The Progesterone Contraceptive Vaginal Ring: Expanding Contraceptive Options in Africa

The three-month progesterone contraceptive vaginal ring (CVR) provides breastfeeding women with an effective, user-initiated contraceptive option. This study explores the opportunities for and barriers to the ring’s introduction in sub-Saharan Africa.

The Issue

For the first several months after childbirth, exclusive breastfeeding is an effective contraceptive option. But many women do not or are unable to exclusively breastfeed; and once a woman stops breastfeeding or begins supplementing her infant’s diet, or resumes menstruation, she is at risk of becoming pregnant.

Breastfeeding women in sub-Saharan Africa who wish to delay another pregnancy have limited options for effective contraception. Council researchers are generating evidence to determine whether and how the progesterone CVR could be introduced into countries in sub-Saharan Africa. The ring releases a continuous low dose of the natural hormone progesterone, which reinforces the inhibitory effect of breastfeeding on ovulation to delay the return of menstruation and therefore prevent pregnancy.  Each ring can be used continuously for three months, and rings can be used successively for up to one year as long as the woman is breastfeeding.

The progesterone CVR, developed by Council researchers and its partners, is approved and being used in several Latin American countries. Clinical trials that preceded regulatory approval in Latin America have demonstrated that the ring:

  • Is safe for both the mother and baby
  • Does not affect a woman’s ability to produce breast milk
  • Is 98.5% effective if used correctly (for women who breastfeed at least four times a day)
  • Can be inserted and removed by the mother herself, reducing the need for involvement by skilled health care providers
  • Allows fertility to return shortly after a woman stops using the ring

The Progress

Although the progesterone CVR is available to women in seven countries in Latin America, it is not yet approved for use in sub-Saharan Africa, where it has great potential for meeting the contraceptive needs of women who breastfeed for long durations. This project is supporting efforts to determine the feasibility and likely impact of introducing the ring into three African countries with different contraceptive use dynamics and markets: Kenya, Nigeria, and Senegal. The results will also be relevant for other countries in the region.

Council researchers involved in the study are assessing interest in and support for the progesterone CVR among policymakers, regulators, and others who determine which products are made available in their countries; determining the acceptability of the ring among breastfeeding women, their partners, and providers; and identifying and streamlining pathways for introducing the product if approved, which include understanding the market and product placement.

Researchers have interviewed 15–20 key stakeholders in each of the three countries, and approximately 60 postpartum women in each country will participate in an acceptability study, during which they will use the progesterone CVR for six months and describe their experiences. In addition, in-depth interviews will be conducted with a small number of women, and focus-group discussions will be held with women’s partners, community members, and providers regarding their experiences with the ring.

The Council is also conducting assessments in each country to determine the most appropriate sectors (public, private, NGO, social marketing) in which to make the progesterone CVR available, including a market segmentation analysis using DHS data to determine the characteristics of women who may want to use the ring.

The Impact

If the progesterone CVR appears to have an appropriate role in the countries’ method mix, the Council will develop an introductory plan to bring the product into these and other countries in sub-Saharan Africa, further contributing to the goal of reducing unmet need for reproductive health services.

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