Year 8 Semi-Annual Performance Monitoring Report: Expanding Effective Contraceptive Options (EECO)

The project focuses on four products: modern fertility awareness method (mFAM) apps, the hormonal intrauterine device (hormonal IUD), the Dual Prevention Pill (DPP), and the SILCS Diaphragm, also known as Caya. The project operates in multiple countries, including Zambia and Madagascar. In Zambia, the project has been working to introduce the hormonal IUD, including the Avibela brand from Medicines360. The project has selected MSI Reproductive Choices - Zambia as the new Marketing Authorization Holder and Local Technical Representative for Avibela in Zambia. The project has also prepared and submitted post-approval variations for Avibela in Zambia, including changes to the Marketing Authorization Holder, indication for use, and shelf life. The project has also supported the procurement and quality assurance of the hormonal IUD in Zambia. EECO-supported sites received a final donation of unbranded hormonal IUD units from the International Contraceptive Access Foundation in early 2020. The project has also oriented provincial maternal and child health coordinators and provincial pharmacists on monthly and quarterly reporting on the supply chain, stock, and service delivery in preparation for national scale-up of the hormonal IUD in the public sector. As of the end of the project activities in Zambia, 2,073 women had received voluntary hormonal IUD insertions since EECO-supported services began in mid-2017. Public sector community health workers will continue to educate communities on the full range of available family planning methods, including the hormonal IUD, without EECO funding. In Madagascar, the project has also been working to introduce the hormonal IUD, including Avibela. The project has prepared post-approval variations for Avibela in Madagascar, including minor Chemistry, Manufacturing, and Controls changes. A new abbreviated marketing authorization will also be filed to change the Marketing Authorization Holder from Population Services International Madagascar to Medicines360. The project has also supported service delivery of the hormonal IUD in Madagascar. During this reporting period, 47 providers continued to offer Avibela in 37 private and public clinics throughout five regions of Madagascar. The project has also generated demand, distributed stock, monitored service quality, and provided supportive supervision to Avibela providers while maintaining COVID-19 mitigation measures. The project has also strengthened its engagement of satisfied users as family planning champions in Madagascar. Satisfied users, composed of different social and demographic profiles, promoted the advantages of modern family planning to groups of women in their communities. The top reasons satisfied users cited for adopting Avibela were lighter and fewer periods leading to well-being and opportunities for professional activities, minor side effects, and Avibela as an option to treat menstrual disorders and/or fibroids. The project has also collaborated with a charity organization that provides services for adolescent girls who had early pregnancies before the age of 18. Brand Ambassadors spoke with these adolescent mothers about voluntary family planning, including Avibela, and made referrals to EECO-trained providers. The project has also supported providers to use Population Services International's approach to Counseling for Choice, which includes PSI's "Choice Book" job aid. This approach has been used to counsel clients on the benefits and risks of different family planning methods, including the hormonal IUD. The project has also conducted in-depth interviews and focus group discussions with clients and providers to gather feedback on the project's services and identify areas for improvement. The project has also conducted a study on the acceptability of the hormonal IUD in four countries, including Zambia. The study found that the hormonal IUD was highly acceptable among clients, with many citing its convenience and effectiveness as reasons for choosing the method. However, the study also found that some clients experienced side effects, such as bleeding and cramping, which may have affected their ability to continue using the method. Overall, the EECO project has made significant progress in introducing new and improved family planning methods, including the hormonal IUD, in multiple countries. The project has also strengthened its engagement of satisfied users as family planning champions and has collaborated with local organizations to promote the benefits of modern family planning.