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.

Supportive supervision plays a critical role to ensure high-performing health workers have the appropriate knowledge, skills, and motivation in order to deliver quality family planning (FP) services and informed choice counseling. This package includes three supportive supervision tools that can be used by regional or district health teams when conducting supervision visits at health facilities that offer FP services:

1. Supportive supervision checklist to assess provision of family planning counseling
2. Observation checklist to assess health workers counseling clients on DMPA-SC self-injection
3. Remote supervision of family planning providers (includes family planning and self-injection)

Tools #1 and #2 can be used together or separately, depending on whether or not the supervision visits include follow-up with providers recently trained to counsel clients on DMPA-SC self-injection.

Tool #3 is intended for use in situations where in-person supervision is not possible; the supervision exercise can be conducted through phone or video. This tool includes guidance and instructions for supervisors who plan to conduct supervision remotely.

The tools are intended to serve as guides and can be adapted for specific settings as needed. For more information, contact FPoptions@path.org.

This DMPA-SC advocacy pack 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.

This brief lists key references and resources from the evidence base on DMPA-SC. Pair this with the Evidence at-a-glance brief if your target decision-maker would like to have access to the data in that handout.

WHO’s global family planning handbook provides high-quality, up-to-date guidance for health-care professionals working in low- and middle-income countries.

This 32-page publication outlines the GATHER model of family planning counseling, which has been successfully used for nearly two decades and is based on the elements described including tips, illustrations, techniques, technical information, and charts.

Counseling for Choice (C4C) is an evidence-based approach to contraceptive counseling that supports clients to decide which method is right for them. By addressing many of the root causes of unmet need for contraception and discontinuation, C4C aims to change how providers and clients participate in voluntary family planning (FP) counseling discussions. The approach comprises a thorough training in C4C techniques and the use of the Choice Book for Providers, a job aid and visual tool providers use with clients during counseling sessions.

Quality of family planning counseling is likely associated with whether or not women continue to use the same contraceptive method over time. The Method Information Index (MII) is a widely available measure of contraceptive counseling quality but little is known about its association with rates of method continuation. Using data from a prospective cohort study of 1,998 social franchise clients in Pakistan and Uganda, we investigated the relationship between reported baseline MII and the risk of method continuation over 12 months using survival analysis and Cox proportional hazard models. Higher scores on the 3-question Method Information Index (MII)—measuring client-reported receipt of contraceptive information—was associated with continued use of family planning over 12 months. We recommend incorporating use of the MII in routine assessments of family planning service quality.

Global Health: Science and Practice. March 2019, 7(1):87-102. https://doi.org/10.9745/GHSP-D-18-00407

This brief provides an overview of PATH’s research studies assessing the feasibility and acceptability of self-injection in Uganda and Senegal.