Abstract
ObjectivesSubcutaneous depot medroxyprogesterone acetate (DMPA-SC) is seen as a valuable innovation in family planning, but little is known about trends in DMPA-SC use or characteristics of users. Using data from Burkina Faso, the Democratic Republic of Congo (DRC) and Uganda, we measured trends in DMPA-SC and identified characteristics associated with DMPA-SC use. Study designWe used repeated cross-sectional representative data collected between 2016 and 2019. First, we plotted trends in DMPA-SC use for all women and married women. Next, we presented the sociodemographic and family-planning-related characteristics of DMPA-SC users. Finally, we conducted weighted multivariate logistic regression analysis to examine how DMPA-SC users were different from women (1) using all other modern methods combined and (2) not using any modern method. ResultsDMPA-SC use increased monotonically in all three countries. Many DMPA-SC users were first-time users of modern contraception (54.5% in Burkina Faso, 34.6% in DRC, 50.7% in Uganda). Never-married women had lower odds than married women of using DMPA-SC (compared to other modern methods) in all three countries [Burkina Faso adjusted odds ratio (AOR) 0.40, 95% confidence interval (95% CI) 0.20–0.80; DRC AOR 0.31 95% CI 0.10–0.93; Uganda AOR 0.24; 95% CI 0.08–0.71]. Level of education was positively associated with DMPA-SC use (compared to no use) (Burkina Faso AOR 1.79; 95% CI 1.03–3.14; Uganda AOR 3.23; 95% CI 1.33–7.84). ConclusionsDMPA-SC is a rapidly growing method in these settings. Despite the comparable levels of and increases in use for all three countries, the characteristics associated with DMPA-SC use generally differed across countries. ImplicationsThis is the first analysis of patterns of DMPA-SC use with representative data for African countries. Our results confirm that DMPA-SC is increasingly popular, although the profile of users varies across settings.
Highlights
Subcutaneous depot medroxyprogesterone acetate (DMPA-SC), known by the product name Sayana® Press, is seen as a valuable innovation in family planning
DMPA-SC was used by only a small percentage of women in our three geographies, use increased monotonically between 2016 and 2019 in Democratic Republic of Congo (DRC), Burkina Faso and Uganda
Some of these characteristics were consistent across geographies: in all three countries, the age groups in the 20s made up the highest percentage of DMPA-SC users (20–24 for DRC, 25–29 for Burkina Faso and Uganda); the majority of DMPA-SC users had three to five children; and the vast majority were currently married
Summary
Subcutaneous depot medroxyprogesterone acetate (DMPA-SC), known by the product name Sayana® Press, is seen as a valuable innovation in family planning. Studies suggest that DMPA-SC is widely acceptable in sub-Saharan Africa (SSA). Pilot testing in Burkina Faso, Niger, Senegal and Uganda from 2014 to 2016 showed that DMPA-SC can add value to national family planning programs [5]. Some users preferred DMPA-SC over intramuscular depot medroxyprogesterone acetate (DMPA-IM) [1,6]. Some countries, like Burkina Faso, have expanded distribution of DMPA-SC [7] and tested different approaches to distribution, such as self-injection and community-level distribution [5,7,8]
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