Reflections on Advances in DMPA-SC and Self-Injection

Research studies conducted in Uganda and Senegal in 2011 and 2012 explored the acceptability of DMPA-SC among clients and providers. The studies found that facility- and community-based healthcare providers could safely administer DMPA-SC, and clients preferred DMPA-SC over intramuscular DMPA. The introduction of DMPA-SC for self-injection has further increased access to contraception and continued use among adolescent girls and women worldwide. Studies have shown that self-injection can increase access to contraception and continued use among adolescent girls and women. The World Health Organization (WHO) has endorsed DMPA-SC and self-injection, and countries have introduced and scaled up these methods in recent years. Malawi was one of the first countries to introduce DMPA-SC and self-injection simultaneously, based on evidence from a randomized controlled trial conducted by FHI 360 and the University of Malawi. The trial showed that those who self-injected DMPA-SC were more likely to continue using it compared to those who received their injection from a healthcare provider. In 2018, Malawi's Ministry of Health approved the introduction of DMPA-SC self-injection into the family planning method mix and began offering it in seven districts. The Ministry approved the national rollout of self-injection in 2020. Malawi was a pioneer in sub-Saharan Africa in offering DMPA-SC self-injection as part of routine family planning delivery. Workshops and meetings have played a crucial role in expanding knowledge and sharing experiences among countries introducing and scaling up DMPA-SC and self-injection. The DMPA-SC Evidence to Practice meeting in 2019 brought together countries to share and learn from one another's experiences introducing and scaling up DMPA-SC and self-injection. The meeting supported more countries to make action plans to introduce DMPA-SC and self-injection. The virtual Making Self-Injection Count workshop in 2021 focused on integrating self-injection data into routine health management information systems and using public and private sector data to inform policy and practice. Today, more than 40 countries have introduced or scaled up DMPA-SC as a family planning method, with half of these countries also introducing or planning to introduce self-injection. Self-injection of DMPA-SC allows adolescent girls and women to prevent pregnancy in a private and convenient manner for up to one year, making it an essential method for family planning and reproductive health during the COVID-19 pandemic and beyond.