Investigating the Feasibility and Acceptability of DMPA-SC Self-injection in Ghana
Photo credit: PATH/Gabe Bienczyck
As articulated in its FP2020 Commitment, Ghana aims to increase the modern contraceptive prevalence rate among currently married or in-union women from 22 percent to 29 percent, and among unmarried adolescents, from 32 percent to 35 percent, by 2020. To meet this goal, Ghana is focusing on improving access to family planning (FP) in peri-urban and rural areas and at all service delivery levels, building the capacity of health providers, and improving the contraceptive method mix. Injectables are the most commonly used FP method among married women in Ghana, with 8 percent of married women using the method, and are a commonly used method among sexually active unmarried women, with 7 to 8 percent using the method.
DMPA-SC (brand name Sayana® Press) is a three-month, progestin-only, all-in-one injectable contraceptive that combines the drug and needle in the Uniject injection system. Due to its Uniject device, DMPA-SC is small, light, and easy-to-use, requires minimal training, and is expected to help in improving provision of FP services in low-resource settings. DMPA-SC could be particularly useful in Ghana where women’s access to FP services can be curtailed by distance to clinics. DMPA-SC is a safe and effective contraceptive method suitable for community-based distribution and for women to administer themselves through self-injection. Self-injection of DMPA-SC is a method of self-care for women, and thus has the potential to increase privacy and autonomy of users to decide whether, when, and how many children to have.
At the request of the Ghana Health Service and with funding from USAID/Ghana, the Evidence Project/Population Council studied the feasibility and acceptability of DMPA-SC self-injection in Ghana. The primary objectives of the seven-month study were to assess the feasibility of introducing DPMA-SC self-injection to women who voluntarily accept it and its acceptability by both health providers and injectable clients.
As part of the study, 150 healthcare providers were trained to administer DMPA-SC, counsel clients on DMPA-SC, and train clients to self-inject. After receiving FP counseling and voluntarily selecting to use DMPA-SC, 568 clients aged 18-49 years agreed to participate in the study. Women opted for provider-administered DMPA-SC or to be trained in self-injection. Providers assessed clients’ competence to self-inject and when considered competent, clients self-injected under the provider’s supervision and could take two DMPA-SC doses home for future self-injections. Clients were interviewed after their first injection and interviewed again at the time of their second and third injections.
Results indicate that DMPA-SC self-injection is feasible and acceptable to both providers and FP clients. After the training, providers reported that they were very well prepared to offer DMPA-SC services, including counseling, administration, training, and supervising clients. Over one-third of DMPA-SC clients (35 percent) self-administered their first DMPA-SC injection and this proportion nearly doubled to 65 percent at both the 2nd and 3rd follow-up injections.
Results from the study have informed the national strategy for DMPA-SC, including procurement and scale-up in the public and private sectors, which began in April 2019.