Self-Administered Subcutaneous Medroxyprogesterone Acetate for Improving Contraceptive Outcomes: A Systematic Review and Meta-Analysis

Abstract

Background: Subcutaneous depot medroxyprogesterone acetate is an easy-to-use injectable contraceptive. A trained person can administer it, including women through self-injection. Objectives: to assess the effectiveness and safety of self-injection versus provider-administered subcutaneous depot medroxyprogesterone acetate for improving continuation of contraceptive use.Search strategy: We searched for randomized controlled trials on November 1, 2020 in Cochrane Central Register of Controlled Trials, MEDLINE, CINAHL, Embase, Web of Science, Scopus, Open Grey, clinical trials registries, and reference lists of relevant studies. We did not impose any search restrictions.Selection criteria: We included randomized trials comparing self- vs provider-administered subcutaneous depot medroxyprogesterone acetate.Data collection and analysis: Two authors independently screened trials, extracted data, and assessed the risk of bias in the included studies. We used risk ratio and 95% confidence intervals for dichotomous outcomes.Results: We identified 3 randomized trials (9 reports; 1264 participants). The risk of bias in the included studies was low except for performance bias and detection bias of participant-reported outcomes in unmasked trials. Self-administration, compared to provider-administration, increased continuation of contraceptive use (risk ratio 1.35; 95% confidence intervals 1.10 to 1.66); moderate-certainty evidence). Self-injection appears to be making more of an impact on continuation for younger women compared to women 25 years and older and on women living in low and middle income compared to high income countries. There was no subgroup difference by the type of care provider (community health worker vs clinic-based provider).Conclusions: Self-injection of subcutaneous depot medroxyprogesterone acetate probably improves continuation of contraceptive use. The effects on other outcomes remain uncertain because of the very low certainty of evidence.Registration number: CRD42018097388.

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

“…DMPA-SC, available in an allin-one prefilled, auto-disabled Uniject ™ injection system known as Sayana ® Press, has been found to be easy to use and suitable for administration by lower-cadre health workers and women themselves [9][10][11]. Recent research has shown that women who self-injected DMPA-SC had significantly higher rates of continuation than those receiving provider-injected DMPA-SC, demonstrating its role as a self-care innovation [12,13]. 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.…”