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

Abstract

Objectives To what extent is DMPA-SC reaching new users versus encouraging method switching among existing users? Though increasingly-popular, little is known about characteristics of women using DMPA-SC in SSA. We compared characteristics of women using DMPA-SC with those of other modern methods, and identified the extent to which women using DMPA-SC switched from another method or are first-time users of contraception. Study design We used data collected by the Performance Monitoring for Action (PMA) Project between 2016 and 2019 from three countries, Burkina Faso, Democratic Republic of Congo, and Uganda. We tabulated characteristics of DMPA-SC, DMPA-IM, implant, and male condom users, and used multivariate analysis to compare characteristics of women using DMPA-SC those of the other three methods. We also examined previous contraceptive method use (if any) among women currently using DMPA-SC. Results We found that never-married women were more likely to use male condoms instead of DMPA-SC. Women with two or more children (compared to no children or one child) were more likely to use implants instead of DMPA-SC in both Uganda and DRC. DMPA-SC was the first method used by the majority of current users in Burkina Faso and Uganda. DMPA-SC users who previously used another method generally switched from less effective methods. Conclusions Although the characteristics of women using DMPA-SC varied across countries, DMPA-SC appears to be reaching new populations of women instead of inspiring existing modern users to switch to DMPA-SC, and appears to be appealing to first time users of contraception. Implications It appears that DMPA-SC appeals to new contraceptive users in sub-Saharan Africa, which implies that DMPA-SC may have the potential to increase modern contraceptive prevalence in sub-Saharan African countries.

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

“…These challenges echo many of those found to pose barriers to adolescents accessing contraceptive care in other contexts ( 24 , 34 ) and are not specific to DMPA-SC or self-injection. Indeed, some analyses have found that never-married women are more likely to use easier-to-access methods such as condoms over methods that require interaction with healthcare workers, such as injectables ( 35 ), likely due to these sorts of access and stigma barriers. A study with SI users in Uganda also found that adolescents were less likely than adults to first hear about DMPA-SC SI from a community health care worker/Village Health Team member), and more likely to hear about it from friends, suggesting that these access and stigma barriers may also pose a challenge to awareness about the method ( 24 ).…”

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

“…Previous research using national PMA data showed increases in DMPA-SC use in Burkina Faso and the DRC between 2016 and 2019 13. Importantly, many DMPA-SC users were first-time users of modern contraception, ranging from 34.6% in the DRC to 54.7% in Burkina Faso,13 29 and switching to DMPA-SC from other contraceptive methods was less common 29. The stagnation in prevalence of DMPA-SC as a proportion of the method mix across settings, with the exception of Nigeria-Kano, may correspond with a similar slowing in modern contraceptive use levels; all settings except for Kongo Central displayed modest (<3%) rises in modern contraceptive prevalence across the three preceding PMA survey rounds 30.…”

“… 13 Importantly, many DMPA-SC users were first-time users of modern contraception, ranging from 34.6% in the DRC to 54.7% in Burkina Faso, 13 29 and switching to DMPA-SC from other contraceptive methods was less common. 29 The stagnation in prevalence of DMPA-SC as a proportion of the method mix across settings, with the exception of Nigeria-Kano, may correspond with a similar slowing in modern contraceptive use levels; all settings except for Kongo Central displayed modest (<3%) rises in modern contraceptive prevalence across the three preceding PMA survey rounds. 30 For DMPA-SC use to continue to rise, DMPA-SC should be offered to both non-users of contraception and users of other contraceptive methods, to ensure that women have access to a wide range of methods to use in line with their preferences.…”

DMPA-SC stock: Cross-site trends by facility type

“…According to the DMPA-SC Access Collaborative—a project led by PATH and John Snow, Inc. that supports countries in the introduction and scale-up of the product—approximately 53 countries offer DMPA-SC as of 2021, and up to 33 are currently either piloting or scaling up DMPA-SC self-injection [4] . Many current DMPA-SC users are also first-time users of contraception, suggesting that DMPA-SC is reaching new populations, and can potentially increase overall modern contraceptive prevalence in some settings [5] .…”

“…The limited set of studies on supply-side factors mostly explore service provider-related characteristics and behaviors, with minimal or no data on method availability [8] , [9] , [10] , [11] . The Performance Monitoring for Action (PMA) project collects national data on DMPA-SC from service delivery points and a representative sample of women, but the few publications to date have largely focused on user characteristics [ 3 , 5 , 12 ].…”