Self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is poised to increase access to contraception; however, governments are concerned about the waste management of used units. Self-injectors in Malawi and Uganda are currently instructed to store used units in containers and return them to health workers for disposal. However, this may not be feasible in low-resource settings, especially for younger or covert self-injectors. We describe adolescent (15–19 years) and adult (20–49 years) self-injectors’ disposal experiences in Uganda and Malawi. When possible, we compare covert and overt users’ experiences.

This presentation highlights the background and resources on the appropriate method of sharps disposal. It presents country practices and evidence on disposal from DMPA-SC self-injection studies and projects, while offering disposal options and considerations for contraceptive self-injection program design and planning. It is designed for in-country stakeholders and decision-makers developing DMPA-SC self-injection programs and plans.

To describe women’s experiences with subcutaneous depot medroxyprogesterone acetate (DMPA-SC) to inform scale-up of self-administered DMPA-SC. We conducted a 12-month randomized controlled trial in Malawi to measure DMPA-SC continuation rates. A total of 731 women presenting at six Ministry of Health clinics or to community health workers (CHWs) in rural communities were randomized to receive DMPA-SC administered by a provider or be trained to self-inject DMPA-SC. Data collectors contacted women after the reinjection window at 3, 6 and 9 months to collect data on satisfaction and use; self-injectors were also queried about storage and disposal of DMPA-SC. We compared frequencies of injection experiences and satisfaction by study group and over time.

This study aimed to evaluate DMPA-SC (Sayana Press) management and administration in low-resource settings, focusing on how the delivery logistics, administration time, storage and waste-management requirements compare to the traditional intramuscular DMPA injectable (DMPA-IM).

Cover J, Blanton E, Ndiaye D, Walugembe F, Lamontagne DS. Operational assessments of Sayana® Press provision in Senegal and Uganda. Contraception. 2014 May;89(5):374-8. https://doi.org/10.1016/j.contraception.2014.01.005. Epub 2014 Jan 18. PMID: 24565737.

This four-page brief describes results from three analyses conducted by PATH and John Snow Inc. (JSI) comparing the intramuscular version of depot medroxyprogesterone acetate (DMPA) injectable contraceptive compared with the new DMPA-SC formulation packaged in the Uniject injection system. The analyses focused on waste management implications and identified key quantitative and qualitative differences between the two products.