11 November 2013

Africa: Price Cut On Contraceptive Implants Paves Way for Wider Use in Developing World

Photo: Médecins Sans Frontierès
A group of mothers with their children line up to receive their drugs at a hospital pharmacy in Bossangoa, Central African Republic.

Mother of four Everlyn Irusa was given an injection to numb her inside upper arm before two four-centimetre-long rods were inserted just under her skin.

Irusa, 37, was being fitted with a contraceptive implant to prevent pregnancy for up to five years. She had decided the implant would suit her better than injectable contraceptives, which last three months and require regular clinic appointments.

"I decided to use this one because I'm not always able to come to the clinic," she said, after having the implant inserted at a government clinic. "It'll give me more time between visits."

Irusa lives in Nairobi's Mathare slum and makes a living from selling vegetables by the roadside. Her youngest child is four years old and she does not want any more children.

Implants, which release a hormone into the body to stop the ovaries releasing eggs, are used by less than two per cent of the 600 million women in developing countries who use modern contraceptives. In the past, they have often not been available, nor have health workers been trained to fit them.

There have also been concerns about side effects, such as irregular menstrual bleeding, nausea, headaches and depression, which prompted legal suits in the United States.

But experts are trying to encourage more women to adopt these longer-lasting contraceptive methods because they do not require repeated visits to health clinics, are cheaper and more effective in preventing pregnancy - 99 percent effective when inserted correctly.

PHARMACEUTICAL DEALS

Implant use in Kenya has risen from zero in 1999 to almost five per cent in 2008, according to USAID. A price reduction agreed this year is likely to further increase availability and use.

In February, the Gates Foundation signed a deal with pharmaceutical company Bayer for it to make Jadelle - a contraceptive implant that lasts up to five years - available to 27 million women in the world's poorest countries over the next six years.

The implants are being sold to governments and international organisations like the United Nations Population Fund (UNFPA) for $8.50 a unit, down from $18.

"We are proud to play our role in helping to avoid almost 30 million unintended pregnancies while averting some 280,000 infant and 30,000 maternal deaths as a direct benefit of the Jadelle Access Programme," said Klaus Brill, vice president of corporate commercial relations at Bayer, at a press conference in Nairobi on Thursday.

The Gates Foundation agreed a similar partnership with Merck Sharp and Dohme, which has reduced the price of Implanon, its three-year contraceptive implant, by 50 per cent over the next six years.

Family planning services are free in government facilities across Kenya but the price reduction means the government's budget for contraceptives will stretch further.

In Nairobi, condoms are the most popular form of contraceptive, used by 40 per cent of clients in government clinics. Injections are the second most popular, followed by pills.

There was a 52 per cent increase in demand for implants in 2012, compared to 2011, according to government statistics. Condom, coil and injection use increased by 13 per cent while that of microgynon pills and bilateral tubal litigation - a permanent form of birth control that involves blocking a woman's fallopian tubes - increased by 10 per cent.

"We are trying to promote the long acting reversible contraceptive methods," said Moses Owino, a medical officer at Mathare North health clinic. "It's more convenient for the mother as she doesn't have to come [to a clinic] every time."

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