Reproductive Health Global Program

Subcutaneous DMPA (Sayana Press):
Expanding contraceptive access and options

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Advocacy Pack for Subcutanous DMPA

Advocacy Pack for Subcutaneous DMPA
Tools for advocacy and communications to increase access to a new type of injectable contraception.

About the product

Subcutaneous DMPA*(DMPA-SC) is a new, lower-dose, easy-to-use injectable contraceptive that is administered every three months under the skin rather than into the muscle. Sayana® Press, the subcutaneous DMPA product available to Family Planning 2020 (FP2020) countries, is manufactured by Pfizer Inc. and combines the drug and needle in the prefilled BD Uniject™ injection system. The product’s user-friendly design means that any trained person can administer it, including community health workers, pharmacists, and even women themselves through self-injection.

Self-injection with subcutaneous DMPA

Self-injection of Pfizer’s subcutaneous DMPA product, Sayana Press was officially approved by the United Kingdom’s lead stringent regulatory authority in 2015, and has been recommended by the World Health Organization in contexts where women have information, training, and support. PATH’s research to determine the feasibility and acceptability of self-injection in Senegal and Uganda suggest that most women are able to self-inject competently three months after one-on-one training. These studies, co-led by the Senegal and Uganda ministries of health, led directly to government decisions to pilot self-injection outside of a research setting in both countries.

Two additional studies are ongoing in Senegal and Uganda to assess whether women who self-inject continue using injectable contraception longer than women who receive intramuscular DMPA from a provider at a clinic, and to assess the cost-effectiveness of each approach.

In 2016, PATH also coordinated the first offer of contraceptive self-injection outside a research setting in Mubende district, Uganda. PATH worked with the Ministry of Health and district leadership to teach over 100 health providers at government facilities to train clients to self-inject. Now, under a project designed to identify and share self-injection best practices, PATH and the Uganda Ministry of Health are applying evidence from self-injection studies to design and deliver programs at facilities in the public sector, through community-based distribution, and in the private sector.

Product introduction: Making injections available from new providers

Subcutaneous DMPA has been available from providers in Senegal, Uganda, Burkina Faso, and Niger since 2014 under a country-led introduction initiative coordinated by PATH. These introductions have helped to make injectable contraception available in remote locations, closer to where women live. Between July 2014 and June 2016, nearly 500,000 doses of Sayana Press were administered by family planning providers in the four countries. Now, all four countries, in additional to several other countries worldwide, are moving forward with scale-up of provider-administered subcutaneous DMPA into their national family planning programs.

To understand the potential impact of subcutaneous DMPA administered by providers, PATH and partners are also conducting studies on the effectiveness and cost-effectiveness of subcutaneous DMPA administered by clinic-based (Burkina Faso) and community-based (Uganda) health providers; results are forthcoming in 2017.

Pricing and regulatory approval of Sayana Press

Under a pricing agreement negotiated by Pfizer Inc., the Bill & Melinda Gates Foundation, and the Children’s Investment Fund Foundation (CIFF) in 2017, qualified purchasers in FP2020 countries can obtain Sayana Press for US$0.85 per dose. For more information on this topic, please contact sayanapress@path.org.

Sayana Press has regulatory approval in the European Union and more than 25 countries around the world. The formulation of depot medroxyprogesterone acetate (DMPA) used in Sayana Press is also approved in the United States.

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Sayana Press and Depo-Provera are registered trademarks of Pfizer Inc. Uniject is a trademark of BD.


*DMPA: depot medroxyprogesterone acetate

Sayana Press was approved in the European Union via procedure number UK/H/0960/002UK/H/0960/002. The UK was the Reference Member State. A Public Assessment Report is available at the Heads of Medicines Agency website and the Medicines and Healthcare Products Regulatory Agency web page.