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.
The Access Collaborative provides free data-driven technical assistance (TA), coordination, resources, and tools to ensure that women and girls have increased access to DMPA-SC and 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.
This DMPA-SC Advocacy Pack brief details the strong body of evidence and experience with self-injection of DMPA-SC, including how the practice can reduce access-related barriers, improve contraceptive continuation, and enhance women’s autonomy.
These DMPA-SC Advocacy Pack briefs outline existing evidence on DMPA-SC grouped into top-line messages featuring data from different countries. Several “spotlight” handouts on specific topics can be paired with the summary brief as needed. All handouts can be printed and distributed directly to decision-makers.
One-third of contraceptive users in low- and middle-income countries access their method from a private sector source. Momentum is growing to ensure that contraceptive injectables, including DMPA-SC/self-injection, are among the range of methods offered through private channels. Speakers shared the latest evidence regarding pharmacy and drug shop provision of DMPA-SC/self-injection, updates on the release of a generic product, reflections on packaging for the private sector, and tensions between equity and financial sustainability in a changing landscape for contraceptive procurement financing. Speakers and participants discussed innovations to improve private sector channel economics and advance both equity and sustainability.
On March 21, 2023, the DMPA-SC Access Collaborative hosted this webinar highlighting the strengths and gaps of monitoring scale-up in the context of efforts to institutionalize DMPA-SC and self-injection in national family planning programs. The discussion focused on findings from Madagascar, Nigeria, Uganda, and Zambia, touching upon national goals for DMPA-SC, in-country perspectives on the value proposition of DMPA-SC, and suggested indicators for use in tracking the scale-up of a new product.
An in-depth look at DMPA-SC and self-injection introduction in Zambia
The DMPA-SC Access Collaborative (AC) hosted this virtual discussion on February 16, 2023 to explore the challenges of introducing new contraceptive methods in the context of informed choice programming. This webinar focused on findings from a recent study conducted in Zambia which aimed to determine:
The barriers to clients’ ability to exercise autonomy in their choice of family planning methods and modes of administration.
The extent to which provider perceptions and method bias affect access to self-injection as a new contraceptive option.
This research was conducted as part of the AC’s broader learning agenda and focused on the potential risks to informed choice that could arise as new products or service innovations are integrated in family planning programs. While a new intervention is intended to expand contraceptive access and options, its introduction may inadvertently convey to providers that it is inherently better than existing products or practices. In the case of DMPA-SC, providers may promote self-injection over provider administration. Alternatively, providers may feel hesitant about a new method and withhold information. In either case, the client’s right to receive accurate information about a variety of methods and to make an informed choice about her reproductive health care is compromised. To explore these questions, the AC conducted a literature review and study interviewing both clients and providers to understand how DMPA-SC and self-injection are being offered in Zambia’s Copperbelt Province.
The DMPA-SC Access Collaborative has produced the brief and program design guide linked below to support countries and partners that are planning and rolling out DMPA-SC self-injection as part of an expanded range of contraceptive methods delivered through informed choice programming.
The Recommendations for Contraceptive Self-Injection brief summarizes the latest key findings, insights and recommendations the AC has accumulated through six years of technical assistance to ministries and partners engaged in self-injection program introduction and scale-up. These practices should be universally considered and implemented to increase family planning program success.
The Contraceptive Self-Injection Program Design Guide is a comprehensive tool that outlines optimal program models for DMPA-SC self-injection. It was originally developed in 2020 based on the self-injection program rollout in Uganda, the first country in sub-saharan Africa to offer contraceptive self-injection outside of a research setting. The guide has been updated in 2022 to reflect subsequent learnings, evidence, and data from scale-up efforts. The program design guide:
Walks users through each step of a self-injection program, including all components related to health workers and clients.
Highlights essential evidence on self-injection program design.
Establishes areas where more research is needed.
Draws attention to key moments for program design decision-making.
Links users to additional resources and tools for program development.
The global family planning handbook provides high-quality, up-to-date guidance for health care professionals working in low- and middle-income countries. “Chapter 4: Progestin-Only Injectables” includes information and guidance for DMPA-SC administration and self-injection.
Results From the Uganda Self-Injection Best Practices Project
We used qualitative and quantitative data to evaluate the differing experiences of adolescents and adult women in the contraceptive self-injection program in primary care settings in Uganda. From these results, we assessed barriers to adolescent DMPA-SC self-injection access and continuation and provide recommendations to address them.
The Self-Injection Best Practices project (2017–2019) in four districts trained clinic-based providers and Village Health Teams to provide self-injection training in clinics, community settings, and small group meetings for adolescent girls and young women. More than 12,000 women of reproductive age received self-injection services through the program, including 2,215 under 20 years. Structured surveys (n = 1,060) and in-depth interviews (n = 36) were conducted with randomly selected adolescent participants between July and November 2018. Mixed-effects logistic regression was used to assess quantitative differences in outcomes of interest between age groups.
The study found no significant difference in self-injection proficiency or continuation between adolescents and adult women; 92.6% of adolescents self-injected independently when due for reinjection. Adolescents were significantly less likely than adults to report first hearing about self-injection from a community health worker. More adolescents expressed concern over discovery when seeking contraception at a clinic and fear of their DMPA-SC units being discovered at home. Adolescents were significantly less likely than adult women to mention convenience as a rationale for self-injecting, and more likely to mention wanting to learn a new skill and/or that friends recommended self-injection.
Self-injection is a promising method of contraception for adolescents in Uganda, given comparable proficiency and continuation relative to adult women. Policies and programs should ensure rights-based access to a range of methods, including self-injection for this age group.