Feasibility and acceptability of DMPA-SC self-injection in Addis Ababa, Ethiopia: a mixed-methods study

Depot Medroxyprogesterone Acetate (DMPA) in a prefilled auto-disabled subcutaneous injectable contraceptive (Uniject™) can be administered by community health workers and clients. Self-injection of DMPA-SC is an evidence-based practice endorsed globally by the World Health Organization and approved in several countries. The Ethiopian Ministry of Health is interested in introducing DMPA-SC self-injection to expand family planning options. This research aimed to generate information on the safety, acceptability, and feasibility of the introduction and scale-up of DMPA-SC self-injection in Ethiopia.

We used mixed-method research. Four hundred women aged 18-49 interested in DMPA-SC self-injection were enrolled in the study. Participants were recruited from six public health facilities with high family planning client load in Addis Ababa. In-depth interviews were conducted with 15 family planning providers trained on self-injection and provided DMPA-SC from six public health facilities. Participants' self-injection competency was assessed using a standardized checklist at enrollment and follow-up (three months post-enrollment). Quantitative data were analyzed using descriptive statistics, and the qualitative data were analyzed using thematic analysis.

Self-injection competency among women at baseline (95%) was high and at three months follow-up (83%). Competency levels did not differ by sociodemographic characteristics. Participants reported increased confidence and comfort with self-injection during the three-month follow-up compared to baseline; 74% said they were confident to self-inject during enrollment compared with 93% at follow-up. 84% of participants said they were satisfied or very satisfied with DMPA-SC self-injection. Providers saw the benefit of offering DMPA-SC self-injection because it saves clients time, money, and the burden of having to come to a health facility. Providers suggested that DMPA-SC self-injection be added to the method mix and offered through community distribution by health extension workers.

Results showed that women can competently self-inject DMPA-SC and that it is highly acceptable to clients and providers. If made available, most women would like to continue with the method and would recommend it to others. DMPA-SC self-injection has the potential to support the Ethiopian Ministry of Health in reaching its FP2030 targets. The results from this study further support the introduction and scale-up of DMPA-SC self-injection in Ethiopia.