How provider knowledge, perceptions, and attitudes about user-administered injectable contraception shape demand and use
Awarded 2022
In their hands: Exploring the potential of self-administered injectable contraception
Jennifer Karlin, MD, PhD
University of California, Davis

While subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was designed for self-administration, the FDA approved it in the US for provider administration and insurance often covers only the clinic-administered intramuscular (IM) formulation. Despite evidence about patients’ interest in, as well as the efficacy of, DMPA-SC for user-administration, it remains an under-utilized contraceptive option for reasons hypothesized to include provider awareness, knowledge, time needed for counseling, as well as financial and logistical challenges. Yet, this contraceptive option offers the opportunity for increased access to an injectable contraceptive given that it can be administered outside of the clinic easily. Additional benefits include improved autonomy and empowerment for users, decreased side effects, and higher continuation rates reflecting patient satisfaction. In the context of the COVID-19 pandemic, DMPA-SC also provided benefit by reducing the need for in-person visits and allowing for social distancing. We have found barriers to use to be specific to local practices as well as insurance policies. However, we do not have an overall understanding of the use of DMPA-SC by US health care providers including pharmacists who are able to directly provide DMPA in some states. This mixed-method study will survey providers about their knowledge, attitudes, and experience with DMPA-SC as well as the barriers that they perceive for use in their settings. In addition, we will interview providers about how their perceptions may affect demand and interest in DMPA-SC for users and evaluate the feasibility and acceptability of a newly developed toolkit for DMPA-SC use as an educational intervention.