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Injectable contraception

emerging evidence on subcutaneous self-administration

Lerma, Klaira; Goldthwaite, Lisa M.

Current Opinion in Obstetrics and Gynecology: December 2019 - Volume 31 - Issue 6 - p 464–470
doi: 10.1097/GCO.0000000000000574
FAMILY PLANNING: Edited by Paul D. Blumenthal
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Purpose of review Injectable contraception is a widely available and popular family planning method globally. It has evolved to allow for subcutaneous self-injection (DMPA-SC, Depo medroxyprogesterone acetate-subcutaneous). In this review, we will focus on research evaluating DMPA-SC, with specific regard to continuation rates, safety, and satisfaction among users.

Recent findings Emerging evidence from the United States, Malawi, Uganda, and Senegal has established safety and higher continuation rates among self-inject users, compared with provider-inject users. Continuation is 10–28% higher among DMPA-SC self-inject users. Self-inject users across studies were highly satisfied and reported DMPA-SC was easy to use. Studies indicate continuation is likely to be attributable to self-administration and user autonomy, rather than inherent properties of the DMPA-SC injection.

Summary DMPA-SC should be made available in high-resource and low-resource settings. Future efforts should be focused on implementation and evaluating how to best add DMPA-SC to the method mix. Cost–benefit analyses will need to evaluate the up-front costs of DMPA-SC for clients, facilities, and health systems compared with the higher continuation rates and saved opportunity-costs over time. Task-shifting strategies and development of mobile phone technologies to assist users in adherence should be considered in future service scale-up.

Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA

Correspondence to Klaira Lerma, MPH, Division of Family Planning Services and Research, Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, HG332, Stanford, CA 94305, USA. Tel: +1 650 721 1562; e-mail: klerma@stanford.edu

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