Women's Perspectives on the Unique Benefits and Challenges of Self‐Injectable Contraception: A Four‐Country In‐Depth Interview Study in Sub‐Saharan Africa
Implementing self-injection (SI) of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) is a key self-care strategy for sexual and reproductive health, but SI uptake remains low, and assertions about the potential of SI to increase women's control over contraceptive use lack evidence. We sought to qualitatively explore how women with diverse contraceptive experiences-including those with and without experience using SI-view the benefits and challenges of SI as compared to other methods. We conducted 241 in-depth interviews with women across four sub-Saharan African countries and found alignment between the perceived and experienced benefits of SI across our diverse sample. Through the benefits of privacy, easier access, and self-management, we found SI can promote greater control over the contraceptive experience by facilitating a woman's ability to act on her preferences and control who is involved in or aware of her contraceptive use. Interviews revealed SI's potential is, however, constrained by inherent limitations in the method; for example, it is often not private or accessible enough and many fear injecting themselves. SI has the most potential when implemented with programmatic solutions that mitigate challenges women experience or anticipate and allow more women to benefit from the privacy, easier access, and self-management that SI offers.
Authors
- Beth Phillips (ORCID: https://orcid.org/0000-0001-7467-0494)
- Mandayachepa Nyando
- Janelli Vallin (ORCID: https://orcid.org/0009-0002-3383-9868)
- Sneha Challa (ORCID: https://orcid.org/0000-0001-5220-6834)
- Betty Kaudha
- Elizabeth A. Bukusi (ORCID: https://orcid.org/0000-0002-2031-2808)
- Agnes Kayego
- Catherine Birabwa (ORCID: https://orcid.org/0000-0003-2916-9275)
- Dinah Amongin (ORCID: https://orcid.org/0000-0002-1420-005X)
- Zachary Kwena (ORCID: https://orcid.org/0000-0002-5117-5084)
- Phoebe Alitubeera
- Martha Kamanga (ORCID: https://orcid.org/0000-0002-1576-6848)
- Louisa Ndunyu
- Address Malata (ORCID: https://orcid.org/0000-0002-8844-935X)
- Lauren Suchman (ORCID: https://orcid.org/0000-0002-3684-0314)
- Pauline Wekesa (ORCID: https://orcid.org/0009-0004-9706-3979)
- Peter Waiswa (ORCID: https://orcid.org/0000-0001-9868-0515)
- Alfred Maluwa (ORCID: https://orcid.org/0000-0002-4451-7277)
- Kelsey Holt (ORCID: https://orcid.org/0000-0001-9093-4322)
- Aminat Tijani
- Lynn Atuyambe (ORCID: https://orcid.org/0000-0001-5886-5080)
- Ayobambo Jegede
- Elizabeth Omoluabi (ORCID: https://orcid.org/0000-0003-1754-5384)
- Serah Gitome (ORCID: https://orcid.org/0009-0002-3371-4213)
- Chioma Okoli
- Shakede Dimowo
- Tamandani Jumbe
- Innocencia Mtalimanja
- Emily Himes (ORCID: https://orcid.org/0000-0003-2713-0051)
- Jenny Liu (ORCID: https://orcid.org/0000-0002-3929-0135)
- Grace Nmadu
- Sarah Okumu (ORCID: https://orcid.org/0000-0002-8668-0048)
Institutions
- University of Malawi (MW)
- University of California, San Francisco (US)
- Maseno University (KE)
- University of Washington (US)
- Malawi University of Science and Technology (MW)
- Kamuzu Central Hospital (MW)
- Karolinska Institutet (SE)
- Kenya Medical Research Institute (KE)
- African Field Epidemiology Network (NG)
- Busoga University (UG)
- Kamuzu University of Health Sciences (MW)
- Makerere University (UG)
- University of San Francisco (US)
Publication Details
- Journal
- Studies in Family Planning
- Published
- 2024-11-07
- DOI
- https://doi.org/10.1111/sifp.12277
- Citations
- 13
- Primary Topic
- Reproductive Health and Contraception
- Type
- article
- Field-Weighted Citation Impact
- 7.06
Funders
- Bill and Melinda Gates Foundation