Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi
IntroductionMalawi has made progress in expanding access to modern contraceptive methods over the last decade, including the introduction of depot-medroxyprogesterone acetate subcutaneous (DMPA-SC) in 2018. DMPA-SC offers women the option to self-inject at home and may benefit adolescents with unmet...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-03-01
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| Series: | Frontiers in Global Women's Health |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fgwh.2023.1059408/full |
| _version_ | 1797865948250636288 |
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| author | Gracious Ali Chelsey Porter Erlank Frehiwot Birhanu Melinda Stanley Jessie Chirwa Fannie Kachale Andrews Gunda |
| author_facet | Gracious Ali Chelsey Porter Erlank Frehiwot Birhanu Melinda Stanley Jessie Chirwa Fannie Kachale Andrews Gunda |
| author_sort | Gracious Ali |
| collection | DOAJ |
| description | IntroductionMalawi has made progress in expanding access to modern contraceptive methods over the last decade, including the introduction of depot-medroxyprogesterone acetate subcutaneous (DMPA-SC) in 2018. DMPA-SC offers women the option to self-inject at home and may benefit adolescents with unmet need for contraception due to its discretion. This qualitative study was conducted to assess perspectives and preferences of adolescents with unmet need for contraception regarding the self-injection option of DMPA-SC in Malawi.MethodsSix focus group discussions were conducted involving 36 adolescents with unmet need for contraception (aged between 15 and 19 years, married and never-married) in October 2021 in three districts in Malawi. Data were coded inductively and analyzed thematically, using Dedoose software. Two validation workshops were conducted with other adolescents with unmet need in February 2022 to elucidate the preliminary findings.ResultsDMPA-SC attributes such as discretion and reduced facility visits were ranked most appealing by both married and never-married adolescents, particularly for adolescents needing covert contraception use. Concerns about self-injection included fear of pain, injury, and doubt in ability to self-inject. Never-married adolescents had additional concerns around privacy at home if using covertly, and fears of affecting long-term fertility. Overall, health surveillance assistants (community-based healthcare workers) were voted to be the most private, convenient, and affordable sources for potential DMPA-SC self-injection training.ConclusionSelf-injection of DMPA-SC may offer an appealing option for adolescents in Malawi, aligning most closely to the needs of married adolescents who may wish to delay or space pregnancies conveniently and discreetly, and who also may face fewer access barriers to receiving self-injection training from health care providers. Access barriers including stigma and concerns about privacy at home for adolescents needing to use contraception covertly would need to be adequately addressed if never-married adolescents were to consider taking up this option. |
| first_indexed | 2024-04-09T23:16:20Z |
| format | Article |
| id | doaj.art-5d4231126002412e9138e61809f6021f |
| institution | Directory Open Access Journal |
| issn | 2673-5059 |
| language | English |
| last_indexed | 2024-04-09T23:16:20Z |
| publishDate | 2023-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Global Women's Health |
| spelling | doaj.art-5d4231126002412e9138e61809f6021f2023-03-22T06:13:56ZengFrontiers Media S.A.Frontiers in Global Women's Health2673-50592023-03-01410.3389/fgwh.2023.10594081059408Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in MalawiGracious Ali0Chelsey Porter Erlank1Frehiwot Birhanu2Melinda Stanley3Jessie Chirwa4Fannie Kachale5Andrews Gunda6Sexual, Reproductive, Maternal and Newborn Health program, Clinton Health Access Initiative (CHAI) Inc., Lilongwe, MalawiAnalytics and Implementation Research Team, Clinton Health Access Initiative (CHAI) Inc., London, United KingdomSexual, Reproductive, Maternal and Newborn Health program, Clinton Health Access Initiative (CHAI) Inc., Lilongwe, MalawiIndependent Consultant, Sydney, NSW, AustraliaReproductive Health Directorate, Malawi Ministry of Health, Lilongwe, MalawiReproductive Health Directorate, Malawi Ministry of Health, Lilongwe, MalawiClinton Health Access Initiative (CHAI) Inc., Lilongwe, MalawiIntroductionMalawi has made progress in expanding access to modern contraceptive methods over the last decade, including the introduction of depot-medroxyprogesterone acetate subcutaneous (DMPA-SC) in 2018. DMPA-SC offers women the option to self-inject at home and may benefit adolescents with unmet need for contraception due to its discretion. This qualitative study was conducted to assess perspectives and preferences of adolescents with unmet need for contraception regarding the self-injection option of DMPA-SC in Malawi.MethodsSix focus group discussions were conducted involving 36 adolescents with unmet need for contraception (aged between 15 and 19 years, married and never-married) in October 2021 in three districts in Malawi. Data were coded inductively and analyzed thematically, using Dedoose software. Two validation workshops were conducted with other adolescents with unmet need in February 2022 to elucidate the preliminary findings.ResultsDMPA-SC attributes such as discretion and reduced facility visits were ranked most appealing by both married and never-married adolescents, particularly for adolescents needing covert contraception use. Concerns about self-injection included fear of pain, injury, and doubt in ability to self-inject. Never-married adolescents had additional concerns around privacy at home if using covertly, and fears of affecting long-term fertility. Overall, health surveillance assistants (community-based healthcare workers) were voted to be the most private, convenient, and affordable sources for potential DMPA-SC self-injection training.ConclusionSelf-injection of DMPA-SC may offer an appealing option for adolescents in Malawi, aligning most closely to the needs of married adolescents who may wish to delay or space pregnancies conveniently and discreetly, and who also may face fewer access barriers to receiving self-injection training from health care providers. Access barriers including stigma and concerns about privacy at home for adolescents needing to use contraception covertly would need to be adequately addressed if never-married adolescents were to consider taking up this option.https://www.frontiersin.org/articles/10.3389/fgwh.2023.1059408/fulladolescentsself-injectionfamily planningcontraceptionDMPA-SCunmet need for contraception |
| spellingShingle | Gracious Ali Chelsey Porter Erlank Frehiwot Birhanu Melinda Stanley Jessie Chirwa Fannie Kachale Andrews Gunda Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi Frontiers in Global Women's Health adolescents self-injection family planning contraception DMPA-SC unmet need for contraception |
| title | Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi |
| title_full | Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi |
| title_fullStr | Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi |
| title_full_unstemmed | Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi |
| title_short | Perspectives on DMPA-SC for self-injection among adolescents with unmet need for contraception in Malawi |
| title_sort | perspectives on dmpa sc for self injection among adolescents with unmet need for contraception in malawi |
| topic | adolescents self-injection family planning contraception DMPA-SC unmet need for contraception |
| url | https://www.frontiersin.org/articles/10.3389/fgwh.2023.1059408/full |
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