Expanding Effective Contraceptive Options: Lessons Learned from the Introduction of the Levonorgestrel Intrauterine System (LNG-IUS) in Zambia and Madagascar

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214 million women in developing countries do not wish to become pregnant yet are not using a modern method of family planning (FP). Top method-related reasons for non-use of modern contraceptives include contraceptive side effects, infrequent sex, a need for discreet methods and methods compatible with breastfeeding. Studies suggest that the critical factors for meeting women’s contraceptive needs are access to a broad choice of methods, improvement in the quality of information and services available, a consistent supply of contraceptive products, and the reduction of social barriers to use.


Expanding Effective Contraceptive Options (EECO) is a USAID project with funding from 2013-2022 that supports the introduction of new contraceptive options, like the SILCS diaphragm, and dual protection methods, like the women’s condom. Each product in the EECO portfolio is designed to address one or more method-related reasons for non-use of contraception. Among these methods is the Levonorgestrel Intrauterine System (LNG-IUS), a contraceptive option with a side effect profile that differs from other methods and may appeal to women seeking reduced menstrual bleeding.

EECO conducts pilot introductions of new contraceptive products, like the LNG-IUS, in countries that have high levels of unmet need for contraception such as Madagascar, Malawi, Niger, Nigeria, and Zambia. By the project’s end, EECO will have produced step-by-step roadmaps for product introduction which can be used to scale up access to the products or expand introduction to additional countries.

This program brief focuses on the lessons learned through each stage of the project’s pilot introductions of the LNG-IUS in Zambia and Madagascar from 2016 to 2018.


WCG Cares (WCG) leads the team, bridging the private sector and non-profit worlds, and linking upstream product developers/suppliers and downstream marketing and distribution partners. WCG leads regulatory and quality assurance efforts, intensive medical detailing and data collection.

Population Services International (PSI), the social marketing and service delivery partner, works through existing healthcare and product distribution networks to market EECO products. In Zambia, PSI works through its local network member, the Society for Family Health.


EECO introduces new and innovative contraceptive products by collaborating with market players along the supply chain from product manufacturers to providers and clients, as well as the stakeholders who influence the policy environment for FP. EECO product introduction takes place in five stages, which are outlined in Figure 1.