Adolescent and Youth Experiences With Contraceptive Self-Injection in Uganda: Results From the Uganda Self-Injection Best Practices Project

Corneliess, Caitlin; Cover, Jane; Secor, Andrew; Namagembe, Allen; Walugembe, Fiona

doi:10.1016/j.jadohealth.2022.08.010

Cited by 7 publications

(16 citation statements)

References 14 publications

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“…The strength of these concerns among never-married adolescents appeared to somewhat outweigh the appeal of the discretion and fewer visits to facilities—suggesting that these areas would need to be adequately addressed in any future program aiming to expand access among this group. These findings echo insights from similar studies in Uganda, where fear of lack of privacy at home and misconceptions about the impact of hormones on long-term infertility were cited as key adolescent concerns with the DMPA-SC SI concept ( 23 , 24 , 30 ). The need for a private, safe space at home to take up the SI option may also indicate that for some adolescents, receiving injectables from community-based providers may be the more discreet option.…”

Section: Discussionsupporting

confidence: 80%

“…Indeed, some analyses have found that never-married women are more likely to use easier-to-access methods such as condoms over methods that require interaction with healthcare workers, such as injectables ( 35 ), likely due to these sorts of access and stigma barriers. A study with SI users in Uganda also found that adolescents were less likely than adults to first hear about DMPA-SC SI from a community health care worker/Village Health Team member), and more likely to hear about it from friends, suggesting that these access and stigma barriers may also pose a challenge to awareness about the method ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…We recommend that further research should be conducted in Malawi and other contexts to explore the experiences of adolescents already self-injecting, especially those who are never-married, who face the highest barriers. Building on the work of Corneliess et al ( 24 ) in Uganda, future studies could focus on understanding adolescents' experiences with the method and level of satisfaction, and how they have managed to overcome challenges around access, storage and use of SI at home (particularly if they use FP covertly) that have been highlighted by their peers with unmet need for contraception in this study. Future research could also monitor and evaluate adolescent and youth uptake of DMPA-SC in the context of a full contraceptive method mix in Malawi and other contexts to determine effective models of care for reaching this population with a comprehensive contraceptive method mix to reduce unmet need for contraception.…”

Section: Discussionmentioning

confidence: 99%

“… DMPA-SC attributes exercise — breaking down the attributes of DMPA-SC and asking about each attribute's suitability for the archetype individually For this exercise, married and never-married adolescents in the focus group discussions were introduced to 12 attributes of DMPA-SC one-by-one and asked if they felt each attribute made the product suitable or unsuitable for their archetype. These attributes were drawn from the broader literature on DMPA-SC features that appealed or did not appeal to women and adolescents in Malawi and other contexts ( 17 , 24 , 30 ) and care was taken to try and use neutral and balanced framing of each attribute. The wording of the 12 attributes of DMPA-SC included in the exercise are listed in Table 1 .…”

Section: Methodsmentioning

confidence: 99%

“…Another study among DMPA-SC clients in Malawi showed that younger self-injectors (18-24 years old) have similar continuity rates with using DMPA-SC compared to older women (21). It had been hypothesized during the roll-out of DMPA-SC in Malawi that the SI option could be a feasible, discreet and convenient option for adolescents, as indicated by studies from other contexts (22)(23)(24), and could even help expand access among adolescents with unmet need for contraceptives. A recent study from Uganda (24) found no significant differences in competence in initial and subsequent SI of DMPA-SC between adolescent self-injectors (aged under 20) and older women, a finding which raises prospects of feasibility of SI among adolescents in similar contexts.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

Ali

Erlank²,

Birhanu

et al. 2023

Front. Glob. Womens Health

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IntroductionMalawi has made progress in expanding access to modern contraceptive methods over the last decade, including the introduction of depot-medroxyprogesterone acetate subcutaneous (DMPA-SC) in 2018. DMPA-SC offers women the option to self-inject at home and may benefit adolescents with unmet need for contraception due to its discretion. This qualitative study was conducted to assess perspectives and preferences of adolescents with unmet need for contraception regarding the self-injection option of DMPA-SC in Malawi.MethodsSix focus group discussions were conducted involving 36 adolescents with unmet need for contraception (aged between 15 and 19 years, married and never-married) in October 2021 in three districts in Malawi. Data were coded inductively and analyzed thematically, using Dedoose software. Two validation workshops were conducted with other adolescents with unmet need in February 2022 to elucidate the preliminary findings.ResultsDMPA-SC attributes such as discretion and reduced facility visits were ranked most appealing by both married and never-married adolescents, particularly for adolescents needing covert contraception use. Concerns about self-injection included fear of pain, injury, and doubt in ability to self-inject. Never-married adolescents had additional concerns around privacy at home if using covertly, and fears of affecting long-term fertility. Overall, health surveillance assistants (community-based healthcare workers) were voted to be the most private, convenient, and affordable sources for potential DMPA-SC self-injection training.ConclusionSelf-injection of DMPA-SC may offer an appealing option for adolescents in Malawi, aligning most closely to the needs of married adolescents who may wish to delay or space pregnancies conveniently and discreetly, and who also may face fewer access barriers to receiving self-injection training from health care providers. Access barriers including stigma and concerns about privacy at home for adolescents needing to use contraception covertly would need to be adequately addressed if never-married adolescents were to consider taking up this option.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

Ali

Erlank²,

Birhanu

et al. 2023

Front. Glob. Womens Health

View full text Add to dashboard Cite

show abstract

Self-care interventions for women’s health and well-being

Narasimhan,

Hargreaves,

Logie

et al. 2024

Nat Med

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Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

Erlank¹,

Ali

Birhanu

et al. 2023

Preprint

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Since the introduction of depot medroxyprogesterone acetate (DMPA-SC) in 2018, Malawi has achieved national coverage of trained providers in the public sector and steady increases in uptake of DMPA-SC. However, the rate of clients opting to self-inject DMPA-SC has remained lower than early acceptability studies suggested. Providers play an instrumental role in building client confidence to self-inject through counselling. This cross-sectional qualitative study explored the perspectives of providers and injectable clients on the integration of self-injection into contraceptive counselling, to identify best practices and gaps. The study was conducted at public sector sites in three districts (Nkhotakota, Mzimba South, Zomba) in Malawi. In-depth interviews were conducted with provider-administered injectable clients, self-injecting clients, and DMPA-SC trained providers. All providers interviewed reported successfully integrating self-injection into their approach. During health education sessions, providers tended to focus mainly on benefits of self-injection to spark interest in the method, and then follow that up with more in-depth information in individual counselling. Due to time pressures, a minority of providers reported replacing individual counselling with small-group counselling and limited their use of peer testimonials, visualizations, and demonstrations. Most providers skipped client practice on inanimate objects, feeling this was either not necessary or not appropriate given stock or resource constraints. Current self-injecting clients showed the best recall for self-injection steps and tended to report having received comprehensive, supportive counselling including aspects such as peer testimonials, visualizations, and demonstrations to build confidence. Injectable clients who had declined self-injection tended to demonstrate less detailed recall of key self-injection messages and report receiving incomplete information, and lack of peer testimonials, visualization, or demonstrations. Comprehensive counselling and training from supportive providers, including best practices identified in this study, are vital to improving client confidence to self-inject. Providers should be supported to overcome time- and resource-pressures to invest in these best practices.

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Adolescent and Youth Experiences With Contraceptive Self-Injection in Uganda: Results From the Uganda Self-Injection Best Practices Project

Cited by 7 publications

References 14 publications

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi

Self-care interventions for women’s health and well-being

Health care provider and client experiences of counselling on depot medroxyprogesterone acetate subcutaneous (DMPA-SC) for self-injection in Malawi

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