Acceptability of Contraceptive Self-Injection with DMPA-SC Among Adolescents in Gulu District, Uganda
In Uganda, an estimated one in four adolescent women have begun childbearing. Many adolescent pregnancies are unintended because of substantial barriers to contraceptive access. The injectable contraceptive is the most commonly used method in Uganda, and a new subcutaneous version offers the possibility of reducing access barriers by offering a self-injection option. However, more information about adolescent attitudes toward and interest in self-injection is needed.
In 2015, in-depth interviews were conducted with a purposive sample of 46 adolescent women aged 15–19 from rural and urban areas of Gulu District. Respondents were asked about their demographic characteristics, experience with contraceptives and opinions about injectable contraception, then introduced to subcutaneous depot medroxyprogesterone acetate (DMPA-SC) and trained in how to give an injection using a model. They were then asked their opinion about contraceptive self-injection. The interviews were transcribed and analyzed qualitatively to identify key themes.
Although the injectable was generally viewed favorably, some adolescents expressed reservations about the suitability of injectable contraception for adolescents. The most common concern was fear of infertility. The majority felt self-injection would be an appealing option to adolescents because of the time and money saved and the discreet nature of injecting at home. Barriers to self-injection included fear of needles, the potential of making a mistake and lack of privacy at home.
Contraceptive self-injection has the potential to increase contraceptive access and use for adolescents in Uganda, and should be considered as a delivery modality in the context of adolescent-friendly contraceptive services.
Jane Cover is research manager, Jeanette Lim is program officer and Jennifer Kidwell Drake is project director—all at PATH, Seattle, WA, USA. Allen Namagembe is evaluation manager, and Justine Tumusiime is program officer, both at PATH, Kampala, Uganda. Carie Muntifering Cox is assistant professor, Department of Public Health, St. Catherine University, St. Paul, MN, USA.
Author contact: [email protected]
This work was funded by the Children's Investment Fund Foundation, London (Grant 333). The funding source did not play a role in study design; the collection, analysis and interpretation of data; the writing of the report; or the decision to submit the manuscript for publication. The authors would like to thank the study nurses and consultant interviewers at the research study sites in Gulu district, as well as the Reproductive Health Uganda and Straight Talk Foundation staff who helped to recruit women for the study.