Introduction of DMPA-SC self-injection in Ghana: A feasibility and acceptability study using Sayana® Press

This research report describes results from a study that explored the feasibility and acceptability of introducing depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) to health providers and family planning (FP) clients in Ghana. DMPA-SC is an injectable contraceptive method that can be self-administered. The study, conducted by the Population Council through the USAID-funded Evidence Project in collaboration with the Ghana Health Service, was implemented in rural, peri-urban, and urban areas of the Ashanti and Volta regions. A total of 150 health providers were trained to administer DMPA-SC and to train clients on self-injection. A total of 568 clients aged 18-49 years who sought FP services and chose to use DMPA-SC after receiving counseling agreed to participate in the study. Clients were given the option to have the provider administer DMPA-SC or to be trained on self-injection and, if deemed competent by the provider, to self-inject under supervision and to take two doses of DMPA-SC home for future self-injection. Clients were interviewed at the facility after their first injection and over the phone (for clients who chose to self-administer) or in person at the facility (for clients who chose provider administration) following their scheduled second injection (3-month interview) and third injection (6-month interview).

Over one-third of DMPA-SC clients (35%) chose to self-administer their first injection of DMPA-SC and this portion nearly doubled to 65 percent at both 3 months and 6 months.

The report examines the socio-demographic profile of clients, method continuation, and feasibility and acceptability of home self-injection, including storage and disposal. The report also describes findings from the training of providers on both DMPA-SC administration and client self-injection. Results of this study show that DMPA-SC self-injection is feasible and acceptable to both FP clients and providers. Results have informed the national scale-up of DMPA-SC in public and private facilities, which began in April 2019.