Self‐administration of injectable contraceptives: a systematic review

Abstract

BackgroundThe contraceptive injectable is a safe and effective method that is used worldwide. With the variety of injectable delivery systems, there is potential for administration by the woman herself. Self‐administration of the contraceptive injectable is the subject of this systematic review.ObjectivesTo assess how effective and safe the contraceptive injectable method is when women themselves perform/administer it, compared with when the usual healthcare providers administer it.Search strategyWe searched PubMed, Popline, Cochrane, CINAHL, and Embase for articles with subject headings or text words related to ‘self‐administration’ and ‘contraception’.Selection criteriaStudies that compared the administration of the contraceptive injectable by the woman herself versus administration by the healthcare provider were included. Outcomes of interest were continuation rates, safety, and the women's overall satisfaction with the contraceptive provider and method.Data collection and analysisWe undertook data extraction, descriptive analysis, and assessment of risk of bias.Main resultsThree studies met the inclusion criteria. The best available evidence shows that there may be little or no difference in continuation rates when women self‐administer contraceptive injections (326 per 1000 women; 95% CI 192–554 per 1000 women) compared with administration by healthcare providers (304 per 1000 women). Safety was not estimable as no serious adverse events were reported in any of the studies. With regards to overall satisfaction towards the provider and the method, the effect of the intervention was uncertain.Authors’ conclusionsFindings suggest that with appropriate information and training the provision of contraceptive injectables for the woman to self‐administer at home can be an option in some contexts.Tweetable abstractThis review assessed the continuation rates and safety of self‐administration of the contraceptive injection.

Effect of self-administration versus provider-administered injection of subcutaneous depot medroxyprogesterone acetate on continuation rates in Malawi: a randomised controlled trial

“…As of August, 2017, Sayana Press was registered for self-injection in 18 countries, including seven in sub-Saharan Africa (Radola A, Pfizer, personal communication). Proponents of self-injection cite the potential for improved contraceptive use due to increased timeliness of re-injection; 16 self-injection would also eliminate the barrier of having to visit the clinic or CHW. Indeed, previous research in high-income countries has shown that self-injection of DMPA-SC is feasible and safe.…”

Women's satisfaction, use, storage and disposal of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) during a randomized trial

“…More than 40 million women worldwide use injectable contraceptives, and in many low-and middle-income country (LMIC) settings, injectables account for at least one half of modern contraceptive method use [1]. The subcutaneous formulation of depot medroxyprogesterone acetate (DMPA-SC) in the prefilled Uniject™ injection system, commercially known as Sayana® Press, is gaining popularity among family planning providers and women.…”

The feasibility of contraceptive injections at the community pharmacy

“…It is therefore unsurprising that self-injection at a time and place of their own choosing offers patients another level of convenience that they are keen to take advantage of. The available literature on self-injection highlights the convenience of this method (Kim et al, 2017; Cameron et al, 2012b).…”