Injectable contraception: emerging evidence on subcutaneous self-administration

Purpose of review: Injectable contraception is a widely available and popular family planning method globally. It has evolved to allow for subcutaneous self-injection (DMPA-SC, Depo medroxyprogesterone acetate-subcutaneous). In this review, we will focus on research evaluating DMPA-SC, with specific regard to continuation rates, safety, and satisfaction among users.

Recent findings: Emerging evidence from the United States, Malawi, Uganda, and Senegal has established safety and higher continuation rates among self-inject users, compared with provider-inject users. Continuation is 10–28% higher among DMPA-SC self-inject users. Self-inject users across studies were highly satisfied and reported DMPA-SC was easy to use. Studies indicate continuation is likely to be attributable to self-administration and user autonomy, rather than inherent properties of the DMPA-SC injection.

Summary: DMPA-SC should be made available in high-resource and low-resource settings. Future efforts should be focused on implementation and evaluating how to best add DMPA-SC to the method mix. Cost–benefit analyses will need to evaluate the up-front costs of DMPA-SC for clients, facilities, and health systems compared with the higher continuation rates and saved opportunity-costs over time. Task-shifting strategies and development of mobile phone technologies to assist users in adherence should be considered in future service scale-up.