By Nelly Munyasia

Naomi, a young woman from a village in Kakamega County, visits her local health clinic for birth control. She expresses her desire to prevent pregnancy and seeks a convenient contraceptive method that she can easily manage on her own.

The nurse explains the various contraceptive options available, including the implant, which would offer her freedom. However, Naomi is informed that the healthcare provider performing implant insertions is currently on leave, and they won't be able to accommodate her until the following month.

This disappointment shatters Naomi's hopes, as she had travelled a long distance to reach the clinic. She thanks the nurse and leaves the clinic, burdened by uncertainty. As Naomi returns to her village, the road ahead feels daunting and uncertain.

She wonders if she will have the opportunity to return next month or if fate will intervene, leaving her vulnerable to an unintended pregnancy. Despite the obstacles, Naomi remains steadfast in her pursuit of autonomy over her reproductive health, a beacon of strength and resilience amidst life's tumultuous tide.

Incidents like this are common in parts of Kenya, especially in rural areas, slums and remote settings where only doctors are allowed to provide clinical methods of contraception. However, one option women can turn to is DMPA-SC (subcutaneous depot medroxyprogesterone acetate).

As a safe, effective, and acceptable contraceptive option, DMPA-SC can increase access and continuation for women in their communities and homes, including through self-injection.

The practice of self-injection is supported by evidence, receiving global endorsement and national approval, while also witnessing implementation and scaling in an increasing number of nations.

Data from numerous countries underscores the safety and efficacy of women, including those in resource-constrained settings, self-administering DMPA-SC, with reported satisfaction in doing so.

Additionally, the World Health Organization (WHO) has issued a "strong" recommendation for self-injection in its guidelines on self-care interventions for health, advocating for its availability as an additional method for delivering injectable contraception and promoting self-care.

According to Kenya Demographic and Health Survey 2022, 57 per cent of married women use modern contraceptive methods, 6 per cent traditional methods and there is a 14 per cent unmet need for contraception.

Among married women, injectables (20 per cent), implants (19 per cent), and contraceptive pills (8 per cent) are the most commonly used methods. Male condoms are the most commonly used contraceptive method among sexually active unmarried women. The percentage of married women using modern methods is lowest in Arid and Semi-Arid counties.

Injectables like DMPA-SC offer women freedom and easy to use because any trained person can administer — including community health workers, pharmacists, and even through self-injection.

This means that women like Naomi, who may face obstacles in accessing healthcare facilities or encountering shortages of healthcare providers, can still benefit from reliable contraception without the need for frequent clinic visits.

By empowering women to self-inject, it expands their reproductive health choices and enhances their autonomy, ultimately contributing to improved family planning outcomes and overall well-being.

As governments and partners collaborate to ensure a diverse array of contraceptive options are accessible within their respective countries, DMPA-SC emerges as a pivotal solution to address the unmet need for family planning and to expand access through various distribution channels including but not limited to trained community health promoters, and mid-level providers.

This therefore reignites the need for national and county governments through the ministry of Health and partners to expand their support for Task-Shifting to free up time for higher-level providers, improve the quality of care, increase the use of contraceptives, and reduce the costs of providing services.

That is why an on-going initiative by the Reproductive Health Network Kenya (RHNK), in collaboration with the Ministry of Health, Division of Reproductive and Maternal Health, and the Clinton Health Access Initiative is important.

This initiative aims to improve access to family planning and contraception in Kenya, focusing on self-care and empowering women and adolescent girls to make informed decisions about their reproductive health. 

[The writer is the Executive Director, Reproductive Health Network Kenya.]