The three-month progesterone contraceptive vaginal ring (PVR) 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.
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 PVR 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. A woman can begin using the PVR as early as six weeks after birth if her menstrual cycle has not yet returned and she is breastfeeding. A single ring can be used for three months and a woman can replace it with a new one up until her child’s first birthday.
The progesterone contraceptive vaginal ring, 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
Although the PVR 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 PVR 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 have participated in an acceptability study, during which they used the PVR for six months and described their experiences. In addition, in-depth interviews were conducted with a small number of women, and focus-group discussions with community members, and providers regarding their experiences with the ring. The results indicate that the PVR is a highly acceptable contraceptive to women, their partners and to the community at large. Efforts are now underway to register the PVR in Kenya, Nigeria and Senegal and thus expand the range of contraceptive options for women living in these countries.
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 PVR available, including a market segmentation analysis using DHS data to determine the characteristics of women who may want to use the ring.
If the PVR 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.