Scale-up of the DMPA-SC in Nigeria: Why policy matters

Abstract

Background Injectable contraceptives have contributed substantially to Nigeria's rise in modern family planning methods usage. They are one of the most commonly used and preferred means of contraception among women in the country. Enabling policies are required to assure contraceptive access, security, and use. This study aimed to investigate the policy environment and how it supports or limits Nigeria's introduction and scale-up of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC). Methods The design of this mixed-methods study was cross-sectional. Desk reviews of policy papers, key informant interviews, and in-depth interviews were used to obtain information from respondents about the introduction of DMPA-SC in Nigeria and how existing policies influenced its scale-up. Data on DMPA-SC and other injectables were gathered from Nigeria's national electronic logistics management information system. Results The findings suggest that policies such as task-shifting and task-sharing, cost-free policies, reproductive health policies, and others created an enabling environment for the scale-up of DMPA-SC adoption in Nigeria. The inclusion of DMPA-SC on the essential medicines list and the approved patent medicines list facilitated the scale-up process by ensuring private sector participation, removing economic barriers to access, fostering greater collaboration among health worker cadres, improving intersectoral partnerships, and improving logistics and client access. Despite significant anomalies in some implementing policies, injectable contraceptive consumption data demonstrate a progressive increase in DMPA-SC use during the study period. The results also indicate that policy initiatives have a favorable impact on the use of DMPA-SC throughout the country. Conclusion The existence of policies, the active participation of stakeholders, and the political will of the Nigerian health system's leadership have all aided in the scaling-up of the DMPA-SC. Understanding how to build an enabling policy climate is critical for providing women with family planning options. These lessons from Nigeria emphasize the importance of these levers, which should be considered by teams intending to introduce innovative health products, particularly in developing countries.

Acceptability and effectiveness of empathy-based provider training and community-level awareness activities on self-injectable contraceptive use in Niger, Lagos, and Oyo States, Nigeria: A mixed methods program evaluation

“…In Nigeria, injectables and implants are the most utilized modern contraceptive methods, each comprising one-fourth of total modern contraceptive method use nationally [12]. DMPA-SC was introduced through private health channels in 2015, with public sector rollout beginning in 2016 [13]. Nigeria moved quickly to develop national DMPA-SC guidelines and policies, including a ve-year "roadmap" to scale DMPA-SC nationally [13].…”

“…DMPA-SC was introduced through private health channels in 2015, with public sector rollout beginning in 2016 [13]. Nigeria moved quickly to develop national DMPA-SC guidelines and policies, including a ve-year "roadmap" to scale DMPA-SC nationally [13]. Despite the supportive policy environment, awareness of contraceptive self-injection remains low: While nationally representative information on knowledge, awareness, and practice of contraceptive self-injection are not yet available, the Performance Monitoring for Action (PMA) program estimates that -despite high awareness of injectable contraception -only 21% of women of reproductive age in both Kano and Lagos States had ever heard of contraceptive self-injection as of 2020-2021 [14].…”

Service Delivery Considerations for Introducing New Injectable Contraceptives Lasting 4 and 6 Months in Nigeria and Uganda: A Qualitative Study

“…Stakeholder engagement is critical for the launch of any new contraceptive innovation, as evidenced by the recent successful introduction of DMPA-SC in several sub-Saharan African countries. 13 During pilot introductions in Burkina Faso, Niger, Senegal, and Uganda, country stakeholders shared their perspectives on key questions, including the number of doses, intended populations of users (first-time mothers, young and adolescent women), the coexistence of DMPA-SC with intramuscular DMPA (DMPA-IM) and other methods on the market, and the potential effects of community-based distribution approaches. Stakeholders' opinions on these questions led to the formation of a global monitoring system that provided relevant information for decisions around investments in and scale-up of DMPA-SC in those countries.…”