilogramme of tea leaves. On a good day, she says she would make about Sh60, an amount that she would use to buy their daily needs.
“At the end of the three months, saving Sh300 for the hospital visit to seek the family planning commodities was almost impossible.”
Last year, however, she was introduced to the injectable contraceptive and has never looked back.
According to latest data released by the Reproductive Health Network, more than 55, 000 women countrywide have utilised DMPA-SC since its roll-out.
The data also revealed that women aged between 24 years and below are leading in the uptake of the commodity at 39,600. More than 15,400 women aged 25 years and above have also accessed the commodity since 2023.
“We have also observed that we have older clients coming forward to access the commodity, but most of them do not want to administer it themselves,” says Ms Chepkoech.
The health practitioner says most of the women have a notion that the commodity should only be administered by a health worker.
Other clients, she says, also fear injecting themselves and prefer to have it administered by a health practitioner.
“We are taking time to educate the women on how to self-inject themselves, with time, we hope to have more clients administering the commodity on their own,” says Ms Chepkoech.
Mr David Choge, Emgwen Sub-County Reproductive Health coordinator, says more than 500 women have been enrolled under the self-injectable commodity at Kapsabet County Hospital.
He says the commodity was supplied to the facility late 2022, but the roll-out started last year.
In early 2023, health experts in the county were taken through training by Marie Stopes Kenya through financial and technical support from the United Nations Population Fund (UNFPA) on commodity administration.
With the injectable product, the coordinator says the queues at the hospital’s contraceptive section have continued to grow shorter.
"Our major challenge currently is disposal of the syringes, especially for the clients in city set-ups," says Mr Choge, who explains that while those in the village can dispose of the needles in pit latrines, those in towns are required to keep them at a safe place and return them to the hospital during their next visit.
He adds: "This has made a number of city clients a little uncomfortable, but we believe with continued education, the women will fully embrace it.”
Mr Anders Thomsen, the UNFPA representative, says the self-injectable interventions in sexual and reproductive health offer huge potential to increase family planning services.
Mr Thomsen says adding the subcutaneous DMPA to the available family planning methods will provide women in Kenya with more choices and autonomy to fulfill their fertility goals.
The self-administered method can also play a crucial role in addressing the unmet need for contraception among women from vulnerable and remote communities who encounter numerous barriers in accessing family planning.
"With support from the UK Government, UNFPA procured and distributed 450,000 doses of DMPA-SC to the Ministry of Health for onward distribution to health facilities across the country," says Thomsen.
“The contraceptives are expected to benefit over 400,000 women of reproductive age, which is estimated to contribute to the prevention of 42,750 unintended pregnancies and 122 maternal deaths,".
DMPA-SC, among other contraceptives, will also help prevent maternal deaths, maternal complications such as obstetric fistula and unsafe abortions, and reduce unintended pregnancies.
