{"id":5586,"date":"2021-05-27T18:37:44","date_gmt":"2021-05-27T18:37:44","guid":{"rendered":"https:\/\/kmtraining.org\/reflections-on-advances-in-dmpa-sc-and-self-injection\/"},"modified":"2026-04-28T12:46:46","modified_gmt":"2026-04-28T12:46:46","slug":"reflections-on-advances-in-dmpa-sc-and-self-injection","status":"publish","type":"post","link":"https:\/\/kmtraining.org\/fr\/reflections-on-advances-in-dmpa-sc-and-self-injection\/","title":{"rendered":"Reflections on advances in DMPA-SC and self-injection"},"content":{"rendered":"
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“Sayana is easy to use, and [there is] no need to spend time coming to the hospital to be injected. When it\u2019s your date, you just help yourself at home.”<\/em> \u2013 Participant in the randomized controlled trial of DMPA-SC self-injection in Malawi, 2017<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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I joined FHI 360 as a Research Assistant in 2011. I was delighted when I found out that I would get to work on two research studies about a new family planning method called DMPA-SC* (often known by its brand name, Sayana\u00ae Press). The goal of these studies was to explore the acceptability of this new contraceptive injectable in Uganda and Senegal. We wanted to answer the questions: Can facility- and community-based healthcare providers safely administer DMPA-SC (give injections)? How do family planning clients and providers feel about this method?<\/p>\n\n\t\t<\/div>\n\t<\/div>\n\n\t

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J’ai rejoint FHI 360 en tant qu’assistant de recherche en 2011. J’ai \u00e9t\u00e9 ravie d’apprendre que j’allais travailler sur deux \u00e9tudes de recherche sur une nouvelle m\u00e9thode de planification familiale appel\u00e9e DMPA-SC* (souvent connu sous son nom de marque, Presse Sayana\u00ae). Le but de ces \u00e9tudes \u00e9tait d’explorer l’acceptabilit\u00e9 de ce nouveau contraceptif injectable en Ouganda et au S\u00e9n\u00e9gal.. Nous voulions r\u00e9pondre aux questions: Peuvent les prestataires de soins de sant\u00e9 bas\u00e9es aux formation sanitaires ainsi qu\u2019\u00e0 la communaut\u00e9 administrent en toute s\u00e9curit\u00e9 le DMPA-SC (faire des injections)? Que pensent les clients et les prestataires de planification familiale de cette m\u00e9thode?<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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I had studied abroad in Senegal, so I was excited to return there and train the people collecting data for the studies. The data collectors interviewed clients who had used DMPA-SC<\/a> as a contraceptive method and the healthcare providers who administered it<\/a>. We found that facility- and community-based health providers could safely administer DMPA-SC to clients. All of the clients and providers interviewed had previously used or administered another form of injectable contraception called intramuscular DMPA (or DMPA-IM). We asked clients what they liked and did not like about DMPA-SC, and whether they preferred DMPA-SC or DMPA-IM (most said they preferred DMPA-SC). We also asked providers about their experiences administering DMPA-SC, and most said they preferred to administer DMPA-SC compared to DMPA-IM.<\/p>\n

These were the first studies to measure the feasibility (“Can we deliver it?”) and acceptability (“Do clients feel positive about it?”) of DMPA-SC in sub-Saharan Africa. At that time, the product was not registered in either Senegal or Uganda, so we needed to get special permission to bring in DMPA-SC for use in our studies. For decades, FHI\u202f360 has generated and used evidence to advocate for more family planning access and to improve quality of care (including through task sharing). For example, these efforts led to scaling up community-based provision of injectable contraception<\/a>, which is now well-recognized as the standard of practice.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n\n\t

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J’avais \u00e9tudi\u00e9 \u00e0 l’\u00e9tranger au S\u00e9n\u00e9gal, J’\u00e9tais donc ravi d’y retourner et de former les personnes qui collectent des donn\u00e9es pour les \u00e9tudes. Les collecteurs de donn\u00e9es interrog\u00e9s clients qui avaient utilis\u00e9 le DMPA-SC<\/a> comme m\u00e9thode contraceptive et fournisseurs de soins de sant\u00e9 qui l’ont administr\u00e9<\/a>. Nous avons trouv\u00e9 que les prestataires de soins bas\u00e9es aux formations sanitaires et \u00e0 la communaut\u00e9 pourraient administrer en toute s\u00e9curit\u00e9 le DMPA-SC aux clients. Toutes les clientes et prestataires interrog\u00e9s avaient d\u00e9j\u00e0 utilis\u00e9 ou administr\u00e9 une autre forme de contraception injectable appel\u00e9e DMPA intramusculaire (ou DMPA-IM). Nous avons demand\u00e9 aux clients ce qu’ils aimaient et n’aimaient pas \u00e0 propos du DMPA-SC, et s’ils pr\u00e9f\u00e9raient le DMPA-SC ou le DMPA-IM (la plupart ont dit qu’ils pr\u00e9f\u00e9raient le DMPA-SC). Nous avons \u00e9galement interrog\u00e9 les prestataires sur leurs exp\u00e9riences d’administration du DMPA-SC, et la plupart ont dit qu’ils pr\u00e9f\u00e9raient administrer le DMPA-SC par rapport au DMPA-IM.<\/p>\n

Ce sont les premi\u00e8res \u00e9tudes \u00e0 mesurer la faisabilit\u00e9 (\u201cPouvons-nous le livrer?\u201d) et acceptabilit\u00e9 (\u201cLes clients sont-ils positifs \u00e0 ce sujet?\u201d) du DMPA-SC en Afrique subsaharienne. \u00c0 ce moment-l\u00e0, le produit n’a \u00e9t\u00e9 enregistr\u00e9 ni au S\u00e9n\u00e9gal ni en Ouganda, nous devions donc obtenir une autorisation sp\u00e9ciale pour utiliser le DMPA-SC dans nos \u00e9tudes. Depuis des d\u00e9cennies, FHI360 a g\u00e9n\u00e9r\u00e9 et utilis\u00e9 des preuves pour plaider en faveur d’un plus grand acc\u00e8s \u00e0 la planification familiale et pour am\u00e9liorer la qualit\u00e9 des soins (y compris via La d<\/span>\u00e9<\/span>l<\/span>\u00e9<\/span>gation des t<\/span>\u00e2<\/span>ches<\/span>). Par exemple, ces efforts ont conduit \u00e0 une intensification fourniture communautaire de contraceptifs injectables<\/a>, qui est maintenant bien reconnu comme la norme de pratique.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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Evidence to Support Scale-up<\/h3>\n

During the past decade, FHI 360, PATH, and other groups have generated strong evidence showing that DMPA-SC is safe and acceptable to clients and providers. DMPA-SC was soon made available for self-injection: Clients could take the product home with them to use themselves. Since then, studies have also shown that DMPA-SC and self-injection can increase access to contraception and continued use among adolescent girls and women around the world. Thanks to the resulting endorsement by the World Health Organization<\/a> (WHO) and advocacy efforts, countries have introduced and scaled up DMPA-SC and self-injection in the past several years. For example, Malawi was one of the first countries to introduce DMPA-SC<\/a> and self-injection at the same time (it is more common to introduce provider-administered DMPA-SC first, and introduce self-injection later). This was based on evidence from a randomized controlled trial<\/a> conducted by FHI 360 and the University of Malawi. This 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\u2019s\u202fMinistry of Health (MOH) approved\u202fthe\u202fintroduction\u202fof\u202fDMPA-SC self-injection into the family planning method mix and began offering it in seven districts. Malawi was a pioneer in sub-Saharan Africa in offering DMPA-SC self-injection as part of routine family planning delivery. The MOH approved the national rollout of self-injection in 2020.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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Workshops Expand Knowledge<\/h3>\n

In 2019, I was fortunate to attend the DMPA-SC Evidence to Practice meeting<\/a>. This meeting was convened by the DMPA-SC Access Collaborative and took place over four days in Dakar, Senegal. It was amazing to see the progress achieved through the introduction and availability of this product and the hard work of people around the world. During that meeting, countries shared and learned from one another\u2019s experiences introducing and scaling up DMPA-SC and self-injection. Based on these learnings, the meeting supported more countries to make action plans to introduce DMPA-SC and self-injection.<\/p>\n\n\t\t<\/div>\n\t<\/div>\n

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In March 2021, the DMPA-SC Access Collaborative organized the virtual Making Self-Injection Count<\/a> workshop. The eight sessions focused on how to integrate self-injection data into routine health management information systems (HMIS). Sessions also focused on how to use public and private sector data to inform policy and practice. I helped to support the session, \u201cIntegrating Self-Care Methods into the National Health Information System: Experiences and Lessons Learned from Malawi.\u201d<\/a> This session was based on the Malawi Ministry of Health\u2019s (MOH) integration of DMPA-SC and self-injection into their HMIS and the effective partnership that enabled the successful rollout of DMPA-SC. In addition to the Malawi MOH, this partnership included ten other organizations:<\/p>\n