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Injectable contraceptive continuation and user experiences in Punjab, Pakistan: a non-randomized prospective cohort

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This study compares self-administered subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) with health worker-administered injections in Pakistan. It aims to provide evidence on DMPA-SC for improving contraceptive access and continuation rates.

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Area of Science:

  • Reproductive Health
  • Contraception
  • Public Health

Background:

  • Self-administered subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) shows promise for improving contraceptive continuation and access.
  • Limited studies exist in South Asia, particularly Pakistan, where non-hormonal methods dominate contraceptive use.
  • Policymakers need context-specific evidence for introducing DMPA-SC in Pakistan.

Purpose of the Study:

  • To compare the 12-month contraceptive continuation rate of DMPA-SC versus intramuscular depot-medroxyprogesterone acetate (DMPA-IM).
  • To compare participant characteristics and experiences between DMPA-SC and DMPA-IM users.
  • To assess adherence to self-injection standards for DMPA-SC.

Main Methods:

  • Prospective cohort study in 41 health facilities and communities in Punjab, Pakistan.
  • Comparison of 12-month continuation rates between DMPA-SC and DMPA-IM.
  • Sub-study on self-injection adherence (storage, timing, technique, disposal).

Main Results:

  • Results pending further analysis.
  • The study is registered on clinicaltrials.gov (NCT05774626).

Conclusions:

  • This research will inform health sector decision-making in Pakistan regarding DMPA-SC introduction.
  • Findings will contribute to global efforts to reduce inequities in contraceptive method access.
  • The study provides a foundation for future research on alternative service delivery and support models for self-injection.