Abstract
Depot medroxyprogesterone acetate administered subcutaneously (DMPA-SC) is an all-in-one injectable contraceptive administered every 3 months, either by a trained health care provider or community health worker or by training a client to self-inject. Using a prospective cohort of family planning (FP) clients in Ghana, this study explores patterns of DMPA-SC use and mode of injection administration over a 6-month period. This study also examines the predictors of self-injection adoption 6 months after initiating DMPA-SC. Our analysis focuses on 378 women who were using DMPA-SC at the 6-month interview. Adjusted odds ratios accounting for clustering show that clients who were new FP users, never married, or attended high school/attained higher education were significantly more likely to self-inject by the third injection. Results of this study suggest that in Ghana, adding DMPA-SC to the method mix may improve access to FP, especially among new users. Results of this study may inform FP projects and programs aiming to improve access to contraceptive methods and increase contraceptive prevalence by introducing or scaling up DMPA-SC self-injection. The findings also provide a sociodemographic profile of FP clients most likely to adopt DMPA-SC self-injection over time, which could serve as an evidence base for social marketing strategies.
Highlights
In Ghana, between 22% and 25% of married women use a modern contraceptive method, and close to a third (32%) of sexually active unmarried women do so.[1,2] The total fertility rate (TFR) ranges between 3.9 and 4.2 births per woman.[1,2] These data reveal that approximately 30% of married women in Ghana wanting either no more children or to postpone childbearing for at least the 2 years were not using any contraceptive method.[1]
The timeliness of the data should be taken into consideration as data collection ended in 2018 and patterns of Depot medroxyprogesterone acetate administered subcutaneously (DMPA-SC) use may have changed over time. These limitations notwithstanding, the present analysis provides useful insights into the characteristics of depot medroxyprogesterone acetate (DMPA)-SC selfinjectors, their choice to self-inject over time, and factors that play an important choice in selfinjection 6 months into using DMPA-SC
In a more likely and typical scenario of a nonrandomized setting, where family planning (FP) clients who choose DMPA-SC after counseling are given the choice between a provider-administered injection or self-injection, it is important to examine the profile of women who choose self-injection, their patterns of use, and predictors of this mode of administration
Summary
In Ghana, between 22% and 25% of married women use a modern contraceptive method, and close to a third (32%) of sexually active unmarried women do so.[1,2] The total fertility rate (TFR) ranges between 3.9 and 4.2 births per woman.[1,2] These data reveal that approximately 30% of married women in Ghana wanting either no more children or to postpone childbearing for at least the 2 years were not using any contraceptive method.[1] To meet the needs of these women who want to delay or avoid childbearing, exploring new avenues for increasing access to modern family planning (FP) methods is paramount. The proportion of currently married contraceptive users in Ghana using an injectable contraceptive has increased from 2% in 1988 to 27% in 2017,2 and it is the most popular modern contraceptive method used among this group. The most common type of contraceptive injectable contains depot medroxyprogesterone acetate (DMPA) as the active ingredient and is administered
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