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

This research report describes results from an implementation science study that explored the feasibility and acceptability of administering depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) among healthcare 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 healthcare providers were trained to administer DMPA-SC and to train clients on self-injection. After receiving FP counseling and voluntarily selecting to use DMPA-SC, 568 clients aged 18-49 years agreed to participate in the study. Clients were given the option to have the provider administer 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 at the facility after their first injection, and either over the phone for clients who chose to self-administer at home or in-person at the facility for clients who chose provider administration following their scheduled 2nd injection and 3rd injection.

Results indicate that DMPA-SC self-injection is feasible and acceptable to both providers and FP clients. 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.

The report also examines the socio-demographic profile of providers and clients, method continuation, and feasibility and acceptability of home self-injection, including storage and disposal. Results have informed the national scale-up of DMPA-SC in public and private facilities, which began in April 2019.