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WHO Consolidated Guideline on Self-Care Interventions for Health

This guidance from the World Health Organization (WHO) aims to provide a people-centred, evidence-based normative guideline that will support individuals, communities, and countries with quality health services and self-care interventions, based on PHC strategies, comprehensive essential service packages and people-centredness. The guidance includes a “strong” recommendation for self-administered injectable contraception, stating that this should be made available as an additional approach to deliver injectable contraception for individuals of reproductive age.

Institutional Author(s): World Health Organization (WHO)
Publication date: June, 2021

How self-injection contributes to contraceptive autonomy and the power of making self-injection count

This opening plenary of the Making Self-Injection Count workshop highlighted how self-injection data can help close the gender data gap by providing key information and insights on the experiences of women and adolescents. Presenters discussed how self-injection can contribute to contraceptive autonomy by enabling women and girls to make and actualize their own decisions. The session featured personal stories from a self-injection ambassador, self-injection provider, and self-injection client.

Objectives

By the end of this session, participants were able to:

  • Describe the importance of self-injection for contraceptive autonomy, and self-injection in the context of self-care.
  • Describe the landscape of self-injection data availability.
  • Understand experiences of self-injection from the lens of a provider, user, and advocate.

Key takeaways

  • While progress is being made, self-injection data availability is still limited compared to other contraceptive data sets.
  • Disaggregation by client age, district, and DMPA-SC delivery mode (self-injected vs. provider-administered DMPA-SC) is essential to DMPA-SC data tracking.
  • High-quality data systems give us insight into women’s and girls’ preferences, client access to family planning, provider training needs, and global supply management opportunities.

Presenters

  • Caitlin Corneliess, MPH, Project Director, DMPA-SC Access Collaborative
  • Fannie Kachale, Director Reproductive Health Services, Ministry of Health, Malawi
  • Briana Lucido, WHO Department of Sexual and Reproductive Health and Research
  • Dr. George Swomen, MD, Programme Officer of Special Projects, Planned Parenthood Federation of Nigeria (PPFN)
  • Fatimata Deme, President, Senegalese Women’s Network for the Promotion of Family Planning
  • Matilda, Volunteer, Kibalinga Health Centre in Uganda

Institutional Author(s): PATH, JSI, Inc.
Publication date: March, 2021

Self-injected subcutaneous DMPA: A new frontier in advancing contraceptive access and use for women

This brief details the strong body of evidence and experience with self-injection of DMPA-SC in low-resource settings, including how the practice can reduce access-related barriers, improve contraceptive continuation, and enhance women’s autonomy.

Institutional Author(s): PATH
Publication date: October, 2019

Task-shifting the provision of DMPA-SC in the DR Congo: Perspectives from two different groups of providers

This article compares results from interviews with DMPA-SC providers in two separate pilot studies: 1) 53 medical and nursing school students teaching women how to self-inject (2016–2017); and 2) 34 lay community health workers providing DMPA-SC in rural areas of Lualaba (2017). All providers gave information on socio-demographic characteristics, recruitment,) training, supervision, experience and satisfaction with the provision of DMPA-SC. The paper examines variations in responses from the different provider cadres.

Institutional Author(s): Tulane School of Public Health and Tropical Medicine, Kinshasa University School of Public Health, École de Santé Publique de Lubumbashi
Individual Author(s): Julie Hernandez, Pierre Akilimali, Annie Glover, Rebecca Emel, Albert Mwembo, Jane T Bertrand
Publication date: July, 2018

Journal Article Link to Journal Article

Insight synthesis report on DMPA-SC self-injection

This report distills more than a year of programmatic research findings, looking at self-injection from a user journey perspective to analyze what drives consumer and provider decisions and attitudes. It reflects the unique perspectives of DMPA-SC self-injection early adopters and prospective users across Uganda and Nigeria. The report outlines how women perceive their own power, what makes self-injection convenient for them, who they trust as partners in their de-medicalized contraceptive experience, and more.

Institutional Author(s): Population Services International (PSI)
Publication date: September, 2021

The “why” and the “how” of routine data collection: Real world examples of using data from routine HMISs in policy and programming

In this session from the Making Self-Injection Count workshop, presenters discussed challenges to data use for decision-making and shared examples of how countries and programs have made data actionable in other health areas, specifically Malaria and immunization. The presentation included an example of an application of routine family planning data, including a new analysis of self-injection data from Senegal, and wrapped up with a panel Q&A focused on solutions.

Objectives

By the end of this session, participants were able to:

  • Understand key principles for fostering data use for decision-making.
  • Understand how countries and programs have used routine health data for decision-making.
  • Identify strategies to overcome challenges to data use.
  • Consider data quality and understand how it can be evaluated.

Key takeaways

  • Better data will lead to better decision-making and better health outcomes.
  • Data should:
    • be subjected to quality audits.
    • be delivered in a form that works for each intended audience and in alignment with their goals.
    • be shared with those who contributed the data and who have control over how services are offered.
    • include visualizations that effectively convey key details.
    • be iterative and ongoing.
  • There is a need for standardized metrics that allow for comparability among countries.

Presenters

  • Jonathan Drummey, Data Visualization Specialist, PATH
  • Fred Njobvu, Technical Advisor, Center for Digital & Data Excellence, PATH
  • Marie-Reign Rutagwera, Strategic Information Advisor, PAMO Plus, PATH
  • Jessica Williamson, Data Analyst, Track20 Project, Avenir Health

Institutional Author(s): PATH, JSI, Inc.
Publication date: March, 2021

Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi: implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

Self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is poised to increase access to contraception; however, governments are concerned about the waste management of used units. Self-injectors in Malawi and Uganda are currently instructed to store used units in containers and return them to health workers for disposal. However, this may not be feasible in low-resource settings, especially for younger or covert self-injectors. We describe adolescent (15–19 years) and adult (20–49 years) self-injectors’ disposal experiences in Uganda and Malawi. When possible, we compare covert and overt users’ experiences.

Institutional Author(s): FHI 360
Individual Author(s): Holly M Burke, Catherine Packer, Laura Wando, Symon Peter Wandiembe, Nelson Muwereza, Subarna Pradhan, Akuzike Zingani, Bagrey Ngwira
Publication date: August, 2020

Journal Article Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi: implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

Injectable Contraceptive Assessment in Uganda and Nigeria

This webinar will present the key findings from a two-phased research program funded by The Bill and Melinda Gates Foundation, in Nigeria and Uganda. The first phase was a qualitative exploration within Focus Group discussions (total sample n=600 in 100 Focus Groups (n=6 per FG) across 8 different FG types and split across 2 urban and 2 rural settings per country) with women and their male partners (separately). The second phase was a quantitative survey with women (total sample n=1,410 women) split across 4 regions within each country. The research explored several central topics: the various contraceptive journeys and experiences of women and their male partners, including satisfied and discontinued users of the injectable contraceptive (Depo), satisfied users of the DMPA-SC (Sayana Press), naïve users of modern contraceptive and those using traditional methods. Factors which lead to discontinuation and experiences with/perception of side effects. Gauge level of acceptability and preference for certain injectable attributes, in particular the impact of DMPA-SC 3 months or a potential 6 month injectable on likelihood to try. We tested 3 fully developed concepts and vary the most impactful features from phase 1 with women. Develop a forecast model for the Depo, DMPA-SC 3 month and a potential 6 month injectable in Nigeria and Uganda.

Institutional Author(s): Reproductive Health Supplies Coalition (RHSC), Routes2Results
Publication date: November, 2019

Costs and cost-effectiveness of subcutaneous DMPA through different delivery channels: What new evidence tells us

This brief summarizes recent evidence from African countries on the costs and cost-effectiveness of DMPA-SC. Key findings include that DMPA-SC may help reduce service delivery costs by catalyzing expansion of channels closest to women and that self-injected DMPA-SC is cost-saving as compared to clinic-administered DMPA-IM when accounting for costs to women and health systems.

Institutional Author(s): PATH
Publication date: October, 2019

Self-administration of injectable contraception: a systematic review and meta-analysis

Introduction: Depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) may facilitate self-administration and expand contraceptive access. To inform WHO guidelines on self-care interventions, we conducted a systematic review and meta-analysis comparing self-administration versus provider administration of injectable contraception on outcomes of pregnancy, side effects/adverse events, contraceptive uptake, contraceptive continuation, self-efficacy/empowerment and social harms.

Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, LILACS and EMBASE in September 2018 for peer-reviewed studies comparing women who received injectable contraception with the option of self-administration with women who received provider-administered injectable contraception on at least one outcome of interest. Risk of bias was assessed using the Cochrane tool for randomised controlled trials (RCTs) and the Evidence Project tool for non-randomised studies. Meta-analysis was conducted using random-effects models to generate pooled estimates of relative risk (RR).

Results: Six studies with 3851 total participants met the inclusion criteria: three RCTs and three controlled cohort studies. All studies examined self-injection of DMPA-SC; comparison groups were either provider-administered DMPA-SC or provider-administered intramuscular DMPA. All studies followed women through 12 months of contraceptive coverage and measured (dis)continuation of injectable contraception. Meta-analysis found higher rates of continuation with self-administration compared with provider administration in three RCTs (RR: 1.27, 95% CI 1.16 to 1.39) and three controlled cohort studies (RR: 1.18, 95% CI 1.10 to 1.26). Four studies reported pregnancies; all showed no difference across study arms. Four studies reported side effects/adverse events; while two controlled cohort studies showed increased injection site reactions with self-administration, no other side effects increased with self-administration. One study found no difference in social harms. No studies reported measuring uptake or self-efficacy/empowerment.

Conclusion: A growing evidence base suggests that self-administration of DMPA-SC can equal or improve contraceptive continuation rates compared with provider administration. This benefit comes without notable increases in pregnancy or safety concerns. Self-injection of DMPA-SC is a promising approach to increasing contraceptive use.

Institutional Author(s): Johns Hopkins Bloomberg School of Public Health, World Health Organization (WHO), PATH
Individual Author(s): Caitlin E Kennedy, Ping Teresa Yeh, Mary Lyn Gaffield, Martha Brady, Manjulaa Narasimhan
Publication date: April, 2019

Journal Article Link to Journal Article