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Tag: waste disposal


Recommendations for contraceptive self-injection: brief and program design guide

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.

Please contact FPoptions@path.org for further information or requests for assistance.

Institutional author(s): PATH, JSI
Publication date: November, 2022

DMPA-SC self-injection journey maps for clients and health workers

These journey maps were designed to help program planners think through the key components of their DMPA-SC self-injection programs. For more information, consult Recommendations for contraceptive self-injection: brief and program design guide.

Institutional author(s): PATH
Publication date: 2020

Lessons from Ghana to inform DMPA-SC safe storage and disposal

In the resources linked below, Population Council researchers from the Evidence Project highlight lessons learned from research in Ghana on the expansion of access to DMPA-SC. While improper disposal in pit latrines or open spaces remains a challenge to safely scaling this highly effective method, the authors underscore that with education on safe disposal and provision of appropriate containers, self-injection clients enrolled in a pilot study in Ghana were able to appropriately store and dispose of DMPA-SC.

These results offered evidence for the Ghana Health Service to include provision of safe disposal containers in nation-wide scale-up plans for home-based self-injection, with important implications for other countries seeking to expand access while addressing safety and ecological hazards.

Institutional author(s): Population Council
Publication date: March, 2021

Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi

Implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

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.

Institutional author(s): FHI 360
Individual author(s): Holly M Burke, Catherine Packer, Laura Wando, Symon Peter Wandiembe, Nelson Muwereza, Subarna Pradhan, Akuzike Zingani, Bagrey Ngwira
Publication date: August, 2020

Journal article Reproductive Health journal

Safe and sustainable waste management of self care products

This article outlines how a safe and sustainable waste management system for self care products requires education and multisectoral approaches.

Institutional author(s): Center for Human Progress
Individual author(s): Ash Pachauri, Prerna Shah, Bethanie C Almroth, Norma PM Sevilla, Manjulaa Narasimhan
Publication date: April, 2019

Journal article BMJ journal

Household waste disposal in DMPA-SC self-injection programs

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.

Institutional author(s): PATH, JSI
Publication date: April, 2019

Women’s satisfaction, use, storage and disposal of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) during a randomized trial

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.

Institutional author(s): FHI 360, College of Medicine, University of Malawi
Individual author(s): Holly M Burke, Mario Chen, Mercy Buluzi, Rachael Fuchs, Silver Wevill, Lalitha Venkatasubramanian, Leila Dal Santo, Bagrey Ngwira
Publication date: May, 2018

Journal article Contraception journal

Operational assessments of Sayana® Press provision in Senegal and Uganda

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.

Institutional author(s): PATH
Individual author(s): Jane Cover, Elizabeth Blanton, Dieynaba Ndiaye, Fiona Walugembe, D Scott Lamontagne
Publication date: January, 2014

Journal article Operational assessments of Sayana® Press provision in Senegal and Uganda

Logistics and Waste Management Benefits of depo-subQ in Uniject

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.

Institutional author(s): PATH, JSI
Publication date: February, 2011