The aim of this study was to examine continuation of subcutaneous and intramuscular depot medroxyprogesterone acetate (DMPA-SC and DMPA-IM) when administered by facility-based health workers in Burkina Faso and Village Health Teams (VHTs) in Uganda. Participants were family planning clients of health centers (Burkina Faso) or VHTs (Uganda) who had decided to initiate injectable use. Women selected DMPA-SC or DMPA-IM and study staff followed them for up to four injections (providing 12 months of pregnancy protection) to determine contraceptive continuation. Study staff interviewed women at their first injection (baseline), second injection, fourth injection and if they discontinued either product.

The subcutaneous (SC) injectable, widely known by its commercial name Sayana Press, has potential to improve access to contraceptive methods. In Burkina Faso, SC-injectables were first piloted in select regions in 2014 and introduced nationally in 2016. PMA2020 is the first national survey to track programmatic progress of SC-injectable introduction at both population and health facility levels in the country across 2 rounds of data collection: March–May 2016 and November 2016–January 2017. Over this 6-month period, SC-injectable availability at public service delivery points increased from 50% to 85%, largely driven by increases in availability among the non-pilot regions. In terms of use, while the modern contraceptive prevalence rate among all women remained constant at about 23%, SC-injectable prevalence nearly doubled from 1.1% to 2.0%, making up approximately 9% of all modern method users in Burkina Faso by late 2016, though the difference was not statistically significant. Increases were comparable between pilot and non-pilot regions. While the difference was not statistically significant, more rural women were using the method compared with their urban counterparts in the pilot regions, an interesting finding considering the opposite pattern is generally true for contraceptive prevalence nationally. In summary, following national scale-up, data show substantially improved availability of SC-injectables at service delivery points and potential for changes in the method mix in Burkina Faso. In order to further improve contraceptive access and choice, scale-up of community-based distribution of SC-injectables should be considered, especially among rural populations with higher unmet need for family planning.