Barriers and Facilitators to Expanding User-Administered Injectable Contraceptives in the United States

To identify facilitators and barriers to prescribing subcutaneous depot medroxyprogesterone acetate (DMPA) for user administration.

This mixed-methods study comprised surveys (N=422) and interviews (N=34) with family planning experts, defined as health care professionals who see at least three contraceptive visits a month, regarding their awareness, knowledge, and practice of prescribing subcutaneous DMPA for user administration.

We found that 74.5% of professionals reported awareness of subcutaneous DMPA for user administration, but only 34.8% actively prescribed it. Professionals who completed a fellowship in reproductive health, specialized in obstetrics and gynecology, saw a higher number of visits for contraception in a setting with a larger number of pregnancy-potential patients, or worked at a clinic with Title X funding, Planned Parenthood, or a freestanding clinic were more likely to be aware of subcutaneous DMPA for user administration. Negative predictors of awareness included internal medicine specialization, working in a pharmacy, and having a fewer number of contraception options available. Significant predictors for prescribing subcutaneous DMPA if aware of the option include being gender diverse or male, having access to subcutaneous DMPA-specific clinical workflows, and having state Medicaid and private insurance coverage for subcutaneous DMPA. Negative predictors for prescribing if aware include living in a state with abortion restrictions.

Our data among experts in contraceptive care highlight that awareness is associated by professional- and institutional-level factors and barriers between awareness of subcutaneous DMPA for user administration and provision that are primarily institutional and systemic. Facilitators for awareness and provision of subcutaneous DMPA for self-administration span multiple domains, including professional's perceived patient barriers, professional demographics, institutional challenges, and government policies.