SAYANA PRESS. It sounds like a new coffee maker, doesn’t it? Or the latest Victoria’s Secret angel. If the giddy endorsement of Cosmopolitan’s Jill Filipovic last month is to be believed, it’s certainly as harmless as either of these and a whole lot more exciting. Sayana Press is actually a version of a drug otherwise known as Depo-Provera, one that comes in a disposable needle-bubble product that a woman can administer herself without the supervision of a medical practitioner. In case you’re not familiar with Depo-Provera, in the US, it’s predominantly provided to lower-income, teen, and African American women as a contraceptive method. It is also administered as a form of chemical castration for male sex offenders.
Most of the recent press coverage of the collaboration between pharmaceutical company Pfizer and the Gates Foundation that will bring this device to women in the developing world gushed about the numbers of women’s lives that will be saved. The implication is that women die during childbirth in high numbers in developing countries because childbirth is inherently dangerous, when of course the context – impoverished living, poor sanitation, and poor nutrition, to name a few – has a large bearing on the outcome. Even if the women have fewer children, the poverty will remain – leaving both the woman and her children vulnerable to sickness and death.
Sayana Press is planned for use in rural areas where women have little to no access to healthcare otherwise and must travel great distances to a clinic. It is small, cheap to produce, and portable, and as such will reach those for whom this will likely be the only form of contraceptive medication made available to them. It’s ironic when you think about it – a device heralded for saving women’s lives and protecting their reproductive health serves to highlight how little healthcare they would otherwise receive. Clearly it’s limiting births and not limiting deaths that’s the main priority when it comes to the development of this product. Sayana Press might seem cheap – $1 per three-month dose – but in comparison to the alternative of providing full healthcare services to all women through the redistribution of wealth and resources, it’s a cost-saving device developed by some of the richest people on the planet.
Filipovic writes, “Eventually, the makers of this injectable contraception say they hope women won’t even have to see a health worker every three months…” It is as though the only reason a woman might want to see a health worker is for birth control, not for, say, antibiotics or anti-inflammatories or for a run-of-the-mill checkup.
When I hear that women in developing countries “like” or “prefer” this form of contraception (can one have a preference when given only one option?), I recall a series of posts written by Laura Wershler for re:Cycling. These have attracted hundreds of comments from women who have suffered from myriad health issues while on and coming off Depo-Provera. On the most extreme end of the spectrum of side effects is the FDA black-box warning that use might cause bone loss and increase the potential risk of transmission and acquisition of HIV. Although the evidence for the latter issue has been deemed “inconclusive,” no caution has been shown in strategies to ensure increased use of the drug in areas with high numbers of HIV infected with and at risk of being infected with HIV.
One more-common side effect is continuous bleeding (the prevalence of which might potentially be increased by the lower-dose Sayana Press). Not only does this pose health issues for women who are malnourished, but it can also obviously cause much anxiety and concern if the intention is for the husband not to know his wife is using the drug and if sanitary products are lacking and general sanitation is poor. All of the other side effects mentioned in the re:Cycling posts might, speculatively, be worsened when a woman already struggles with poor health and low immunity. In areas with strict menstrual taboos, she might face violence and ostracization for her continual bleeding.
Of course, Sayana Press removes one obstacle towards women choosing not to use the drug if they do experience side effects – doctors. A woman in charge of administering her own contraceptive has the freedom to not take the next dose. Coercion is rife in the developing world when it comes to contraception – whether it be bribes or threats. Alternatively, it’s possible that someone locally given the responsibility to aid administration will be provided with incentives to increase uptake in their community. Whereas previously a woman might not choose to return to the clinic, with Sayana Press the coercion and threats she faced there might now be make their way to her doorstep. And either way, she still has to deal with the side effects for three months or longer, depending on when the drug leaves her system entirely.
Whereas continuation rates for Depo-Provera in the US are very low, with around half of women who use the drug not returning for their second injection. It’s interesting that the Pfizer corporation and the Gates Foundation — both American entities — are so eager to export a product to other nations that women in its own country would rather not use.
What kind of information will be provided as to the potential side effects? Many women report waiting months, sometimes over a year, for their menstrual cycle to return after coming off Depo-Provera. This may be different with the lower-dose Sayana Press, or it may provoke other problems. If women receive little support for that situation here in the US, it seems unlikely that women in developing countries will be given any kind of warning.
A recent study revealed that surveys that report a lack of women in developing companies using any form of contraception often overlook women’s use of non-pharmaceutical methods. When asked, women assume “contraception” means a drug or device, when they might be using a form of fertility awareness or withdrawal. Rather than building on the foundation of what is already used, strategies implemented from the outside seek to replace them with “modern” contraceptive methods – often citing their desirability in richer, developed countries. But will we see Sayana Press used here in the US? Depo-Provera is used by only 3% of American contraceptive users currently. And yet it is used at a far higher rate than the pill in some areas of developing countries. Condom use has a far lower growth rate than injectable contraceptives in the same areas.
Is Sayana Press really set to make family planning “easier,” as the BBC’s coverage suggests? Easier, we might ask, for whom?