The privacy, safety, and effectiveness of injectable contraceptives make them a widely used option in many countries. Traditionally, DMPA has been injected into a muscle with intramuscular DMPA (DMPA-IM), which generally requires more training and skill. Subcutaneous DMPA (DMPA-SC) combines a lower dose of DMPA and a shorter needle into a single device that is injected into the fat underneath the skin rather than muscle, protecting against pregnancy for three months. Because DMPA-SC is small, light, and easy to use, any trained person can administer it—including community health workers, pharmacists, and even women themselves through self-injection.
Sayana® Press, the currently available DMPA-SC product, is manufactured by Pfizer Inc. and combines the drug and needle in the prefilled BD Uniject™ injection system, which was originally developed by PATH. The product is now available in more than 50 countries and is approved by regulatory agencies in more than 70 countries worldwide, including in the European Union. The drug used in DMPA-SC is also registered with the United States Food and Drug Administration (as depo-subQ provera 104™). Donors are also investing in the development of an affordable generic alternative to ensure diversity of supply in the future.
Evidence has demonstrated that DMPA-SC is safe, effective, and highly acceptable, and that it can increase access and/or continuation for women and adolescent girls in their communities and homes, including through self-injection.
By putting the power of prevention directly in women’s hands, self-injection with DMPA-SC has the potential to reduce access-related barriers for women, increase contraceptive continuation rates, and enhance women’s autonomy.
Self-injection is an evidence-based practice that is endorsed globally, approved nationally, and being introduced and scaled up in a growing number of countries. Data from multiple countries show that women, including women in low-resource settings, can self-administer DMPA-SC safely and effectively, and that they like doing so. And the World Health Organization (WHO) has made a “strong” recommendation for self-injection in its guidance on self-care interventions for health, stating that it should be made available as an additional approach to deliver injectable contraception and for self-care.
The branded DMPA-SC product Sayana® Press is registered for self-injection in nearly 60 countries, including the United Kingdom and several European countries. More than 30 countries are scaling up self-injection, including Burkina Faso, the Democratic Republic of the Congo, Madagascar, Malawi, Nigeria, Senegal, Uganda, and Zambia.