Frontiers in Global Women’s Health (2022). DOI: 10.3389 / fgwh.2022.911107″ width=”800″ height=”530″/> Flow chart from training through subsequent contraceptive results. *8 individuals with conflicting information who reported having experienced self-injection but also reporting zero self-injection times. attributed to him: Frontiers in global women’s health (2022). DOI: 10.3389 / fgwh.2022.911107
Flow chart from training through subsequent contraceptive results. *8 individuals with conflicting information who reported having experienced self-injection but also reporting zero self-injection times. attributed to him: Frontiers in global women’s health (2022). DOI: 10.3389 / fgwh.2022.911107
Allen Namagembe is a clinical epidemiologist, biostatistician, and global expert in self-injection. She is the Deputy Project Manager for Uganda and the Monitoring and Evaluation lead for the Uganda Autologous Injection Scaling Up Project at PATH. Dr. Jane Cover is the Director of Research and Evaluation for the PATH Sexual and Reproductive Health Team and the PATH-JSI DMPA-SC Access Collaborative.
Now, they explain two studies of their team, which were published in Frontiers in global women’s healthThey used a human-centered design approach to develop and implement a pilot program for self-injection in Uganda. Their results show how the program can increase women’s access to contraceptives and options.
For some, the term “self care“You might conjure up images of your skincare routine, bubble baths, and meditation. But in Public HealthSelf-care refers to the ability of individuals to self-manage their aspects health Care with a view to promoting and maintaining health, preventing disease, and managing disease or disability. Self-care interventions are grounded in evidence, agency and equity, which are essential components of a comprehensive primary health care system and can help fill gaps in access to essential health services.
We both conduct research in the field of sexual and reproductive health, not just because of our love of science, but because ultimately, we hope to empower women and girls to make informed choices about what works best for them — self-care interventions are one way to achieve this.
Self-injected contraceptives are effective and feasible
Self-injected contraception is a self-care intervention that has shown tremendous potential in improving women’s access to high-quality family planning services.
For over 10 years, PATH has collaborated with ministries of health and partners to research, deliver, and extend DMPA subcutaneously (DMPA-SC, subcutaneous depot medroxyprogesterone acetate), an innovative, easy-to-use contraceptive method that can be injected by any trained individual, including women themselves. in a place and at a time that suits them best. Currently, DMPA-SC is available in more than 55 countries, over 35 of which offer self-injection.
The simplicity, privacy, and convenience of self-injected DMPA-SC can help reduce the burden on the healthcare system by expanding who can administer contraception and when. This has enormous implications for women and teenage girls who have the right to choose whether they become pregnant, when they become pregnant, and what type of contraception, if any, they use.
Research by PATH and our partners has shown that self-injected contraceptives are feasible and effective. Findings from two recently published studies of our team at Frontiers in global women’s healthwhich is among the first to evaluate a program of self-injection under routine conditions outside the research environment, provides further evidence to support this.
Women can successfully self-inject themselves with training and support
We used a human-centered design approach to develop and implement a pilot program for self-injection in Uganda, working closely with the Ministry of Health to integrate this option in both the public and private sectors. Trained providers introduced DMPA-SC as a voluntary method of contraception at participating facilities in three regions. Then we evaluated the women’s experiences, teenage girlsAnd the health workers who participated in the program and evaluated the effectiveness of different program designs, and generated evidence to inform the initiation of future self-injection programs.
During the first year, 4,340 women voluntarily chose self-injection. Of the 958 self-injection clients interviewed, 93% were able to self-inject independently at home after receiving one training session—the majority (69%) continued to self-inject for at least 1 year. These results reflect customer satisfaction with autologous injections and the frequency of high autoinjection follow-up rates found in the research settings.
On the flip side, a significant proportion of women who expressed interest in self-injection and received training chose not to self-inject, with most citing fear or mistrust as a major barrier. Their decision is an important reminder that training quality affects the uptake of self-injection, and that even with high-quality training, self-injection isn’t for everyone—and that’s okay.
We learned that unmarried women, women with supportive family planning partners, who trained through labor assistance or offering injections, and those who had individual training were more likely to choose self-injection than their counterparts.
The other main result was, regardless of education levelWith proper training and support, women were able to self-inject successfully. This is an important finding, because uneducated women may face discrimination in accessing self-injection services despite their ability to benefit the most because of the barriers they face in accessing family planning services.
Health workers play an important role in self-care
Clients’ access to self-care can depend on the perspectives of health workers, who often act as gatekeepers to self-care interventions. Through interviews with 120 health workers active in the auto-injection program, we found that most of them were very satisfied with the program and reported that it was fairly easy to incorporate auto-injection training into their workload.
While self-injecting clients can ultimately reduce health workers’ workload, training clients to self-inject can be difficult and time-consuming. Health workers reported obstacles such as lack of time to train clients in the clinic environment, lack of materials among CHWs, and client fear of self-injection. However, CHWs were less likely than clinic-based health workers to report time challenges and indicated higher levels of satisfaction and ease in providing self-injection services.
Government leadership makes the difference
Feedback on self-injection from clients and health workers is very promising. However, as programs are being introduced in more countries, there is a need for more evidence on how to implement them in practical ways for clients, health workers and existing health care systems. Sustainable government leadership and partnership are also critical. The success of our programme, and the ongoing work to expand self-injection in Uganda, would not have been possible without the Ugandan government’s commitment to rights-based family planning.
Jane Cover et al, Self-injection of contraceptives through routine service delivery: Ugandan women’s experiences in the public health system, Frontiers in global women’s health (2022). DOI: 10.3389 / fgwh.2022.911107
the quote: Research shows how self-injecting contraceptives can empower women to take charge of their reproductive health (2022, September 22) Retrieved September 22, 2022 from
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