To expand contraceptive options available for women in Morocco, reduce the risks associated with unintended pregnancies, and encourage the use of self-care interventions for sexual and reproductive health and rights, a pilot project to introduce the self-administered injectable contraceptive has recently been completed.
The successful pilot came about as part of efforts to implement the World Health Organization’s (WHO) guideline on self-care interventions for health and well-being, involving a four-way partnership between WHO; organisation Panafricaine de lutte contre le sida (OPALS) a non-government organization; the Ministry of Health and Social Protection’s Division of Family Planning and UNFPA.
From a global to a national level
Within two months of the publication of the global guideline, Morocco had adapted and launched it, making it the first country in the world to do so. Self-care interventions have also been integrated into the national sexual and reproductive health strategy – another first for Morocco with it being the first country in WHO’s Eastern Mediterranean Region to achieve this milestone.
Greater access and more autonomy
In Morocco, 71% of married women use some form of contraception and 61% use a modern method, typically the contraceptive pill.
Although injectable contraception was already available in the country it had to be administered by a health worker in a health facility. The self-administered version, however, can easily and safely be administered by a client herself, either at home or in another non-health setting. This self-care intervention gives women greater autonomy and provides 12 weeks of contraceptive coverage.
"Having learned about self-care interventions for sexual and reproductive health through WHO, and in view of the significant benefits that self-administered injectable contraception brings to women, it is with conviction and determination that we have helped introduce this method in Morocco," said Dr Bezad, President, OPALS.
OPALS and UNFPA, with technical support from WHO, began intense advocacy efforts to prepare the way for the self-administered version to be introduced. Having secured the Ministry’s support and with their overall leadership, the pilot began to take shape.
Having helped secure the political commitment needed and with regulatory approval in place, UNFPA procured the 400 doses needed for the first phase of the pilot to take place. OPALS then began to train health workers, based on the new national self-care guide for sexual and reproductive health.
Training of health workers
Through training sessions, health workers were taught to show clients how to self-administer the injection by the WHO Collaborating Centre for Sexual and Reproductive Health in Rabat. At first, some health workers were worried that clients would not be able to administer the injection safely or effectively. However, with information, education and training, their fears were quickly put to rest, and they embraced this new approach.
UNFPA and OPALs also held a convention with the Association of Pharmacists to raise awareness of the pilot among their members and encourage them to refer potential clients.
The launch of the pilot
In November 2021, during the COVID-19 pandemic, the pilot project began in seven locations including Rabat, Salé, Beni Mellal, Marrakesh and Meknes.
To receive their first dose, clients attended either an OPALs center, a government-run primary health care facility or the WHO Collaborating Centre where they were taught to self-administer the injection. At three-month intervals, they returned to collect their next dose. Some chose to self-administer the injection at the health facility with a health worker present, whilst others chose to do it at home or in another setting where they felt safe. All doses were free of charge to the client.
“For me this method has several advantages: it is simple, it is long-lasting, and it is discreet,” one client said.
A learning exchange and way forward
Experiences from the pilot were shared on World Contraception Day 2022 between representatives from the Ministry, OPALs, UNFPA, other partners, and the Ministry of Health in Senegal, which shared its experience of introducing self-care interventions. Issues discussed included how to provide better competency-based training for health workers.
Following the pilot, discussions are now taking place to see if self-administered injectable contraception could be introduced more widely in Morocco and to update, finalize and disseminate the national guidelines on self-care interventions. One key issue is the high cost per dose of this contraceptive method, which is currently around US$27 per unit. Talks with the Ministry are exploring whether such costs could be included in future health budgets or if this new method could be introduced into the essential benefit package for universal health coverage in Morocco.