Unfolding the acceptance fears and barriers to the new injectable contraceptive DMPA-SC (uniject-Sayana Press)- Perception of clients in Sindh Pakistan

In Pakistan, the Contraceptive Prevalence Rate (CPR) is 34%, unmet need for FP services is 17%, this means 4 Million Married Women of Reproductive Age (MWRA) are looking for spacing or limiting their families. Injectable contraceptive is among the preferred methods having 2.5% contribution in CPR, that contributes 10% in modern mCPR. Injectable method is common because of its ease, but like some methods in FP, it also requires services of healthcare provider or clinical setting for administration. A new method with features of subcutaneous presentation having depot medroxyprogesterone acetate (DMPA-SC) in Uniject with brand name of Sayana Press have features to be administered by low cadre of health workers in nonclinical settings and even by it can be used by women themselves having proper training. Sayana Press has potential of replacing the conventional FP commodities in restricted environment with less mobility. It is very important to collect the insight of end user regarding the current injectable (DMPA-IM) and new injectable Sayana Press defining the benefits, fears, acceptability, affordability and challenges.  Objectives: Current study was focused to collect insights by the clients to understand women’s perceptions regarding the use of current form of injection (DMPA-IM), its access, availability, affordability, advantages and disadvantages. In addition, perception of client regarding new method (DMPA-SC), especially in the context of self-injection, its barriers, fears of self-injection and potential challenges to new method. Research Questions: What is the perception of client for current injection (DMPA-IM)? What is the perception of client regarding new form of injection (DMPA-SC)? What are the barriers for self-injection? Methodology: Researcher conducted three Female Focus Group Discussion (12-15 respondent in each group) having different demographic characteristics eg. marital status, education, parity, use of family planning services and age. The audio was translated from regional language to English and transcribed through professional linguistic experts.  Transcripts were coded line by line and themes were developed against each research question. Data analysis was performed with NVivo Software. Findings for current injection (DMPA-IM) i. Access: Participants of rural depend on government service providers, 50% of the urban participants looked to some selected private service providers. ii. Affordability: Clients in rural and urban received injection free at Public sector facilities and Bear nominal charges for transportation. Clients pay PKR 200-300 to selected private service providers as service charges. iii. Barrier: 100% participants from shared transport and mobility as barrier. iv. Advantages and Disadvantages: 90% praised injection as easy and accessible method, while 40-30% client complaint for shortage of supplies and perceived side-effects. Findings for (DMPA-SC) i.  Fear: Respondents of all settings show moderate fear of injection and shared self-injection as risk in result of wrong prick. One of the respondents shared “I cannot inject to anyone, how can I do it for myself and if I prick it wrong, what would I do? However, I can do if someone trained me” . ii. Effectiveness: The 80% of respondents are not sure about the effectiveness of the new method. iii. Price: The 100% participants think new method may has high cost, if not available free at Public sector. iv. Threat: The 80% participants shared, service provider who charge service charges may use negative campaign to fail self-injection. It was main theme “business of service provider will go down” . v. Acceptance: 95% participants clients found no any major challenges to new method from community influencers. vi. Affordability: 80% participants agreed to pay 50-200 PKR (around 1 USD) as service charges to private provider. 60% participants will bear transport cost, to get free injection. Knowledge contribution Sayana Press is value addition in the basket of choices and have potential of gamechanger if, the related challenges are properly addressed. There is moderate fear of injection, none of the participant ever heard about the self-injection contraceptive and shared self-administration is as challenge. New injection DMPA-SC will not face any hurdles, except by the private service providers, who may feel threat to their earnings because of self-injection features. Respondents preferred services from providers for injection and repeated dose on next date. Client perceived DMPA-SC may have high cost if not available free at Public Sector facilities. Clients agreed to pay between 50 to 200 PKR (equal around to one USD) as service charge to private service provider, if method is not available free at government facilities. Client agreed to pay transportation cost for getting free service.