Work

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

Year: 2025

Type: article

Abstract: 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. This study looked at whether women in Ethiopia could safely and confidently give themselves a birth control shot called DMPA-SC. The shot comes in a small, easy-to-use device and can be given under the skin. It’s already approved in many countries and supported by the World Health Organization. Researchers worked with 400 women in Addis Ababa who were interested in trying self-injection. They also spoke with 15 health workers to get their views. Most women were able to give themselves the shot correctly, both at the beginning and three months later. There was no significant difference in competency by socio-demographic characteristics. Over time, they felt more confident and comfortable doing it. Nearly all said they were satisfied and would recommend it to others. There were no reports of accidental needle pricks by the used or unused DMPA-SC units. Health workers liked the idea too—they said it saves women time and money and could be offered by community health workers. The study shows that self-injection is safe, popular, and could help more women in Ethiopia access birth control, especially as the country works toward its family planning goals.

Source: Reproductive Health

DOI: 10.1186/s12978-025-02174-z