Sayana Press contraceptive proves effective in remote rural communities

. . . as development partners inject M9 million health aid

’MAKERESEMESE LETUKA

MOKHOTLONG – After travelling for one hour, thirty minutes, or two hours to reach the Moeketsane Health Centre, we meet 27-year-old Mpolai Rakubung from Makorotong in Mokhotlong who recounts the challenges she faced accessing sexual reproductive health services due to distance over the past year.

“I have one child, and I do not plan on having a second one yet. Immediately after giving birth to my son, I began using DEPO, but sometimes I would skip my due dates to go back to the clinic because of the long-distance walk or when it was raining.

“Consequently, there were instances where I discontinued use, only to resume it when I could visit the health centre. This irregularity had adverse effects on my menstrual cycle, leading to prolonged menstruation.

“However, in 2021, I was introduced to Sayana Press by my village health worker. After learning about its usage and benefits, I found it to be a suitable option for me. I then sought further instruction at the health centre. It has been over three years since I started using it, and it has never disappointed me.”

Rakubung adds: “The primary reason I chose Sayana Press is because it eliminates the need for regular visits to the health centre. My village health worker always has it available, and I can administer the injection in the comfort of my home, ensuring I never miss my due dates, unlike before. It is highly reliable, and personally, I have not experienced any side effects. I have even recommended it to my new sister-in-law.”

’Matlotlisang Maliba, a village health worker since 2016, says since the introduction of Sayana Press, she has been advocating for its use within her community, particularly among the youth.

Many of them express concerns about the distance to health facilities, the need for regular interaction with health providers, and the side effects associated with daily contraceptives like Microgynon or injectables.

“Among the various contraceptives available at the health centre, Sayana Press is consistently in high demand, often running out before other options.

“Currently, I have only one left, indicating the necessity for a refill. During the rainy season in particular, access to family planning becomes crucial, particularly for women. Sayana Press is proving invaluable in rural areas where accessing clinics is challenging,” Maliba says.

At Molikaliko Health Centre, which serves 48 villages with a population of 8,934, Nurse Bokang Damane Ntsie, notes that a significant number of women from the age of 15 up to middle age utilise family planning commodities, particularly injectables like Depo and Sayana Press, despite prevailing myths and misconceptions.

Lielelo Senoko, a midwife nurse at the Mokhotlong Hospital, underscores the importance of family planning education. “Family planning is vital as it helps reduce the high rates of abortions, teenage pregnancies, and unintended pregnancies, facilitating better child spacing.

“I have observed a growing preference for Sayana Press due to its numerous advantages, particularly among those residing in remote areas where regular hospital visits pose challenges. I highly recommend it for them,” says Senoko. Subcutaneous Depo-Medroxyprogesterone Acetate (DMPA) is a novel self-administered family planning method that is injected beneath the skin and touted for its high efficacy in preventing pregnancy.

Sayana Press is administered every three months, yet, like other family planning methods, it does not safeguard against HIV or other sexually transmitted infections (STIs).

Initially, healthcare professionals demonstrate proper usage, after which clients self-administer under supervision. Once satisfied with the client’s proficiency, healthcare workers may provide several doses for home use. Pre-filled and ready for injection, the Sayana Press boasts simplicity of use. Its compact design, featuring a shorter needle measuring 2.5cm compared to standard needles of 3.8cm, enhances user convenience.

Clients must update their health booklets for healthcare workers to monitor progress during subsequent visits, thus eliminating the need for frequent facility visits as Sayana Press can be self-administered from home.

The United Nations Population Fund (UNFPA) Lesotho reports that Sayana Press was incorporated into family planning guidelines in 2017 and approved for inclusion in national essential medicines in 2018.

The initial batch was procured in 2019 and piloted in the Mokhotlong and Quthing districts. By 2020, training had been provided to 400 village health workers and 35 healthcare workers, with 4,368 women using Sayana Press. In 2021, this number rose to 19,000, marking a significant increase.

Mokhotlong exhibits one of the country’s highest rates of unmet family planning needs at 25 percent, compared to the national average of 18 percent, alongside the lowest contraceptive prevalence rate (CPR) at 48 percent. These statistics contribute to elevated rates of unplanned pregnancies, school dropouts, child marriages, teenage pregnancies, unsafe abortions, and maternal fatalities.

In 2021, the Government of China and UNFPA forged an agreement to provide healthcare assistance to Lesotho, bolstering the nation’s capacity to combat the COVID-19 pandemic and HIV infections and enhancing basic health services, maternal and child healthcare, and reproductive health services.

Recently, UNFPA organised a field trip in Mokhotlong and Quthing for journalists to document success stories regarding the impact of these interventions.

Under the South-South Cooperation Assistance Fund framework, with support from the China International Development Cooperation Agency (CIDCA), medical supplies, including personal protective equipment and sexual and reproductive health commodities, have been procured for Lesotho’s Ministry of Health.

This assistance, valued at US$500,000 (approximately over M9 million), was part of an initiative jointly developed with the Government of China and the Ministry of Health, ensuring adequate supplies and equipment for healthcare workers during the pandemic, while also ensuring accessibility to family planning commodities, information, and counselling services, including emergency contraception.

UNFPA, with support from the China International Development Cooperation Agency (CIDCA), has facilitated the procurement of various health commodities for the Ministry of Health in the Kingdom of Lesotho. These include oxygen concentrators and personal protective equipment for medical personnel, life-saving devices, contraceptives, and other essential sexual and reproductive health supplies.