TY - JOUR T1 - What Distinguishes Women Who Choose to Self-Inject? A Prospective Cohort Study of Subcutaneous Depot Medroxyprogesterone Acetate Users in Ghana JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00534 VL - 10 IS - 1 SP - e2100534 AU - Dela Nai AU - Elizabeth Tobey AU - Kamil Fuseini AU - Patrick Kuma-Aboagye AU - Aparna Jain Y1 - 2022/02/28 UR - http://www.ghspjournal.org/content/10/1/e2100534.abstract N2 - Key FindingsAt their third injection, or 6 months into using subcutaneous depot medroxyprogesterone acetate (DMPA-SC), 73% of these users chose self-injection, an increase from 42% who chose self-injection at the first injection.Clients who were new family planning users, never married, or attended high school/attained higher education were significantly more likely to self-inject by the third injection compared to their respective counterparts. Expanding method choice through this new mode of injection administration may help to meet these users’ needs.Key ImplicationsPolicy makers and health practitioners in Ghana and other countries with similar profiles should consider results of this study on the key characteristics of DMPA-SC users, patterns of use and mode of injection administration, and factors that increase the likelihood of self-injection when making evidence-based decisions regarding DMPA-SC introduction and/or scale-up.When given the option to choose between provider-administered injection and self-injection at each injection opportunity, many women will learn to self-inject and the path to self-injection may be gradual. Policy makers and health practitioners should consider presenting both choices of administration of injection at every opportunity.Depot medroxyprogesterone acetate administered subcutaneously (DMPA-SC) is an all-in-one injectable contraceptive administered every 3 months, either by a trained health care provider or community health worker or by training a client to self-inject. Using a prospective cohort of family planning (FP) clients in Ghana, this study explores patterns of DMPA-SC use and mode of injection administration over a 6-month period. This study also examines the predictors of self-injection adoption 6 months after initiating DMPA-SC. Our analysis focuses on 378 women who were using DMPA-SC at the 6-month interview. Adjusted odds ratios accounting for clustering show that clients who were new FP users, never married, or attended high school/attained higher education were significantly more likely to self-inject by the third injection. Results of this study suggest that in Ghana, adding DMPA-SC to the method mix may improve access to FP, especially among new users. Results of this study may inform FP projects and programs aiming to improve access to contraceptive methods and increase contraceptive prevalence by introducing or scaling up DMPA-SC self-injection. The findings also provide a sociodemographic profile of FP clients most likely to adopt DMPA-SC self-injection over time, which could serve as an evidence base for social marketing strategies. ER -