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International Perspectives on Sexual and Reproductive Health

ALLOWING LICENSED CHEMICAL SELLERS IN GHANA TO SELL INJECTABLE CONTRACEPTIVES COULD INCREASE USE

Selling injectable contraceptives at licensed chemical seller shops, a term used in Ghana for privately owned drug shops operated by nonpharmacists licensed to sell a variety of over-the-counter medicines, could increase access to and use of the method, according to “Injectable Contraceptive Sales at Licensed Chemical Seller Shops in Ghana: Access and Reported Use in Rural and Periurban Communities,” by Elena Lebetkin of FHI 360, et al. Use of modern contraceptives remains low in Ghana, with only 23% of married women currently using a modern method. The majority of women in Ghana get oral contraceptives and condoms from shops operated by licensed chemical sellers who are not legally permitted to sell or administer the injectable, the country’s most widely used method.

In 2012, the organization FHI 360—with support from Ghana Health Services and the Pharmacy Council—implemented an intervention in two districts in the country’s Ashanti region to examine whether the sale of the injectables in shops was associated with increased access to and use of the method. A sample of licensed chemical seller shop operators were trained to stock and sell the injectable, and to refer women to a qualified health care provider for counseling, screening for medical eligibility and injection.

According to the analysis, 97% of shop operators reported selling the injectable, and 94% said they felt qualified to provide family planning methods and services. Ninety-nine percent of shops that sold the injectable referred their clients to a health facility for the injection, and 97% of clients said they got their injection at the health facility to which they were referred.

Women most commonly reported convenience of the shop location (29%) and trust of and comfort with the seller (22%) as reasons for purchasing the injectable at a licensed chemical shop. In addition, 33% reported that shops sold the injectable at lower prices than health facilities and 16% indicated that the method was more often in stock at shops as their reasons for buying it there rather than at a health facility. On average, women paid US$1.18 combined for the method, the cost of the injection being administered and transportation expenses.

Some 31% of women completed a follow-up interview three months after their initial injectable purchase. Of these, 79% reported buying the injectable again from a licensed chemical seller. The majority of those who had not bought again from a shop said they were no longer using a contraceptive method, while a few women reported buying the injectable from another source.

The researchers note that most women who use the injectable (87%) currently get their injections from public-sector health facilities, even though the method is often out of stock at these facilities. According to the researchers, licensed chemical sellers have several advantages over pharmacies and health facilities that would make them a good resource for providing the injectable—they outnumber pharmacies five to one nationwide, they keep longer hours than public health facilities and clients perceive that their staff are friendlier.

Injectable Contraceptive Sales at Licensed Chemical Seller Shops in Ghana: Access and Reported Use in Rural and Periurban Communities,” by Elena Lebetkin is now available online and in the most recent issue of International Perspectives on Sexual and Reproductive Health.

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Also in this issue of International Perspectives on Sexual and Reproductive Health :

"Unmet Need, Intention to Use Contraceptive and Unwanted Pregnancy in Rural Bangladesh," by Rebecca Callahan and Stan Becker;

"Relationship Characteristics and Contraceptive Use Among Couples in Urban Kenya," by Laili Irani, Ilene S. Speizer and Jean-Christophe Fotso;

"Differences in Unintended Pregnancy, Contraceptive Use and Abortion by HIV Status Among Women in Nigeria and Zambia," by Akinrinola Bankole, Sarah Keogh, Odunayo Akinyemi, Kumbutso Dzekedzeke, Olutosin Awolude, and Isaac Adewole;

"Is Age Difference Between Partners Associated with Contraceptive Use Among Married Couples in Nigeria,"Latifat Ibisomi.