New contraceptive for increased lockdown demand

For the past two decades, Basanti Paudel, 41, of Nawalpur had always used Depo-Provera to prevent unwanted pregnancies  Then last year, she was given a new choice: Sayana Press.

Sayana Press, a successor to Depo-Provera, was introduced last year in  Nawalparasi and Sindhuli and is a better option because it has a smaller dosage, comes with a small needle, can be stored at room temperature and is injected sub-cutaneously just under the skin rather than in the muscles, making it less painful. Sayana can also be self-injected at home and lasts for three months just like Depo-Provera.

Basanti Paudel immediately took to the new contraceptive. “It is a much better, but I worry about its availability during the lockdown, and that I may have to go back to using Depo-Provera,” she says.

Pabitra Acharya, 42, of the same neighbourhood also started using Sayana Press after her husband who was working in India came back home following Covid-19 pandemic. She would also like to continue using the injection but is also worried about its availability.

“Once we decide on the contraceptive best for us, we should be able to access it each time. Using different methods affects our health,” Acharya says.

Both women were at the Rajahar Health Post in Nawalpur this week to express their concern about availability. At the health post, Dev Bahadur Dahal  Nawalpur assured them that they would not have to go back to using Depo Provera.

“The drug used in Sayana Press and Depo-Provera is the same, the only difference is the dose, which is 30% lower. We thought why not go for an option that has lower drug but is just as effective and not as painful,” says Lhamo Y Sherpa of Ipas Nepal, adding that depending on the results in the two districts, the new contraceptive would be scaled up to the rest of the country.

Nepal’s contraceptive prevalence rate at 53% is a dramatic improvement from 20 years ago, but it is still a long way from the government’s target of 75% contraceptive prevalence by 2030.

Furthermore, the use of modern family planning methods has plateaued since 2006 due to labour migration. But the return of hundreds of thousands of migrant workers from India and the Gulf following the Covid-19 pandemic is leading to an increase in the demand of contraceptives. Which is why there is a fear of shortages  and also a break in the supply chain because of the lockdowns.

According to the Nepal Demographic and Health Survey (NDHS) 2016, there is a 24% unmet need for family planning in Nepal — a quarter of women who need contraceptives are not using them.

Sayana Press offers a new and easy to use contraceptive that can help meet the country’s unmet needs for family planning. It also gives women agency, especially because their husbands often refuse to use condoms.

The new birth control device is already popular with women in Nawalparasi and Sindhuli districts and very few users have complained of side effects normally associated with contraceptives. In fact, users have reported fewer reproductive health complications.

“For 20 years, I never got my periods regularly, once I did not have them for two years, and had to resort to medications to force my period,” says Basanti Paudel. “Since using Sayana, it has become more regular. It evevn seems to have brought down my blood pressure, and I don’t have nausea anymore.”

Dilmaya Pariyar, 29, has been using contraceptives for 12 years and once every three months she needed to go to a health post to get a Depo-Provera injection, which was always followed by a week of pain in her arms, preventing her from working.

“With Sayana Press, I haven’t had any pains. In fact, this has been the most suitable contraceptive for me so far,” she says. The other advantage is that Sayana Press can be injected at home with some basic training.

There are some women who have complained of excessive bleeding for up to seven days after switching to Sayana Press, but according to a survey, the new contraceptive appears to have been well accepted in the trials which are conducted by the reproductive health agency Ipas Nepal and the Ministry of Health and Population (MoH) with financial support from the UK’s Department for International Development (DFID). Sayana Press is already used in 40 European countries.

Of 1,112 women from 17-49 years of age who participated in the Ipas Nepal comparative study, 12% said they preferred Sayana Press to Depo-Provera. Participants also found the fact that it was self-injectible quite appealing.

Says Bhim Singha Tinkaro, head of Family Welfare Division in the Health Ministry: “Given the positive results so far, Sayana Press can now be expanded to other parts of the country, and the ministry is expected to make a decision soon.”