Accessing DMPA-SC through the public and private sectors in Nigeria: users’ characteristics and their experiences

Abstract

Background: Beginning in 2015, subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was added to the contraceptive method mix in Nigeria, primarily through social marketing in the private sector and community-based distribution in the public sector. We compare user experiences in acquiring DMPA-SC across sectors during this national scale-up. Methods: From October 2017 to February 2018, 459 women (Npublic=235; Nprivate=224) completed a phone survey from a convenience sample of 1,444 women (Npublic=912; Nprivate=532) who obtained DMPA-SC from participating providers and agreed to be contacted. We examined the sociodemographic predictors of attending a public vs. private provider and analyzed differences in care-seeking across sectors (becoming aware of DMPA-SC, choosing a provider, choosing DMPA-SC, quality of care). Results: Respondents obtaining DMPA-SC from public providers were younger and less educated than those attending private providers. Both program respondents were comprised of similar percentages of new users of modern contraception (58.7-60.3%), although most respondents became aware of DMPA-SC through a friend/family member (43.1%) or a provider (41.5%). Relatively more public sector respondents also heard about DMPA-SC through community outreaches whereas relatively more private sector respondents became aware through media. Convenience was the most common reason for choosing a provider—43.8% among all respondents (higher among public sector respondents). Private sector respondents were also more likely to choose a past or usual provider. Having overall higher quality interactions were more likely among clients who attended private providers than public providers, but responses to individual quality item measures show specific areas of poor quality for providers in each sector. Conclusions: Training emphasizing technical thoroughness, sensitivity toward younger women, and client choice may help improve women’s experiences with obtaining DMPA-SC, ultimately contributing to accelerating demand for and uptake of DMPA-SC specifically and contraception in general.

Characteristics associated with use of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) in Burkina Faso, Democratic Republic of Congo, and Uganda

“…Another relevant community-level measure of DMPA-SC is the mode of provision: DMPA-SC is also provided by community health workers, and can be self-administered, but the availability of these modes varies within and across countries [ 17 , 18 ]. Since the characteristics of DMPA-SC users differ by how and where the method was received [ 19 ], this might also partly explain our results here. Finally, the quality of counseling provided is another supply-side feature that impacts use of DMPA-SC and other methods, and may explain our results here [26].…”

“…Most studies of DMPA-SC users are not population-based, instead involving sub-populations like adolescents [ 11 ] or family planning clients of community health workers or service delivery facilities [ [14] , [15] , [16] , [17] ]. The few population-based studies have examined a limited set of DMPA-SC user characteristics, and have seldom compared characteristics of DMPA-SC users with women using other prominent contraceptive methods [ 6 , 18 , 19 ]. One population-based study recently compared characteristics of DMPA-SC with users all other modern methods combined and non-users [ 7 ], but how characteristics of women using DMPA-SC compare with DMPA-IM and other specific modern methods is not known.…”

Lessons learned from a public sector community-based distribution program for scaling up DMPA-SC contraceptive services in Nigeria

“…Additional research evaluating DMPA-SC's launch in Nigeria has shown that user satisfaction from DMPA-SC was high (>90%) 13 . As the most common non-condom contraceptive product in Nigeria, injectable contraceptives are already in high demand 2 .…”

“…3. UCSF research staff conducted periodic interviews with program managers in UNFPA and implementing partners (via teleconference in August and September 2017 and via teleconference and in-person meetings in Nigeria in November and December 2018) to provide additional context for understanding program operations c A separate phone survey was conducted to obtain a more detailed understanding of users' experience in care-seeking for DMPA-SC; those findings are reported elsewhere 13 .…”

Contraceptive self-injection knowledge, attitude and practices among female students of a tertiary health institution in south west Nigeria

“…20 Since a lunch of Sayana Press in Nigeria in 2014, empirical evidences show high feasibility and acceptance of this contraceptive method among women in the country. 21,22 However, there has been dearths of information regarding DMPA-SC especially among Nigerian university students who are mostly adolescents and youths with high risks of unprotected sexual activities. Thus, the current study had the objective of assessing the knowledge, attitude and practice of health sciences students on DMPA-SC.…”