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ORIGINAL ARTICLES
Open Access

Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) Injectable Contraception at Facility and Community Levels: Pilot Results From 4 Districts of Uganda

George Odwe, Kate Gray, Annet Kyarimpa, Francis Obare and Grace Nagendi
Global Health: Science and Practice December 2018, 6(4):711-722; https://doi.org/10.9745/GHSP-D-18-00117
George Odwe
aPopulation Council, Nairobi, Kenya.
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  • For correspondence: godwe@popcouncil.org godweus@gmail.com
Kate Gray
bInternational Planned Parenthood Federation, London, United Kingdom.
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Annet Kyarimpa
cReproductive Health Uganda, Kampala, Uganda.
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Francis Obare
aPopulation Council, Nairobi, Kenya.
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Grace Nagendi
dInternational Planned Parenthood Federation, Africa Region, Nairobi, Kenya.
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  • FIGURE 1.
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    FIGURE 1.

    Monthly Trends in the Number of DMPA-SC Units Provided by District, Uganda, April 2016–March 2017

    Abbreviation: DMPA-SC, subcutaneous depot medroxyprogesterone acetate.

  • Figure2
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    During an RHU outreach event in Kabarole district, Uganda, a provider shows women waiting for family planning services what Sayana Press looks like and provides information about the method. © 2016 Irene Kugonza/RHU.

  • FIGURE 2.
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    FIGURE 2.

    Percentage Distribution of Family Planning Methods by Service Delivery Channel, 4 Districts of Uganda, April 2016–March 2017

    Abbreviations: DMPA-IM, intramuscular depot medroxyprogesterone acetate; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; IUD, intrauterine device; VHT, village health team.

    Note: Pills include combined oral contraceptives and progestin-only pills; condoms include male and female condoms; and permanent methods include tubal ligation and vasectomy.

Tables

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    TABLE 1.

    Reproductive Health Indicators for Study Districts, Uganda, 2016

    DistrictSubregionTFRTeenage Pregnancy (%)mCPR (%)Unmet Need for Family Planning (%)
    MbaleBugisu5.628.243.222.1
    KabaroleToro5.430.337.441.3
    MbararaAnkole4.918.936.244.5
    KabaleKigezo4.615.543.2NA
    National5.424.834.831.9
    • Abbreviations: NA, not available (due to small numbers of data); mCPR, modern contraceptive prevalence rate; TFR, total fertility rate.

    • Source: UBOS and ICF (2018).9

    • View popup
    TABLE 2.

    Sayana Press Learning Project Activities by Service Delivery Channel, Uganda, April 2016–March 2017

    Service Delivery Channels
    VHTsStatic ClinicMobile Outreach
    Public SectorRHU Clinics
    Number supported40 VHTs (40% men, 60% women; 10 VHTs per district selected from existing cadre of active VHTs)26 clinics with outreach site
    • Kabale (9)

    • Kabarole (4)

    • Mbale (6)

    • Mbarara (7)

    4 clinics (1 RHU static clinic per project district)Mobile outreach conducted in 26 public-sector clinic sites
    Service delivery
    • Comprehensive family planning counseling, information, and awareness raising

    • Short-acting methods (DMPA-IM, DMPA-SC, oral contraceptives, condoms)

    • Referral to mobile outreach teams, RHU clinics, or public-sector clinics for long-acting methods and other SRH services

    • Comprehensive family planning counseling and information

    • Short-acting methods (DMPA-IM, DMPA-SC, oral contraceptives, condoms)

    • Long-acting methods (implants and IUDs)

    • Permanent methods (tubal ligation and vasectomy)

    • Other SRH services (including HIV and STI testing/treatment and cervical cancer screening)

    TrainingsAll 40 VHTs received a 7-day training on:
    • Comprehensive counseling on all methods (including DMPA-SC)

    • Provision of DMPA-SC

    • Provision of other short-acting methods

    • Referral processes

    • Project data collection

    42 facility-based providers (nurses, midwives, and clinical officers) drawn from public-sector facilities with outreach site and RHU facilities received a 2-day training on:
    • Comprehensive counseling on all methods including DMPA-SC

    • Provision of DMPA-SC

    • Refresher training on all family planning methods

    FP supplies and equipmentVHTs obtained FP commodities from RHU clinics in project districtsFP commodities provided through the NMSAll FP commodities (including DMPA-SC) provided through UHMGAll FP commodities and equipment provided by RHU outreach teams
    Additional support provided
    • Monthly supportive supervision provided by RHU clinical staff

    • Comprehensive counseling on all methods including DMPA-SC

    NANANA
    Demand creation
    • 1 stakeholders' meeting involving 118 participants (including district health officers and religious and community leaders) drawn from all 4 project districts

    • Educational outreach by RHU providers or VHTs about importance of family planning method through door-to-door mobilization, group information sessions, IEC materials, and media (mainly TV and radio programs)

    • Abbreviations: DMPA-IM, intramuscular depot medroxyprogesterone acetate; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; FP, family planning; IEC, information, education, and communication; IUD, intrauterine device; NA, not applicable; NMS, National Medical Stores; RHU, Reproductive Health Uganda; SRH, sexual and reproductive health; STI, sexually transmitted infection; UHMG, Uganda Health Marketing Group; VHT, village health team.

    • View popup
    TABLE 3.

    Number of DMPA-SC Units Provided by Project District and Service Delivery Channel, Uganda, April 2016–March 2017

    DistrictService Delivery ChannelMonthly Average No.Total No.
    Clinics No. (%)Outreach No. (%)VHTs No. (%)
    Mbale131 (2.7)1060 (22.2)3589 (75.1)4780398
    Kabarole110 (3.5)881 (28.0)2157 (68.5)3148262
    Mbarara87 (4.2)405 (19.6)1579 (76.2)2071173
    Kabale267 (6.2)1388 (32.5)2619 (61.3)4274356
    Total595 (4.2)3734 (26.2)9944 (69.7)14,2731189
    • Abbreviations: DMPA-SC, subcutaneous depot medroxyprogesterone acetate; VHT, village health team.

    • View popup
    TABLE 4.

    Volume of Family Planning Methods Provided Before and During the Intervention by Contraceptive Method, 4 Districts of Uganda

    Method6 Months Before Intervention (Oct 2015–Mar 2016) No. (%)First 6 Months of Intervention (Apr 2016–Sep 2016) No. (%)Second 6 Months of Intervention (Oct 2016–Mar 2017) No. (%)Total No.
    Pillsa2303 (10.8)3378 (8.4)3216 (7.6)8897
    DMPA-IM4292 (20.0)9115 (22.7)11,933 (28.3)25,340
    DMPA-SC—6470 (16.1)7803 (18.5)14,273
    Implants1926 (9.0)2140 (5.3)2262 (5.4)6328
    IUD217 (1.0)280 (0.7)254 (0.6)751
    Permanent methodsb21 (0.1)94 (0.2)123 (0.3)238
    Condomsc12,662 (59.1)18,646 (46.5)16,540 (39.3)47,848
    Total21,421 (100.0)40,123 (100.0)42,131 (100.0)103,675
    Total CYPs707311,49113,00931,573
    • Abbreviations: CYP, couple-years of protection; DMPA-IM, intramuscular depot medroxyprogesterone acetate; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; IUD, intrauterine device.

    • ↵a Includes combined oral contraceptives and progesterone-only pills.

    • ↵b Includes tubal ligation and vasectomy.

    • ↵c Includes both male and female condoms.

    • View popup
    TABLE 5.

    Percentage Distribution of Family Planning Clients by Age and Method, 4 Districts of Uganda, April 2016–March 2017

    MethodAge CategoryTotal (N)
    <25 Years (%)≥25 Years (%)
    Pills38.461.66594
    DMPA-IM36.863.221,048
    DMPA-SC42.657.414,273
    Implants21.678.44402
    IUD16.983.1534
    Permanent methods2.397.7217
    Condoms48.151.935,186
    All methods42.157.982,254
    • Abbreviations: DMPA-IM, intramuscular depot medroxyprogesterone acetate; DMPA-SC, subcutaneous depot medroxyprogesterone acetate; IUD, intrauterine device.

    • Note: Pills include combined oral contraceptives and progestin-only pills; condoms include male and female condoms; and permanent methods include tubal ligation and vasectomy.

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Global Health: Science and Practice: 6 (4)
Global Health: Science and Practice
Vol. 6, No. 4
December 27, 2018
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Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) Injectable Contraception at Facility and Community Levels: Pilot Results From 4 Districts of Uganda
George Odwe, Kate Gray, Annet Kyarimpa, Francis Obare, Grace Nagendi
Global Health: Science and Practice Dec 2018, 6 (4) 711-722; DOI: 10.9745/GHSP-D-18-00117

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Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) Injectable Contraception at Facility and Community Levels: Pilot Results From 4 Districts of Uganda
George Odwe, Kate Gray, Annet Kyarimpa, Francis Obare, Grace Nagendi
Global Health: Science and Practice Dec 2018, 6 (4) 711-722; DOI: 10.9745/GHSP-D-18-00117
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