Introducing the Progesterone Vaginal Ring (PVR) as a New Option for Postpartum Family Planning in Sub-Saharan Africa: Insights from Engagements with Stakeholders

Salisu M Ishaku, Nafissatou Diop, Babacar Mané, Wilson Liambila, Saumya RamaRao, Heather Clark, Harriet Birungi, Godwin Unumeri, Francis Obare

Abstract

The progesterone vaginal ring (PVR) is a ring-shaped device designed for use by women in the postpartum period to regulate fertility by complementing and extending the contraceptive effectiveness of lactational amenorrhea to suppress ovulation.1 It is available in eight Latin American countries for use by breastfeeding women who want more effective modern contraceptives in addition to contraceptive benefits provided by lactational amenorrhea alone.1 The PVR is a method that can be suitable to women in sub-Saharan Africa, given the near-universal practice of breastfeeding and the current level of unmet need for contraception in the postpartum period.  Efforts are currently underway to introduce the PVR in Africa and south Asia. To ensure a seamless introduction, scale up and sustainability of the PVR in the region, the Population Council conducted pre-introductory activities with stakeholders in Kenya, Nigeria and Senegal to determine the level of interest in the ring, potential facilitating  and mitigating factors and identify solutions to address challenges. The research team combined three approaches: in-depth interviews with family planning stakeholders; desk review of reports and policy guidelines; and in-group meetings. The stakeholders reached included public sector officials including policy makers and program managers, implementing partners, regulators, women and religious networks. All three countries had a promising policy and programmatic context that was supportive to PVR introduction. The exercise provided insights on socio-cultural and religious factors that could potentially impact how the PVR is perceived within communities and identified possible remedies to address misperceptions. It also paved the way for the conduct of an acceptability study of the PVR among breastfeeding women in these countries. The high acceptability rate in each country and the support expressed by government and other stakeholders have provided impetus for registration of the product in each country. Learning from this process could also direct how other family planning and reproductive health commodities would be introduced in the future.(Afr J Reprod Health 2018; 22[2]:68-75).

Full Text:

PDF

References

RamaRao S, Ishaku S, Liambila W and Mane B. Enhancing contraceptive choice for postpartum women in sub-Saharan Africa with the progesterone vaginal ring : a review of the evidence. Open Access Journal of Contraception 2015; (6) 117–123

Osotimehin B. Family planning saves lives, yet

investment falters. Comment. The Lancet.com 2012 ;380 ; http://dx.doi.org/10.1016/So140-6736(12)60906-4

Singh S and Darroch JE. Adding it up: costs and benefits

of contraceptive services — estimates for 2012. New York : Guttmacher Institute and United Nations Population Fund.2012

John C, Igbal HS and Lenka B. The contraceptive

revolution: focused efforts are still needed. The lancet.com 2012 ; (381) : S0140-6736(13)60588-7

Jesse R, Elizabeth N, Nora WC, Christine G, Shuyuan H

and Mariela R. Rapid contraceptive uptake and changing method mix with high use of long-acting reversible contraceptives in crisis-affected populations in Chad and the Democratic Republic of the Congo. Global Health : Science and Practice 2016; (4) Supplement 2

John R and John S. Use of modern contraception

increases when more methods become available : analysis of evidence from 1982–2009. Global Health : Science and Practice 2013; (1): 2

Tsigue P, Yolande H, Suzanne H, Abdoulaye D, Blami

D, Rachel W and Priya K. Increasing use of postpartum family planning and the postpartum IUD : Early experiences in West and Central Africa. Global Health : Science and Practice 2016; (4) : 2

Mary EG, Shannon E and Marleen T. It’s about time:

WHO and partners release programming strategies for postpartum family planning. Global Health: Science and Practice 2014; (2): 1

Jane KC Jennifer KD, Imelda TK, Eleanor T, Tanya D

and Claudia H. Stakeholder and provider views regarding peri-coital contraceptive pills in India and Uganda. Studies in Family Planning 2013; 44 (4): 431-444.

Kevin M, Jennet A, Kate HR, Caroline M, Fidele N,

Emmanuel M, Jennifer W and Elizabeth ET. Policy and programmatic considerations for introducing a longer-acting injectable contraceptive : perspectives of stakeholders from Kenya and Rwanda. Global Health: Science and Practice 2014; (2): 4.

Clark H and Sophia DR. New and under-used

reproductive health technologies Caucus meeting background, progress and updates. Reproductive Health Supply Coalition. 2015 ; Retrieved February 2017 from http://.www.rhsupplies.org/fileadmin/uploads/rhsc.

Ujuju C, Anyanti J, Adebayo SB, Muhammad F, Oluigbo

O and Gofwan A. Religion, culture and male involvement in the use of the Standard Days Method: evidence from Enugu and Katsina states of Nigeria. International Nursing Review 2011; 58 : 484–490.

Intrahealth International. 2011 baseline Survey for the

Urban Health Initiative Project. Household Survey.

Final Report. Chapel Hill, NC. 2012

Obare F, Liambila W, Birungi H, Eseoise I, Clark H and

RamaRao S. Progesterone vaginal ring – country mapping : Kenya. Technica report. The Population Council, Inc. 2012

Ishaku S and RamaRao S. Progesterone vaginal ring –

country mapping : Nigeria. Technical report. The Population Council, Inc. 2012

Mane B, Diop N, Nancy T, RamaRao S and Clark H.

Progesterone vaginal ring – country mapping : Senegal. Technical report. The Population Council, Inc. 2012

World Health Organisation. WHO Model List of

Essential Medicines 2015 ; Retrieved 05 February, 2015 from http://www.who.int/medicines/publications/essentialmedicines/en/

World Health Organization. Medical eligibility criteria for

contraceptive use 2015 ; 5th ed. ISBN 978 92 4 154915 8

National Population Commission (NPC) [Nigeria] and

ICF International. Nigeria Demographic and Health Survey 2013. Abuja, Nigeria, and Rockville, MD: NPC and ICF International. 2014

Ishaku S, Ayodeji BO and Unumeri G and Rajamani D.

Willingness to pay for contraceptive vaginal rings in Nigeria. Abuja, Federal Capital Territory: Population Council. 2015.

Refbacks

  • There are currently no refbacks.