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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 36  |  Issue : 3  |  Page : 459-464

Awareness, knowledge, and perception about Sayana press® contraceptive technology in Nigeria


Women Friendly Initiative (WFI), Plot 85A, AAI Employment Area, Off Funtaj College Road, Kuje, P. M. B. 15324, Wuse Post Office, FCT. Abuja, Nigeria

Date of Submission06-Aug-2019
Date of Decision09-Oct-2019
Date of Acceptance07-Nov-2019
Date of Web Publication22-Jan-2020

Correspondence Address:
Dr. F Eremutha
Women Friendly Initiative, Plot 85A, AAI Employment Area, Off Funtaj College Road, Kuje, P. M. B. 15324, Wuse Post Office, FCT. Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/TJOG.TJOG_81_19

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  Abstract 


Background: Access to modern contraception can save lives. Sayana Press® is a 3-month injectable contraceptive that has a small needle and comes in a prefilled syringe, which makes it easy to use and less painful.
Subjects and Methods: A mix method cross-sectional study was carried out in the Federal Capital Territory (FCT) and 3 states chosen across Nigeria: Nassarawa, Benue, and Oyo states. Quantitative data were collected using an interviewer-administered questionnaire while the qualitative data were collected using focus group discussions with selected youths, teachers, family planning service providers (caregivers), and parents.
Results: Despite its years of introduction into the family planning market, Sayana Press® awareness was low, with 37.7% (43) of the 114 respondents in the quantitative study being aware of its existence as a new family planning method. The qualitative data also reinforced the crucial role of contraceptive knowledge (benefits and side effects) and cost on the uptake of Sayana Press®.
Conclusion: Government and donor support for centralizing the procurement and distribution of contraceptives is a key determinant of Sayana Press® awareness and uptake.

Keywords: Awareness; injectable-contraceptive; mix method; Sayana Press®.


How to cite this article:
Eremutha F, Gabriel V C. Awareness, knowledge, and perception about Sayana press® contraceptive technology in Nigeria. Trop J Obstet Gynaecol 2019;36:459-64

How to cite this URL:
Eremutha F, Gabriel V C. Awareness, knowledge, and perception about Sayana press® contraceptive technology in Nigeria. Trop J Obstet Gynaecol [serial online] 2019 [cited 2020 Apr 5];36:459-64. Available from: http://www.tjogonline.com/text.asp?2019/36/3/459/276456




  Introduction Top


Many countries currently face the crises of a rapid growth of human population that has begun to threaten human survival. Therefore, the voluntary control of fertility is of paramount importance to the modern society.

Family planning services and products are available at many public and private facilities. Male condoms and pills, along with injectable are among the most popular modern contraceptive method currently in use.[1] However, injectable contraceptives are more difficult to access because a trained healthcare worker must administer it with a needle and syringe. In addition, personal preferences, social norms, gender preferences, women's education, rural or urban residence, and perceived acceptability of family planning-use affect contraceptive choices.[2],[3]

Sayana Press ® is an injectable contraceptive among the world's most popular methods for preventing pregnancy. It offers women safe and effective protection, convenience, and privacy. It is small, light, easy to use, and a lower-dose formulation and presentation of Depo-Provera®, offers the potential to improve contraceptive access worldwide. It is a three-month, progestin-only injectable contraceptive product packaged in the Uniject™ injection system, a small prefilled auto-disable device. It contains 104 mg per 0.65 mL dose of depot medroxyprogesterone acetate (DMPA) and is administered via subcutaneous injection. It requires minimal training, making it especially suitable for community-based distribution and potentially for women to administer themselves through self-injection. Findings from DKT Nigeria [4] suggest that women under age 25 were more likely to switch from condoms to Sayana Press ® for their main method of preventing pregnancy, suggesting that Sayana Press ® may successfully address some barriers to using longer-acting modern methods for preventing pregnancy among younger women.

Despite various family planning intervention approaches implemented in Nigeria, contraceptive use has not considerably improved.[5],[6] The objective of this quantitative and qualitative research study is to build marketers' understanding of consumers' awareness, knowledge, perception, and use of Sayana Press ® as a new method of family planning in Nigeria. The research findings are intended to better inform the process by which marketers plan effective promotion about Sayana Press ®, as well as to guide formulation of the basic objectives of a campaign to provide consumers with the foundational knowledge they need to better understand the effectiveness and promotion of Sayana Press ® in Nigeria.


  Subjects and Methods Top


A cross-sectional study design with mixed-methodology which adopted both qualitative and quantitative researches was carried out in the FCT and 3 states chosen across Nigeria: Nassarawa, Benue, and Oyo states. The study was primarily descriptive in nature. The aim was to estimate any given population parameter with a specified level of precision and confidence. In each of the three states, one local government was randomly selected and in Abuja, one area council was sampled. Therefore, a total of three LGAs and one Area Council were recruited for the survey.

Questionnaires for the quantitative interviews were administered to a total of 114 respondents [Table 1]; 94 (82.4%) are youth (15–24 years), 33 (35.1%) were male, and 61 (64.9%) were female. [Ibadan, Oyo State—24 respondents, 15 (62.5%) are youth, 8 (33.3%) were male, and 16 (66.7%) were female; Kuje, FCT-Abuja—33 respondents, 32 (97%) are youth, 14 (42.4%) were male, and 19 (57.6%) were female; Lafia, Nassarawa State—28 respondents, 24 (85.7%) are youth, 9 (32.1%) were male, and 19 (67.9%) were female; Mkar, Benue State—29 respondents, 23 (79.3%) are youth, 8 (27.6%) were male, and 21 (72.4%) were female].
Table 1: Age distribution of respondents by sex

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The data obtained were entered into Excel spreadsheet which was also used for analysis and results expressed in figures and simple percentages.

A focus group discussion was carried out to better understand consumers' awareness, knowledge, acceptance, use, and promotion of Sayana Press ® among women (in reproductive age group) of all categories in Nigeria. 16 focus group discussions were conducted. Each focus group included up to 6–10 participants and lasted up to 45 min. The groups were internally homogenous with respect to education and recent experience with family planning methods. A mix of participants—youths, parents, teachers, and caregivers (family planning care providers)—from Ibadan, Oyo State; Kuje, FCT-Abuja; Lafia, Nassarawa State; and Mkar-Gboko, Benue State, with different backgrounds were involved in the discussion. Participants were intentionally recruited to reflect the demographic characteristics of the general population in each location.

Overall, there were 172 focus group participants [Table 2]. 46 (26.7%) people participated in Ibadan, 41 (23.8%) in Kuje, 44 (25.6%) in Lafia, and 41 (23.8%) participated in Mkar. This included 24 youths, 45 teachers, 44 family planning service providers (caregivers), and 59 parents.
Table 2: FGD Participant demographics by location

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A professional moderator led the group discussions. Participation was voluntary and a signed informed consent was obtained from each eligible participant.

Before each focus group began, the moderator talked in-person to review the list of attendees and determine if any potential participants should be eliminated from the group.

All discussions were led by a moderator with a structured FGD guide, which explored respondents' contraceptives likes and dislikes, contraceptive risk and benefits, reactions to the new injectable contraceptive-Sayana Press ®, and strategies to be considered in promoting the use of Sayana Press ® among women of all categories in Nigeria.

The focus group discussions were audio-recorded and documented in word transcripts as report findings of the FGD. No attempt was made to quantify the number of comments made on any issue. Where appropriate, findings indicate differences by education level and gender. There were no observed differences by focus group location.


  Results Top


Main characteristics of respondents

A total of 114 respondents took part in the survey, 94 (82.4%) were youth (15–24 years), 75 (65.8%) were females, while 39 (34.2%) were males. Most of the respondents (23.3%) had completed secondary education 13.1% are married [Figure 1], while 43.0% of the respondents were technicians by occupation.
Figure 1: Percentage distribution of respondents by marital status

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  Description of Results Top


All respondents had heard at least of one method that women or men can use to delay or avoid getting pregnant giving an awareness of 100%. The respondents got to know about the methods of contraception mostly from friends (94.3%) and neighbors (78.2%). Other sources of information on contraception that were mentioned by the respondents included nurses, radio, spouses, church meetings, and health educators. The gradient flow of awareness was the same for all four locations. Contraceptive ever use was slightly higher among respondents in all of the four locations. Of the 114 respondent, 94 (82.4%) had ever used a contraceptive, of which the most commonly used method was condom. 83 (72.8%) of the respondents are currently on one form of contraceptives [Figure 2] with condom (100%) for male participants. Respondents noted that contraceptives could either be used before (condom) or after sexual intercourse (pills) and that contraceptives cannot protect against sexually transmitted infections (STIs).
Figure 2: Distribution of respondents by contraceptive current use

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Only 43 (37.7%) are aware of Sayana Press ® as a new family planning method [Table 3]. 22 (51.2%) were from Ibadan; 7 (16.3%) from FCT, Abuja; 9 (20.9%) from Lafia; and 5 (11.6%) from Mkar, Gboko [Figure 3]. Of the 43 respondents, 30 (69.8%) were females and 13 (30.2%) were males [Figure 4],, whilst by location; 22 (91.6%) of the total respondents in Ibadan are aware of Sayana Press, FCT-Abuja, is 7 (21.2%), Lafia – 9 (32.1%) and Gboko – 5, (17.2%) [Figure 5].
Table 3: Percentage distribution of respondents by location (n = 43)

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Figure 3: Percentage distribution of respondents by awareness of Sayana Press®

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Figure 4: Percentage distribution of respondents by sex

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Figure 5: Distribution of respondents' awareness of Sayana Press® by location

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The qualitative perspective of the FGD gave insights into respondents' perceptions and beliefs about using Sayana Press ®. The FGD findings are organized into three principal issues: major concerns regarding contraceptives, understanding injectable-Sayana Press ®, and behavior toward use and promotion of Sayana Press ®.

According to the respondents, three top major concerns with Sayana Press ® usage are the fear of potential side effects, drug interactions thought to be exacerbated by lack of communication among health care providers, and lastly, costs which were perceived to outweigh safety concerns, especially for end-users in poverty prone areas.

Similarly, on their understanding of Sayana Press ® as an injectable contraceptive, majority of the respondents were of the opinion that the threshold for its effectiveness appears to be lower than the threshold for its safety. “Safe” was perceived as meaning the vast majority of users should not experience side effects. However, fewer participants understood that side effects, risks, and adverse reactions are not the same thing and attempted to assign levels of severity to each. “Side effects” were seen as the least serious and “risks” were seen as the most serious.

On their use and promotion of Sayana Press ® as an injectable contraceptive, respondents concluded that a variety of sources are used to obtain information about contraceptives, and as such a great deal of value is placed on personal stories of drug experiences from family members, friends, other caregivers, and testimonials from users. Caregivers indicated that their approach in deciding whether to provide family planning methods lies solely on the consent of the woman and not the man. However, if the decision was for their child, caregivers were more likely to discuss the risks and possible alternatives with both parents. Most teachers responded that they would prefer to advise parents to educate their wards/adolescent daughters on family planning methods as a means to avoid unwanted pregnancy and summarized that it would be ethically wrong for any teacher to teach or discuss family planning methods with students in the secondary school since such topics are not contained in the school curriculum. However, some parents were of the opinion to marry off such daughters on the grounds of religious beliefs, while some would allow such adolescent daughter to visit family clinics for counseling.

Generally, both female and male participants expressed high awareness of contraceptives and shared their likes and dislikes about taking injectable contraceptives. Participants noted that advantages were improved quality of life ”avoiding risk of getting pregnant is wise decision to save one's life from consequences of abortion.” They recognized that injectable contraceptives alleviate their pain and discomfort “the reaction is immediate once it gets through the veins into the blood and cures whatever ailment you might have.” Similarly, disadvantages were recognized to be side effects ”Sometimes [the side effects are] worse than what they cure.” A few participants mentioned that they have refused to take a family planning method after finding out about the side effects “I actually had a seizure of fertility when I am finally prepared to have more babies. Had to resort to praying.” Another major dislike, especially for caregivers and chronic users, is the concern they have about the interaction of different drugs “The first thing is interactions. I want to make sure it's properly explained by the service provider and available on the drug leaflet.”

Caregivers were especially concerned with how the cost of Sayana Press ® could affect its use and promotion in their community “The poverty level in this community is high. Ordinary registration card of N50.00, most women cannot afford it. Asking them to pay for pregnancy test, consumables as well as for the injectables would discourage them.” Another participant observed that “The cost, because you don't ever know what the price is going to be in another health facility.” Some participants also mentioned dependency on its usage “If it works to your satisfaction with fewer side effects, you're likely to keep taking it. Once you start it, you're stuck. You've got to keep taking it.” A few participants (parents) also verbalized their fear of their adolescent daughters becoming addicted to contraceptives.

Users and caregivers mentioned that taking contraception every three months is a burden to married women because it requires constant awareness. A female youth shared “I had to get a reminder because I'm not smart enough to remember to take my medicine as at when due. So I had to get a reminder.” Some participants suggested that contraception indicated a problem with one's health. Most participants indicated they did not want to take injections unless absolutely necessary, whereas a few participants mentioned that they often look for alternatives, such as natural methods, to avoid taking injections. Participants when asked about their willingness to take a new contraceptive (Sayana Press ®) prescribed by their health care provider indicated that they would be reluctant to do so. Primary concern was ”being a testing animal.” These participants would want detailed information about the new family planning method if at all it would be considered.

On the strategies that should be considered in promoting the use of Sayana Press ® in Nigeria, a common response from the participants was thorough awareness on the effectiveness of the drug. A caregiver opined that ”We're not aware of such brand name of injectable.” Similarly, a female teacher was of the opinion that ”Since it is not forbidden to advertise on the media-radio, television, and prints, the manufacturers should access all possible means to get the product to the hearings of Nigerians.”


  Discussion Top


Findings of this study indicated that in all the states surveyed, the most popular contraceptive type the respondents know and have used is male condoms followed by injectables. This is similar to findings by Eremutha and Gabriel2018.[7]

An analysis of the data gathered showed that only 43 (37.7%) were aware of Sayana Press ® as a new family planning method. Of the 43 respondents, 30 (69.8%) were female and 13 (30.2%) were male; 22 (51.2%) were from Ibadan; 7 (16.3%) from FCT, Abuja; 9 (20.9%) from Lafia; and 5 (11.6%) from Mkar, Gboko. In general, there seems to be a regional variation in the awareness of Sayana Press ® as an injectable contraceptive, which may be as a result of cultural and religious beliefs, contraceptive counseling skills, and individual client perception of the contraceptive method. It is evident among participants that majority of Nigerians are not aware of the new injectable-Sayana Press ®. There's a wide gap in the level of awareness and the number of respondents at each of the locations visited. The literature is not made available for public consumption. However, the study has highlighted that adolescent girls are more likely to use Sayana Press ® depending on the mode of awareness and availability prevalent at both private and public facilities.

The demographic characteristics among the studied population revealed that there was a higher percentage of sexually conscious youth (81.6%) than married (13.1%) participants. Though the number of youth participants in the FGD was purposive, youth generally do not want to be seen as promiscuous because of the general myth that associates awareness and use of contraceptives among youths with sexual permissiveness and also the fear of parental knowledge and disapproval.[8] Similarly, the quantitative study offers the youth a discreet opportunity to further understand the use of contraceptives to avoid unwanted pregnancies. This study showed that even with availability and accessibility of affordable contraceptives in a community with high knowledge of contraceptive among youth, parental support featured as a significant decider of its actual utilization, which is an expression of underlining sociocultural privation.

Qualitative interviews of providers and users to understand their experiences with Sayana Press ® showed that their approach in deciding whether to provide family planning methods lies solely on the consent of the woman and not the man with obvious paradigm shift from the patriarchal culture evident in Nigeria, where men play dominant role in decision-making for reproductive and family health.[2],[3] In contrast, respondents showed a general disinterest to share the responsibility of contraception with students. This finding is braced by results from DKT Nigeria Brief [4] which showed that younger, unmarried women were systematically treated differently when seeking contraception for preventing pregnancy compared to older, married women. The accumulated evidences of this study robustly favor the use of effective and innovative strategies to deliver Sayana Press ® injectable to consumers and in particular the rural population.[9],[10]


  Conclusion Top


The findings of this study showed that Sayana Press® injectable contraceptive is available in the study locations via government and private sources. The utilization of injectable contraceptive in these locations was principally determined by cost and knowledge of contraceptives (benefits and side effects). Therefore, we recommend that government should take responsibility for centralizing the procurement and distribution of contraceptives, and consult with potential donors about the need for additional resources. Also, there is the need to develop culturally sensitive and acceptable strategies directed at relevant determinants as vital tools for improving the acceptance and utilization of contraceptives in these settings.

Acknowledgements

The authors acknowledge Planned Parenthood of America who are the funders of this study, Planned Parenthood Federation of Nigeria (PPFN), Women Friendly Initiative (WFI), Kuje, FCT-Abuja, and NKST, Mkar, Gboko, Benue State., for their collaboration, as well as all respondents who participated in the quantitative interviews, and focus group discussions during the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
National Population Commission and ICF International. Nigeria Demographic and Health Survey (NDHS). National Population Commission, editor. Abuja-Nigeria, Rockville, Maryland, USA: National Population Commission and ICF International; 2014.  Back to cited text no. 1
    
2.
United Nations Population Division. Demographic situation in high fertility countries, Workshop on Prospect for Fertility Decline in High Fertility countries, New York, 2001. Available from: http://www.un.org/esa/population/publications/prospectdecline/highfert.pdf. [Last accessed on 2019 Jul 25].  Back to cited text no. 2
    
3.
United Nations Population Division. The future of fertility in intermediate-fertility countries, 2002. Available from: http://www.un.org/esa/population/publications/completingfertility/revisedPEPSPOPDIVpaperPDF. [Last accessed on 2019 Jul 25].  Back to cited text no. 3
    
4.
DKT Brief. Introducing the Next Generation Injectable in Nigeria 2016. Available from: https://www.dktinternational.org/dktbrief_8nov2016_final-1/. [Last accessed on 2019 Jul 25].  Back to cited text no. 4
    
5.
Federal Ministry of Health (Nigeria), Columbia University Center for Population and Family Health. Community-Based Distribution (CBD) of Low Cost Family Planning and Maternal and Child Health Services in Rural Nigeria (Expansion). New York: Population Council; 1993.  Back to cited text no. 5
    
6.
National Population Commission (NPC) [Nigeria]. Nigeria Demographic and Health Survey 1999. Calverton, Maryland, USA: National Population Commission (NPC) and ORC Macro; 2000.  Back to cited text no. 6
    
7.
Eremutha F, Gabriel VC. Reversible male contraceptives preferences in Nigeria survey. Uni J Med Sci 2018;6:15-21. Available from: http://www.hrpub.org/journals/article_info.php?aid=7581. [Last accessed on 2019 Jul 19].  Back to cited text no. 7
    
8.
Okpani AOU, Okpani JU. Sexual activity and contraceptive use among female adolescent a report from Port Harcourt, Nigeria. Afr J Reprod Health 2000;4:40-7. Available from: http://www.jstor.org/stable/pdf/3583241.pdf. [Last accessed on 2019 Jul 12].  Back to cited text no. 8
    
9.
Akol A, Wamala P, Krueger K, Abbott A. Scaling Up Community-based Access to Injectable Contraceptives in Uganda: Lessons Learned from Private and Public Sector Implementation. Research Triangle Park, North Carolina: Family Health International [FHI]; 2009.  Back to cited text no. 9
    
10.
Mahram M. Middle east assessment. Draper Fund Rep 1984:13-5.  Back to cited text no. 10
    


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