DMPA-SC: an emerging option to increase women’s contraceptive choices

As countries strive to achieve the Sustainable Development Goal of universal access to sexual and reproductive health care services — including modern contraceptive methods through Universal Health Coverage (UHC) strategies, and the Family Planning 2020 goal of expanding access for an additional 120 million women and girls in 69 of the world’s poorest countries — policymakers and program managers have a heightened interest in providing contraceptive methods that better meet women’s needs. A subcutaneous formulation of the injectable depot medroxyprogesterone acetate (DMPA-SC) is one such option for broadening the spectrum of contraceptive choices. DMPA-SC combines the characteristics of an injectable contraceptive with a technology that facilitates task sharing of its delivery to community health workers (CHWs) as well as the possibility of self-injection by women. DMPA-SC is available in a prefilled, single-use injection device marketed as Sayana® Press. While DMPA-SC has many similarities to intramuscular DMPA (DMPA-IM) — it is taken every 3 months, is highly effective and has a similar side effect profile — it also has some significant differences:

• A lower dose of DMPA (104 mg for DMPA-SC versus 150 mg for DMPA-IM) that achieves similar systemic drug levels;
• Smaller needle size (2.5 cm for DMPA-SC versus 3.8 cm for DMPA-IM);
• Subcutaneous administration that is usually less painful than intramuscular injection, but skin reactions are more common;
• An all-in-one device that reduces the commodities needed and requires less skill to administer.

DMPA-SC is currently registered in 33 countries by government authorities or through a World Health Organization (WHO) collaborative procedure. Approximately one million doses of DMPA-SC have been used worldwide through introductory research studies, mostly in sub-Saharan Africa and South and Southeast Asia. Research to date has consistently demonstrated DMPA-SC’s safety, effectiveness and acceptability to both users and health care providers. While this consistency is encouraging, further evidence would help guide acceptable, efficient and effective ways to maximize its potential.