Expanding Access to Injectable Contraception: Results From Pilot Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in 4 African Countries

Abstract

PATH partnered with the United Nations Population Fund (UNFPA) and country ministries of health (MOHs) to coordinate pilot introductions of subcutaneous depot medroxyprogesterone acetate (subcutaneous DMPA or DMPA-SC, brand name Sayana Press) in Burkina Faso, Niger, Senegal, and Uganda from July 2014 through June 2016 in order to expand the range of methods available to women, particularly in remote locations. The pilot introductions aimed to answer key questions that would inform decisions about future investments in DMPA-SC and scaling up product availability and service-delivery innovations nationally. These questions included the extent to which DMPA-SC would appeal to first-time users of modern contraception, as well as adolescent girls and young women; whether DMPA-SC would add value to family planning programs or simply replace DMPA-IM or other modern methods; and the trends in injectables use when introducing DMPA-SC (or any injectable) at the community level for the first time. We implemented a multicountry monitoring system to track key indicators, including the number of doses administered by category of user (e.g., new users, by client age group) or delivery channel. Providers generally collected these data using their national programs' standard family planning registers. Data were analyzed for cumulative information and to examine trends over time using Microsoft Power Query for Excel and Tableau. Across the 4 countries, nearly half a million DMPA-SC doses were administered and approximately 135,000 first-time users of modern contraception were reached. Furthermore, 44% of the doses administered in 3 of the countries with data were to adolescent girls and young women under age 25. Switching from DMPA-IM to DMPA-SC was not widespread, ranging from 7% in Burkina Faso to 16% in Uganda. Results from these pilot introductions demonstrate that DMPA-SC has the potential to expand community-level access to injectables, maximize task-sharing strategies, and reach young women and new acceptors of family planning. Considered within the context of each country's setting, training approach, and introduction strategy, these results can help stakeholders in other countries make informed decisions about whether and how to include this contraceptive option in their family planning programs.

Sayana Press is a 3-month injectable contraceptive that is administered into the fat below the skin. © 2016 Gabe Bienczycki/PATH.

CHWs in Uganda received comprehensive training on all available family planning methods, including DMPA-SC. © 2014 Will Boase/PATH.

A CHW in Uganda enters service delivery data into a family planning register. © 2014 Will Boase/PATH.

FIGURE 1.

Number of DMPA-SC Doses Administered by Quarter and Country, 2014–2016 Abbreviations: DMPA-SC, subcutaneous depot medroxyprogesterone acetate; Q, quarter.

FIGURE 2.

Proportion of DMPA-SC Doses Administered to New Users by Quarter and Country, 2014–2016 Abbreviations: DMPA-SC, subcutaneous depot medroxyprogesterone acetate; Q, quarter. * Senegal data derived from the sentinel sites.

FIGURE 3.

Percentage of Clients in Niger and Uganda Accessing DMPA-SC During the Pilot Compared With Women Reporting Use of Any Injectable in the DHS, by Age Group Abbreviations: DHS, Demographic and Health Survey; DMPA-SC, subcutaneous depot medroxyprogesterone acetate.

FIGURE 4.

Proportion of DMPA-SC Doses Administered to Clients Switching From DMPA-IM, by Quarter and Country, 2014–2016 Abbreviations: DMPA-IM, intramuscular depot medroxyprogesterone acetate; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; Q, quarter.

FIGURE 5.

Relative Proportions of DMPA-SC and DMPA-IM Administered by Level of the Health System and Country,^a 2014–2016 Abbreviations: DMPA-IM, intramuscular depot medroxyprogesterone acetate; DMPA-SC, subcutaneous depot medroxyprogesterone acetate. ^aNo data available from the community level in Burkina Faso. No data available for Niger.