You only get to make a first impression once.
And so it is that the first launch of a new injectable contraceptive called Sayana Press will help determine if this product has the potential to change the way family planning services are provided in many developing countries. Last week, Pfizer, the Bill & Melinda Gates Foundation and the Children's Investment Fund Foundation, announced an agreement that will make Sayana Press available for $1 per dose in some of the world's poorest countries.
While injectable contraceptives have been around for some time, what is new about Sayana Press is its delivery system - an easy-to-use, pre-filled 3-month injection that is administered just under the skin (as opposed to deeper into the muscle). The product is a new formulation of the well-known Depo-Provera (Sayana Press contains 30% less of the active ingredient).
While the product should officially be administered by a health care professional, lesser-skilled health workers will have few problems using this injection method, thereby expanding the number of places it is available. Furthermore, many advocates hope and expect that it will eventually be permitted for self-injection at home. When that happens, it could be the beginning of a contraceptive revolution - especially in countries where access to trained health providers is limited.
This month in Nigeria, my organization, DKT International, has launched this product in collaboration with Pfizer. Sales reached 15,000 units during the first 15 days on the market and the feedback from the markets, clinics and providers has been positive. This follows the successful July introduction of Sayana Press by the Ministry of Health and NGO partners in Burkina Faso. There, some 75,000 Sayana Press units have been distributed to health facilities while 2,500 health care providers have been trained on Sayana administration. Plans to roll out in several other African nations are in the works with support from organizations like PATH, the Gates Foundation, USAID, the Department for International Development (the United Kingdom's aid agency), the Children's Investment Fund Foundation, and UNFPA.
The introduction of Sayana Press in West Africa will guide us for launches elsewhere and serve as a future bellwether for success. The knowledge we gain during this time will inform the procurement and programming decisions of other governments, non-governmental organizations, and donors about whether they should include Sayana Press in other programs and countries.
What happens when this innovation puts family planning decision-making where it belongs - literally into the hands of women who want to prevent pregnancy? Although there may be challenges with promoting Sayana Press this way (the product is not yet indicated for self-injection), the concept is fairly straightforward and should not be terribly controversial. With just a bit of training and education, most women can learn to self-inject just as millions of diabetics do every day. Empowering women with this option could well prove a game-changer.
Another important reason to monitor these product launches is how they will be received by the medical establishment. In many emerging markets, doctors and nurses tend to be concentrated in urban settings. Sayana Press can reduce the need for already-overburdened medical personnel to provide family planning, an area that is typically neither urgent nor highly remunerative. Rural based, lesser-skilled health workers can store and provide Sayana Press easily. Women in rural areas may eventually learn to inject at home. In the developing world, it is more dangerous to be pregnant than to use any method of family planning; de-medicalizing family planning increases access and use with comparatively fewer risks.
In July 2012, at the Family Planning Summit in London, participants committed themselves to providing 120 million new women who have an 'unmet need' with family planning products and services. In order to attain this challenging goal, family planners must try innovative ideas, explore untapped delivery channels for services, and introduce new products and technologies. Sayana Press should be a major step in that direction.
Christopher H. Purdy is President of DKT International and serves as a member of the board. From 1996 to 2011, he served as Country Director of DKT programs in Turkey, Ethiopia, and Indonesia, where he managed the largest private social marketing family planning program in the world. He served as Executive Vice President from 2011-2013. His professional interests center on advancing the cause of social marketing for improved health, and socially responsible capitalism.