Based on evidence and experience, countries worldwide are adding the option of DMPA-SC self-injection to their contraceptive method mix.
Self-injection has the potential to reduce access-related barriers for women, increase contraceptive continuation rates, and enhance women’s autonomy. There are strong data that women, including women in low-resource settings, can self-administer DMPA-SC safely and effectively, and that they like doing so.
Contraceptive self-injection (SI) is a new self-care practice with potential to transform women’s family planning access by putting a popular method, injectable contraception, directly into the hands of users. Research shows that SI is feasible and acceptable; evidence regarding how to design and implement SI programs under real-world conditions is still needed. This evaluation examined women’s experiences when self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was introduced in Uganda alongside other contraceptive options in the context of informed choice. We conducted structured survey interviews with 958 randomly selected SI clients trained in three districts in 2019. SI clients demonstrated their injection technique on a model to permit an assessment of injection proficiency. A randomly selected subset of 200 were re-interviewed 10–17 months post-training to understand resupply experiences, waste disposal practices and continuation. Finally, we conducted survey interviews with a random sample of 200 clients who participated in training but declined to self-inject. Data were analyzed using Stata IC/14.2. Differences between groups were measured using chi square and t-tests. Multivariate analyses predicting injection proficiency and SI adoption employed mixed effects logistic regression. Nearly three quarters of SI clients (73%) were able to demonstrate injection proficiency without additional instruction from a provider. Years of education, having received a complete training, practicing, and taking home a job aid were associated with higher odds of proficiency. Self-reported satisfaction and continuation were high, with 93% reinjecting independently 3 months post-training. However, a substantial share of those trained opted not to self-inject. Being single, having a partner supportive of family planning use, training with a job aid, practicing, witnessing a demonstration and exposure to a full training were associated with higher odds of becoming an SI client; conversely, those trained in a group had reduced odds of becoming an SI client. The self-care program was successful for the majority of women who became self-injectors, enabling most women to demonstrate SI proficiency. Nearly all those who opted to self-inject reinjected independently, and the majority continued self-injecting for at least 1 year. Additional research should identify strategies to facilitate adoption by women who wish to self-inject but face challenges.
Institutional author(s): PATH
Individual author(s): Jane Cover, Allen Namagembe, Chloe Morozoff, Justine Tumusiime, Damalie Nsangi, Jennifer Kidwell Drake
Publication date: August, 2022
The DMPA-SC Access Collaborative provides data-driven technical assistance (TA), resources, and tools that countries need for designing, implementing, and monitoring the introduction and scale up of DMPA-SC self-injection as part of an expanded range of contraceptive methods, delivered through informed choice programming.
In addition to general information and evidence on DMPA-SC, partners can access the support outlined in the menu below by submitting a request through the technical assistance request form, also linked below. Your request can be submitted by emailing the completed form to FPoptions@path.org.
The DMPA-SC Access Collaborative has published a collection of briefs on countries where we have provided focused technical assistance between 2017 and 2021. This includes the Democratic Republic of the Congo, Kenya, Madagascar, Nigeria, Uganda, and Zambia. Each brief describes the country’s introduction and scale-up experiences for DMPA-SC and self-injection, including accomplishments, challenges, innovations, key lessons, factors for success, and plans for the way forward.
Costed implementation plans play an important role in transforming family planning commitments into concrete programs and policies by informing budget creation and management as well as funding allocations and tracking. As part of introduction and scale-up planning across countries, the DMPA-SC Access Collaborative has worked with ministries of health and partners to create costed implementation plans for DMPA-SC specifically and map commitments or available budgets against costed plans to understand funding gaps. This brief describes the Access Collaborative’s costed implementation plan approach as well as costing tools available to enable countries to estimate their own plan’s requirements and potential funding gaps. For more information or assistance, please visit the Access Collaborative technical assistance page or contact FPoptions@path.org.
The DMPA-SC Access Collaborative hosted this April 21, 2021 webinar highlighting lessons learned to date through four years of data-driven technical assistance and coordination to ensure that women have increased access to self-injection as a contraceptive option, delivered through informed choice programming. The discussion focused on key topics for the introduction and scale-up of self-injection—and self-care interventions more broadly—at the country level including:
This discussion was moderated by Monica Mutesa, Zambia Country Coordinator, DMPA-SC Access Collaborative, PATH. Speakers included:
For more information, please contact FPoptions@path.org.
Institutional author(s): PATH, JSI
Publication date: April, 2021
In this Making Self-Injection Count workshop session, participants were engaged in a lively discussion and interactive collaboration around the important considerations for private sector data collection and reporting on self-care products such as DMPA-SC. This session began with a short presentation to set the stage on the important role of private sector and data within the context of mixed health systems. Participants joined a moderated discussion with three in-country implementers from Nigeria (DKT), Uganda (PSI) and Zambia (JSI) who shared their experiences and lessons from introducing DMPA SC self-injection and other self-care products through private delivery channels. The session concluded with a facilitated, interactive activity to identify and prioritize private sector data needs.
Objectives
By the end of the session, participants were able to:
Key takeaways
Presenters
Institutional author(s): PATH, JSI
Publication date: March, 2021
Participants in this Making Self-Injection Count workshop session learned about interim data sources for self-injection data, including Performance Monitoring for Action (PMA) surveys, demographic and health surveys (DHS) surveys, and low-resource, short-term auxiliary data collection systems. This session also highlighted efforts made to collect and use family planning data in humanitarian settings. Presenters addressed general timelines for data access in different countries and evaluated differences in indicators across data sets.
Objectives
By the end of the session, participants were able to:
Key takeaways
Presenters
Institutional author(s): PATH, JSI
Publication date: March, 2021
This session wrapped up the Making Self-Injection Count workshop and highlighted key takeaways. Participants had an opportunity to reflect on what they learned and the action steps they have identified to move forward with their work.
Key takeaways
The workshop closed with four calls to action:
Presenter
Institutional author(s): PATH, JSI
Publication date: March, 2021
In this practical, hands-on simulated data use session in the Making Self-Injection Count workshop, participants first learned about experiences running data review meetings in Kenya and Tanzania, highlighting lessons learned and best practices. Then they practiced skills using a mock decision-support tool to solve a common self-injection data challenge.
Objectives
By the end of the session, participants were able to:
Key takeaways
Presenters
Institutional author(s): PATH, JSI
Publication date: March, 2021
This session of the Making Self-Injection Count workshop took an advocacy lens to highlight the importance of self-injection data. Representatives from the Government of Malawi—which has included self-injection in their HMIS since 2019—shared an overview of their self-injection program, highlighting the process for updating their HMIS including success and challenges. They also highlighted how self-injection data has been used at the national and district program levels. Participants had an opportunity to ask questions during the question and answer session.
Objectives
By the end of this session, participants were able to:
Key takeaways
Presenters
Institutional author(s): PATH, JSI, Malawi Ministry of Health, Clinton Health Access Initiative (CHAI)
Publication date: March, 2021