Adolescent and covert family planning users’ experiences self-injecting contraception in Uganda and Malawi: implications for waste disposal of subcutaneous depot medroxyprogesterone acetate

Abstract

Background: 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. Selfinjectors 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. Methods: We conducted cross-sectional qualitative studies in 2019 with 50 self-injectors in Uganda and 60 in Malawi. We purposively selected approximately half adolescents and included those trained by clinic-based providers and community health workers. We conducted semi-structured interviews and thematic data analysis and compared the findings across settings.

Adolescent and Youth Experiences With Contraceptive Self-Injection in Uganda: Results From the Uganda Self-Injection Best Practices Project

“…Burke et al. make the case through qualitative inquiry that adolescents prefer individual over group training; however, our quantitative results did not reveal significant differences in their preferences [ 16 ]. Indeed, a sizable share desired group training.…”

Self-injected contraceptives: does the investment reflect women’s preferences?

“…To date, qualitative research on motivators and barriers to self-injection has been limited. In Malawi and Uganda, Burke and colleagues explored barriers to DMPA-SC use for adolescents and/or covert users of contraception, where the authors hypothesised that disposal of the product after self-injection may pose substantial hindrance to continued use and found that indeed disposal placed increased risk and stress on self-injectors, specifically for those attempting to use covertly 38. Therefore, not only storage and usage should be considered when attempting to use this method covertly, but also safe disposal ramifications.…”

“Men can take part”: examining men’s role in supporting self-injectable contraception in southern Malawi, a qualitative exploration

“…These trained qualitative facilitators, including AZ, used semi-structured interview and FGD guides, respective to each participant group, which explored topics such as what participants knew about DMPA-SC and self-injection, personal-and communitylevel views on the methods, why they believed women would or would not choose to self-inject, and how they could support or be supported in DMPA-SC self-injection use (men and female clients). Interview and FGD guides were developed based on several years of experience conducting quantitative and qualitative research about DMPA-SC self-injection in Mangochi district in Malawi [12,15,[26][27][28][29].…”

“…Self-injection requires fewer clinic visits and, therefore, users may save time and money and may inject themselves in a private location at their convenience. Published literature has also described self-injection as particularly promising for reaching younger women, new users of contraceptive methods, and covert users [ 14 , 15 ]. Based on the feasibility and acceptability of DMPA-SC self-injection, Malawi’s Ministry of Health (MOH) introduced DMPA-SC (both provider-administered and self-injected) country wide to expand the contraceptive method mix [ 16 ].…”