Interest in self-administration of subcutaneous depot medroxyprogesterone acetate in the United States.
Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is a low-dose formulation of depot medroxyprogesterone acetate (DMPA) that nonmedical personnel can administer safely and effectively. We sought to determine United States women's interest in self-administration of DMPA-SC to understand whether such use can overcome barriers to contraceptive access.



We analyzed survey data on contraceptive attitudes collected in March-July 2011 from 1592 women at 13 family planning and six abortion clinics throughout the US. A mixed-effects logistic regression model with random site effects examined the determinants of interest in self-administering DMPA-SC.



Overall, 21% [95% confidence interval (CI): 19%-23%] of women reported interest in self-administration. A multivariable model found that women currently using DMPA (Adjusted Odds Ratio [AOR]=3.93, 95% CI: 2.37-6.53, p<.001) and women who previously used DMPA (AOR=1.71, 95% CI: 1.26-2.32, p<.001) were more likely to have an interest in DMPA-SC than those who never used it. Women reporting difficulty obtaining or refilling a prescription were almost twice as likely to have interest in DMPA-SC as women who reported no difficulty (AOR=1.99, 95% CI: 1.43-2.77, p<.001). Women surveyed at abortion sites were more likely to report interest in self-administration than women surveyed at family planning sites (AOR=1.55, 95% CI: 1.05-2.30, p<.05). Interest in DMPA-SC was primarily driven by a desire to eliminate unnecessary return visits to a facility for repeat injections.



Offering women the option to self-administer DMPA-SC at home can expand access and tailor contraceptive provision to the needs of clients, thus supporting client-centered care. To the extent that self-administration may improve contraceptive continuation, DMPA-SC can prevent unintended pregnancies among women who discontinue DMPA use because of difficulty returning for repeat injections.



There is substantial interest in self-administration of DMPA-SC among current DMPA users, women who have recently had an abortion and women reporting difficulty returning to a family planning provider. Offering self-administration of DMPA-SC could potentially increase contraceptive continuation, reduce unintended pregnancies and enhance reproductive autonomy among DMPA users.
Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology & Reproductive Science, University of California, San Francisco, San Francisco, CA 94612, USA. Electronic address: ushma.upadhyay@ucsf.edu.
Ushma D
UD
Upadhyay
Public Health Institute, United States. Electronic address: vzlidar@gmail.com.
Vera M
VM
Zlidar
Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, and the Department of Obstetrics, Gynecology & Reproductive Science, University of California, San Francisco, San Francisco, CA 94612, USA. Electronic address: diana.greenefoster@ucsf.edu.
Diana Greene
DG
Foster
D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003692:Delayed-Action Preparations / Q000008:administration & dosage; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007279:Injections, Subcutaneous / Q000379:methods; D016015:Logistic Models; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D008875:Middle Aged; D010352:Patient Dropouts; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012646:Self Administration / Q000379:methods*; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate
Acceptability; Depot medroxyprogesterone acetate; Injectables; Self-administration; Self-injection; Subcutaneous DMPA