ECHO Study: The Successes and Challenges of Long-Acting Contraception

In developing countries, there will be an estimated 89 million unintended pregnancies this year. Nearly three quarters of these women are predicted to have no access to any contraception. This directly affects maternal mortality.

There are 308 thousand expected maternal deaths in 2017. This can be reduced to 84 thousand with full contraceptive coverage and maternal care so access to contraception is vital not just for women’s choice but preventing many maternal deaths


ECHO Study

The ECHO  (Evidence for Contraceptive options and HIV Outcomes Trial) study wants to look at contraception outcomes when women use different long-acting contraceptive methods and find what is the risk of HIV while using the method and also how women feel using the methods. The study, centered in the Desmond Tutu HIV Foundation Emavundleni clinic, has 18 months of follow up per participant with an HIV test every three months. Contraceptive options include a copper IUD (intrauterine device), a Jadelle implant that goes in the arm or the DMPA (Depo-Provera®), an injectable. The study enrolled young women aged 18-35.

During the study, the participants were randomised onto different contraceptive methods. Generally, South Africans want to use the injectable so it can be a challenge to ask women to change their contraceptive choice for eighteen months.

Contraceptive methods – DMPA injectable, LNG implant, IUD implant (left to right) | ECHO


Factors influencing uptake

During the study, the researchers at Emavundleni asked the participants which people in their lives affected their choice of contraception. They found that the views of the community, education and health care providers had the greatest influence, followed by family and peers. Often, partners had the least influence over these young womens’ contraception uptake.

Dr Shakeera Arnolds, a medical doctor at the Desmond Tutu HIV Foundation (DTHF) and one of the researchers on the study, commented that “most of them are unmarried, so they don’t discuss with their partners about the type of contraception they use. They discuss with their mothers, their peers, their aunts.” This is why the partners had such a low influence over contraceptive choices.



“I think our biggest success, other than getting women to continue their randomised methods and educating them, we’ve had increased uptake (of long acting reversible contraception) in the community” commented Dr Sheetal Kassim, a medical officer at DTHF who was also a researcher for the study.

Women have been introduced to different choices in contraceptives after the study. Expert staff were seen to be very important for facilitating different choices in contraception; this included dependable insertion and removal procedure information.

The ECHO study provided contraception to 560 women. This is a huge burden off the local clinics and empowers these women by enabling them to decide when they want to get pregnant. Some women in marriages, for example, are unable to negotiate when they have sex or condom-use and these contraceptives give them power to choose when they have a baby. The future of the ECHO study is to expand the uptake of long-acting reversible contraception.

Family planning is key to combating poverty, empowering women, improving maternal and child health and also preventing HIV. The chance of pregnancy is reduced with condom-use and the majority of new HIV infections are from sexual transmission which can also be prevented using condoms. The contraceptives used in the ECHO study reduce the number of unintended pregnancies and therefore also the number of HIV positive mothers, children and orphans.


The ECHO Study is funded by a consortium of donors: the Bill & Melinda Gates Foundation, the US Agency for International Development, the Swedish International Development Cooperation Agency, the United Nations Population Fund, and the Medical Research Council of South Africa. In addition, USAID and the South African government are donating the contraceptives used in the study.

ECHO is one of the many research trials ongoing at the clinic at the Philippi clinic. To find out what other trials are ongoing at this clinic, click here.