Behavioral Drivers Influencing Women's Decision to Use Self-Injectable Contraception Provided by Community Health...

Area of Science:

• Family Planning and Reproductive Health
• Behavioral Science
• Global Health

Background:

• Self-injection (SI) for contraception is a WHO-endorsed self-care approach, aiming to improve access and empower women.
• Despite increased contraceptive prevalence in Malawi, uptake of SI, particularly depot medroxyprogesterone acetate subcutaneous (DMPA-SC), remains limited in rural areas.
• Community Health Surveillance Assistants (CHSA) play a role in delivering injectable contraceptives in rural Malawi.

Purpose of the Study:

• To explore the behavioral drivers influencing women's decision to use self-injectable contraception (SI) provided by CHSAs in rural Malawi.
• To understand how capability, opportunity, and motivation influence the adoption of DMPA-SC SI.

Main Methods:

• The study utilized the capability, opportunity, motivation-behavior model.
• Sixty women aged 15-45 years in two rural Malawian districts participated.
• Data were collected through in-depth interviews on contraceptive use and SI experiences.

Main Results:

• Women's capability for SI was enhanced through practical demonstrations by CHSAs, overcoming initial hesitation.
• Improved access, trust, and privacy, alongside counseling and reduced travel costs, increased motivation and opportunity for SI.
• CHSA support was pivotal in encouraging confident and consistent adoption of self-injection.

Conclusions:

• Women's adoption of SI is influenced by a combination of enhanced capability, increased motivation, and improved opportunity.
• Prioritizing CHSA training and deployment is crucial for future family planning programs to boost SI uptake.
• Strengthening the role of CHSAs can foster greater autonomy and accessibility of contraceptive services for rural women.