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Update to US Selected Practice Recommendations for Contraceptive Use

Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate

The United States Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by the Centers for Disease Control and Prevention (CDC) from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers. In 2021, the CDC evaluated the 2019 WHO recommendation on self-administered DMPA-SC. CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.

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