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.
HIV-positive women need contraception to avoid unintended pregnancy and risk of vertical HIV transmission. We assessed acceptability of SP versus intramuscular DMPA (DMPA-IM) among HIV-positive women and their care providers in Rakai, Uganda. Women were randomized to DMPA-IM or SP at baseline, received the alternate product at 3 months, and chose their preferred method at 6 months. We determined preferences among new and experienced contraceptive injectable users who had tried both types of injection during the trial, and from providers before and after providing both types of injectables to clients.
Background: Subcutaneous depo-medroxyprogesterone acetate (DMPA-SC) offers the possibility of self-administration. Study Design: This is a pilot study of self-administration of DMPA-SC. Existing users of the intramuscular preparation (DMPA-IM) who wished to self-inject (n=64) were taught self-administration using DMPA-SC. The main outcome was the continuation rate of the method at 12 months compared to a control group of existing users of DMPA-IM (n=64) who continued to attend a clinic to receive the method. Women’s satisfaction with the method and the proportion of self-injections given at correct time were also determined.
Results: The 12-month discontinuation rate of the DMPA-SC group (12%) did not differ significantly from that of the DMPA-IM group (22%) (95% confidence intervals of 13%–33% and 6%–23% for DMPA-SC and DMPA-IM, respectively; p=.23). All self-injections were given within the appropriate interval. There was no significant difference in the proportion of women in either group who were satisfied with the method.
Conclusion: Self-administration of DMPA-SC for contraception is feasible and is associated with similar continuation rates and satisfaction to clinician-administered DMPA-IM.
Background: The objectives of the study were to assess feasibility, continuation rates and patient satisfaction with self-administration of subcutaneous depot medroxyprogesterone acetate (DMPA-SC). Materials and Methods: The study included 50 DMPA-seeking women between the ages of 18 and 49 years enrolled at two Florida Planned Parenthood health centers. Participants were taught self-injection during their initial study visit and, upon proficiency, self-injected one dose in clinic. Participants then injected a series of three more doses outside the health center over 9 months. Continuation rates, feasibility and acceptability were determined by analysis of four post-injection surveys. Results: Continuation of DMPA-SC at injection 4 was 74% (95% confidence interval 62%-86%). Overall, survey responses from the three at-home injections indicated the method to be convenient (95%), easy (87%) and recommendable to others (94%). Twenty percent of injections were met with difficulty, most commonly cited as plunger resistance. No pregnancies occurred in study. Conclusions: Continuation was high with DMPA-SC self-injection. Participants reported injection to be easy and convenient and are likely to recommend self-administration to other women. Device issues are one potential deterrent.
The intramuscular contraceptive depot medroxyprogesterone acetate (DMPA-IM) is now available in subcutaneous (SC) formulation, potentially allowing for home-based self-administration. We conducted the first examination of adolescent women’s interest in and proficiency at DMPA-SC self-administration.
Depo-Provera (depot medroxyprogesterone acetate, or DMPA) is an important contraceptive option for women worldwide. Currently, it is only available in intramuscular form requiring regular quarterly routine attendance at a health facility. A new subcutaneous preparation has been developed. This is self-administrable and could potentially reduce need for routine attendance to an annual visit.
In a questionnaire survey of 176 women currently using DMPA, 67% would prefer to self-administer. Of the 33% who did not wish to self-administer, the most common reasons were a fear of needles (62%) and concern regarding incorrect administration (43%). In a second survey of 313 women not currently using DMPA, 64% of women said they would prefer to attend less often for contraceptive supplies. Twenty-six percent of women who had never used DMPA and 40% of ex-users would seriously consider DMPA if self-administration were possible.
Our findings would suggest that the advent of subcutaneous self-administrable Depo-Provera with appropriate training and reminder system is likely to be beneficial and popular with many women.
The objective of this study was to evaluate women’s acceptance of and ability to self-administrate the injectable contraceptive Cyclofem® using prefilled UniJect® devices. A total of 102 women were invited to participate in the study. Fourteen women (13.7%) refused to participate. Of the remaining 88 women, 32 women (31.4%) consented to participate and were trained using oranges but were still afraid of the procedure and ultimately refused to self-administer the injections. Only 56 women (55%) ultimately self-injected Cyclofem with UniJect. They performed a total of 144 injections, all of them on the ventral side of the thigh. When nurses evaluated women’s ability to activate the devices, they found that more than 80% were successful in both the group of women that later self-administered the injections and the group that did not. The evaluation of the self-administered injection technique showed that more than 90% of the women correctly self-administered the contraceptive using UniJect. With respect to the opinion of the women about the self-administration of the contraceptive, more than 50% (32 of 56) of women who self-injected preferred to self-administer the injection and said that they wished to continue with the self-administration, one-third (17) reported that they were afraid, and seven women (12.5%) expressed the opinion that the injection in the thigh was more painful than the administration in the buttocks or arm. In conclusion, our study showed that women can be trained to successfully self-administer the monthly injectable contraceptive Cyclofem and generally respond positively to UniJect.