analysisBy Shamiso Lewis
A new public-private partnership is trying to reduce the price and extend the availability of a long-term, reversible contraceptive device.
Joyce Amio, a Ugandan woman living in the Karamoja region, has given birth to nine children in her lifetime. She wanted more, but changed her mind given the circumstances. "I wanted to have 20 children", she says, "but I decided to stop due to famine and other hardships".
Unlike most women in the region, Amio heard about family planning methods thanks to her brother who is a doctor. And when the sexual and reproductive health NGO Marie Stopes brought family planning closer to the people, she discussed it with her husband and they decided to use Implanon, a contraceptive implant. She developed complications and removed it, resorting to a Jadelle implant instead.
The Jadelle implant is a small, four centimetre-long device which is inserted beneath the skin on the upper arm and continuously releases low doses of a hormone into the body which prevents pregnancy. It can last up to five years and is also reversible in that fertility will resume once it is removed. This form of contraception allowed Amio to control her reproduction safely and effectively.
Unfortunately, however, there remain at least 200 million women across the world that, like Amio, want to use family planning methods but simply do not have access to them. And while contraceptive use in many parts of the developing world, including Asia and Latin America, seem to be slowly increasing, contraceptive use in Africa as a whole remains low. In one study, only 28% of African women in relationships reported using any contraceptive method.
Partners in planning
One reason behind this failure is lack of supply. Speaking at the recent 2012 London Summit on Family Planning, Melinda Gates, co-chair of the Bill and Melinda Gates Foundation, told stories of women who had to sneak away from their husbands in order to receive birth control injections at their local clinic, only to be turned away as the clinic had run out of stock.
Surveys have shown that while 600 million women in the developing world do use some form of contraception, only 1-2% of them are using long-acting, modern devices. The same surveys show that as many as 20% of women would choose implants or other long-acting contraceptive methods if they were consistently available.
This is exactly what a new public-private partnership - which came about as a result of the London summit - is trying to address. The Jadelle Access Programme is aiming to make Jadelle progestogen implants - a long-acting and reversible form of contraception - available to more than 27 million women in more than 50 countries worldwide.
Born out of a partnership between Bayer HealthCare (the makers of the implant), the Gates Foundation, the Clinton Health Access Initiative, the United Nations Population Fund, the Children's Investment Fund Foundation and the governments of the UK, US, Norway and Sweden, the initiative aims to ensure millions more women can access the implants at less than 50% of the current price over the next six years.
According to the agreement, the unit price of the contraceptive device has been reduced from $18 to $8.50 in over 50 countries, including those considered least likely to meet the United Nations Millennium Development Goals for child and maternal health by 2015.
But the partners behind this price reduction are contributing more than just funds and products. The group is also working with domestic organisations to provide training in counselling and the provision of high quality clinical services to healthcare providers. They aim to improve delivery systems so that a range of family planning options are available and accessible even in the most remote locations.
It is in these isolated areas that limited stock is common, and in which there is a strong demand for long-acting and reversible contraceptives like Jadelle, which provides effective contraceptive protection for up to five years.
Saving lives and saving money
Julia Bunting, Director at the International Planned Parenthood Federation, told Think Africa Press that "increasing access to Jadelle, and other long-acting and reversible contraceptives, as part of a comprehensive method mix, has the potential to transform the lives of women in developing countries". Indeed, family planning can have empowering effects for women far beyond just the homestead.
When fully implemented, this new initiative is hoping to avert more than 28 million unintended pregnancies and prevent approximately 280,000 infant and 30,000 maternal deaths, 10-15% of which are believed to be caused by unsafe abortions. This will mean that thousands more children will have mothers while growing up, significantly increasing their chances of attending school, eating well and staying healthy.
"Efforts such as the Jadelle Access Programme will also have significant financial effects", continues Bunting. As a result of the health benefits that will be generated from the programme, an estimated $250 million in global health costs will be saved and potentially reinvested into other health and development programmes aimed at improving the lives of women and children in the continent.
Planning for the future
While the Jadelle Access Programme could prove hugely beneficial, affordability and accessibility are not the only impediments to women using family planning methods.
As a report by the Guttmacher Institute highlighted, there are a number of reasons why some women in Africa chose not to use birth control. These reasons include a lack of access, fears of the methods, and opposition to contraception whether on the part of the woman, her partner or another influential person.
Amio, for example, explains that rumours began circulating around the Jadelle implant when it became available in the region. "They say that in a meeting of elders, it was decided that family planning is making women weak and they can't push babies leading to caesarean births", she says.
While the Jadelle Access Programme will clearly contribute to the alleviation of the 'supply' side constraints therefore, there are also the 'demand' side barriers that need to be addressed. With 30-45% of women in Chad, Guinea and Nigeria attributing their non-use of modern birth control to 'opposition to contraceptives', it is clear that the Jadelle Access Programme on its own will not be enough to help women in Africa to gain full control of their own fertility.
In order to overcome these barriers and support the Jadelle Access Programme, "we need to continue to bring a range of partners to the table", says Bunting, "[including] governments, the private sector, civil society and others". This next step will be crucial to ensure African women will truly benefit from global health programmes like Jadelle.
Shamiso Lewis is a writer and editorial assistant at Think Africa Press. Her interests include African Feminism, human rights and Zimbabwean politics. Shamiso can be contacted at firstname.lastname@example.org