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.
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.
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.
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.
By leveraging digital training tools, family planning programs can integrate new approaches that help reduce the costs, time, and inconvenience associated with traditional classroom training. The PATH-JSI Access Collaborative has recently developed digital training resources for health workers and clients learning to administer DMPA-SC.
A 10-lesson DMPA-SC eLearning course for health workers is available for free in English and French and can be taken on computer or mobile device with internet access. Content includes an emphasis on informed choice counseling, new lessons on calculating the injection date and conducting follow-up visits, and updated information on training clients to self-inject.
In addition to the eLearning course, PATH and JSI have developed short 5- to 7-minute DMPA-SC training videos for both self-injection clients and health workers. Available in English and French, the videos can be translated or adapted to fit in program contexts.
If you are interested in introducing DMPA-SC digital training approaches in your program, please contact the Access Collaborative at FPoptions@path.org.
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.
These short training videos are intended for both self-injection clients and health workers learning to administer the contraceptive DMPA-SC. The 5-minute self-injection training video is intended for women who have made the decision to self-inject DMPA-SC in the context of informed choice counseling. The 7-minute training video is for health workers who are giving injections to women who have chosen to use DMPA-SC in the context of informed choice counseling.
If you are interested in customizing these videos for your family planning program, we can make the voiceover scripts and video files available. To request these files please email FPoptions@path.org.
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.
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 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.
We want to hear from you! We welcome your reflections on the Contraceptive Self-Injection Program Design Guide. Do you have feedback for consideration? By completing this short survey open through November 30, you can help us ensure these resources are meeting the needs of key stakeholders.
This policy landscape can be leveraged by applicants interested in applying to the DMPA-SC Regulatory Advocacy Catalytic Opportunity Fund (COF). The landscape was originally developed in 2020 to understand policies and regulations, including over-the-counter regulations, that impact women’s access to DMPA-SC and identify short- and long-term advocacy opportunities. In 2022, it was refreshed to understand policy shifts and additional advocacy opportunities in a subset of 12 of the original 18 countries currently eligible for the Regulatory Advocacy COF. Insights from the policy landscape have informed the design and eligibility criteria of the Regulatory Advocacy COF, proactively identified opportunities, and provided frameworks and guidance for interested applicants.
The DMPA-SC Access Collaborative has compiled the list linked below featuring presentations, posters, and events on the topic of DMPA-SC, including self-injection and self-care, to be featured at the International Conference on Family Planning on November 14-17, 2022. The list includes more than 60 abstracts highlighting the latest DMPA-SC research and implementation experience from a diverse array of partner organizations including the AC.
Lessons learned from training and support for health workers in the public and private sectors
Malawi has made significant progress in scaling up DMPA-SC and self-injection in the public sector with 100% of service delivery points activated. The country has also learned valuable lessons through private sector pilots and is in the process of finalizing new guidelines to authorize pharmacies and drugstores to provide self-injection training to clients. The country’s approach is widely appreciated as an example of effective government-led and partner-supported scale-up involving both the public and private sector.
This webinar hosted by the PATH-JSI DMPA-SC Access Collaborative Learning and Action Network on August 3, 2022 featured public and private partners’ insights on national scale-up of DMPA-SC and self-injection, with a focus on provider training and supportive supervision as well as strong cross-sectoral partnerships. Speakers included representatives from the Malawi Ministry of Health Reproductive Health Directorate, Clinton Health Access Initiative, FHI 360, and Population Services International.
Drawing from program data and research, panelists discussed practical lessons learned from Malawi’s national scale-up of public-sector provider training, public provider reflections on integrating self-injection, and experiences from a private sector provider training pilot. These lessons may benefit governments and public and private partners in other contexts who are in the process of introducing or scaling up DMPA-SC for self-injection.