Resilient and Accelerated Scale-Up of Subcutaneously Administered Depot-Medroxyprogesterone Acetate in Nigeria (RASuDiN): A Mid-Line Study in COVID-19 Era

Determinants of DMPA-SC self-care/self-injectable contraceptive uptake among modern contraceptive users in Burkina Faso: findings from the 2021 demographic and health survey

Introduction

This study aimed to identify the determinants that influence the use of DMPA-SC/Sayana Press among women who use modern contraceptive methods in Burkina Faso.

Methods

This study used secondary data obtained from the 2021 Burkina Faso Demographic and Health Survey (EDSBF). The dependent variable is the use of DMPA-SC among women aged 15-49 who employ modern contraceptive methods. The descriptive analysis used percentages to describe the study variables. The Pearson chi-square test was used to assess the associations between the explanatory variables and the study variable of interest. Bivariate logistic regression was used to examine the crude odds ratios of each explanatory variable with respect to the dependent variable. The multivariate model was used to determine the net effect of each independent variable on the dependent variable. The significance levels were defined at p < 0.05, with corresponding confidence intervals.

Results

The study revealed significant differences in the use of DMPA-SC according to age, marital status, region of residence, level of education, number of children, and involvement in contraceptive decision-making within the couple. Younger women (aged 15-29 aOR = 2.12, p < 0.001)) and women aged 30-39 (aOR = 1.51, p = 0.02) are also more likely to use DMPA-SC compared to those aged 40-49. Married women or those living with a partner [aOR = 1.93 (1.22, 3.05)] are more likely to use DMPA-SC. Women with 1-3 children are twice as likely to use DMPA-SC as those without children (aOR = 1.97, p = 0.02). Region and Wealth Index were significantly associated with DMPA-SC use. The Boucle du Mouhoun region showed a significantly higher likelihood of DMPA-SC use (aOR = 8.10) and women in the highest wealth group are significantly less likely to use DMPA-SC (aOR = 0.59, p = 0.001).

Conclusion

These results demonstrated the importance of adapting interventions to account for socio-demographic, regional, and cultural differences. This will enable the provision of services to the entire female population in a fair and equitable manner, while also addressing the limitations and enhancing the understanding of the underlying factors influencing the use of DMPA-SC.

Implementation strategies to scale up self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception: a scoping review

BACKGROUND

Self-administered depot medroxyprogesterone acetate subcutaneous injectable contraception (DMPA-SC) is registered in many countries. It shows great potential for improving contraceptive access, continuation, and autonomy. However, there are challenges in rolling out this new efficacious intervention, and major implementation problems have been encountered during scale-up.

OBJECTIVE

To describe the implementation strategies to scale up self-administered DMPA-SC and the barriers, facilitators, and outcomes of these programs.

METHOD

Recent guidelines, including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews, were used to design and report this review. An article or report was eligible for inclusion if it reported interventions that could scale up self-administered DMPA-SC implementation or its facilitators, barriers, or outcomes. We searched six electronic databases and the grey literature for eligible articles and reports. Two reviewers independently screened the document titles, abstracts, and full texts to identify eligible documents. Data were extracted using structured forms. Using the Effective Practice and Organization of Care (EPOC) taxonomy of health systems framework for thematic analysis, data were presented in a narrative approach.

RESULTS

Of the 755 retrieved documents, 34 were included in this review. Most of the documents included were multi-country reports (n = 14), and all documents were published within the last 5 years (2018-2021). This review identified documents that reported interventions in all EPOC domains. The most-reported interventions were: task-sharing amongst health workforce cadres, engaged leadership, encouraging policies, training and education, DMPA-SC demand generation, integration into existing programs, improved funding mechanisms, collaboration with development partners, and supply chain strengthening. The main barriers were suboptimal funding, inadequate human resources, and poor logistics supply of DMPA-SC. There was minimal evidence of scale-up outcomes.

CONCLUSION

This scoping review reported a wide range of interventions employed by countries and programs to scale up DMPA-SC self-administration but minimal evidence of the scale-up outcomes. Evidence from this review can help design better programs that improves access to quality family planning services to achieve the Sustainable Development Goals (SDG) targets 3.7. However, efforts should focus on rigorous implementation research that assess scaled up self-administered DMPA-SC interventions and report their outcomes.

REGISTRATION

The protocol for this review was registered in the protocols.io repository ( https://www.protocols.io/view/a-protocol-for-a-scoping-review-of-implementation-x54v9yemmg3e/v1 ).

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

Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is an innovative contraceptive method aimed at meeting women's unique circumstances and needs, largely due to its ability to be self-injected. Substantial research and advocacy investments have been made to promote roll-out of DMPA-SC across sub-Saharan Africa. To date, research on the demand for DMPA-SC as a self-injectable method has been conducted largely with healthcare providers, via qualitative research, or with highly specific subsamples that are not population based. Using three recent rounds of data from Performance Monitoring for Action, we examined population-representative trends in demand, use, and preference for self-injection among current non-users in Burkina Faso, the Democratic Republic of Congo (Kinshasa and Kongo Central regions), Kenya, and Nigeria (Lagos and Kano States). We found that while over 80.0% of women had heard of injectables across settings, few women had heard of self-injection (ranging from 13.0% in Kenya to 24.8% in Burkina Faso). Despite initial increases in DMPA-SC prevalence, DMPA-SC usage began to stagnate or even decrease in all settings in the recent three years (except in Nigeria-Kano). Few (0.0%-16.7%) current DMPA-SC users were self-injecting, and the majority instead were relying on a healthcare provider for administration of DMPA-SC. Among current contraceptive non-users wishing to use an injectable in the future, only 1.5%-11.4% preferred to self-inject. Our results show that self-injection is uncommon, and demand for self-injection is very limited across six settings, calling for further qualitative and quantitative research on women's views on DMPA-SC and self-injection and, ultimately, their contraceptive preferences and needs.