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SANGINI (Depo-Provera): Three Monthly Injectable contraceptives (DMPA) through Pharmacies in Nepal

Social Franchising of Injectable contraceptive was introduced  in Nepal on September 25,1994 by a non -profit marketing company popularly known as Nepal Contraceptive Retail Sales company, on a pilot basis in Kathmandu Valley through the network of Pharmacies, under a local brand name called Sangini-Tin Mahiney Sui. Prior to social franchising of Sangini, Depo-Provera was available only through public sector clinics and hospitals. In the first year Sangini was introduced through 50 trained and certified service providers (Paramedical) in selected medical shops in Kathmandu valley and was priced at Rs. 40 in the retail market including service charge.

Nepal CRS Company was responsible for marketing the contraceptive where as Nepal Fertility Care Centre (NFCC) was responsible for conducting quality of care service which includes training and monitoring quality of care in the 50 outlets. These initial 50 pharmacies were selected to participate in the quality of care service training to certify them to sell and administer Sangini in their medical shops.

In the first year Sangini was sold 1,248 vials through 50 medical shops and in the second year, it was expanded outside the capital to 170 medical shops and increased the sale to 11,424 vials. In the third year the number of medical shops reached to 274 and sales was 48,372 vials. In the 4th and 5th year, the number of outlets reached to 430 and 737 and the sales was a 51,190 and 94,435 vial. The social franchising of Sangini has now expanded to all 75 districts and the total number of franchising outlets have reached to 3,301 outlets while its sales have reached to 491,418 vials in the year 2011/2012.

Sangini is provided at Rs.45 per vial through Sangini Franchising outlets.

What is Depo-Provera?

Depo-Provera (Medroxy progesterone acetate) is a drug very similar to progesterone, a hormone normally produced by the ovaries every month as part of the menstrual cycle. Depo-Provera is an injectable form of contraceptive that prevents pregnancy for up to 3 months with each injection.

How does it work?

Depo-Provera prevents pregnancy by stopping ovulation (the release of an egg from the ovary). If an egg is not released, pregnancy is unlikely. Depo-Provera is given as 1 shot in the buttock or upper arm. The first shot should be given within 7 days after the beginning of a normal menstrual period, and shots should be repeated every 3 months.

Is it effective?

Depo-Provera is 99.7% effective preventing pre

gnancy. It does not, however, protect against sexually transmitted diseases such as AIDS.

Is the effect permanent?

No. Depo-Provera only works for about 3 months. The shot must be repeated every 3 months to prevent pregnancy. After a woman stops using Depo-Provera, her normal ovarian function returns after a short time.

Are there side effects?

Most women have some changes in their menstrual periods while using Depo-Provera, including irregular and unpredictable bleeding or spotting, an increase or decrease in menstrual bleeding, or no bleeding at all. The absence of periods is not harmful, and periods usually return to normal after Depo-Provera is stopped. If unusually heavy or continuous bleeding occurs, you should see your doctor. Other possible side effects include weight gain, headaches, nervousness, abdominal discomfort, dizziness and weakness or fatigue.

Can I use it if I am breast feeding?

Depo-Provera can be used safely in women who are breast feeding. Long-term studies of babies whose mothers used Depo-Provera while breast feeding found no bad effects.

Who should not use Depo-Provera?

Women who have any of the following should not use Depo-Provera: liver disease, a history of blood clots (phlebitis) or stroke, vaginal bleeding without a known reason, cancer of the breast or reproductive organs, known or suspected pregnancy.