Acceptability of Self injected contraception (DMPA-SC) among adolescent girls and young women in Lilongwe district
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Date
2021-09-15
Authors
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Kamuzu University of Health Sciences
Abstract
Study Type
This study will employ a cross sectional mixed methods approach to collect data. Quantitative
data will be collected from secondary sources (family planning registers) while interviews will
be used to collect qualitative data.
The problem to be studied
Approximately 1 in every 2 women (49.85) in Malawi uses an injectable contraceptive (Depo-
Provera) and is required to travel to a health facility every 3 months to get their next dose [1].
This is according to the 2015 – 16 Malawi Demographic and Health survey (DHS). In the same
DHS, distance to a facility was one of the reported problems in accessing health care by 56%
of the women aged 15-49 interviewed. Subcutaneous depot medroxyprogesterone acetate or
DMPA-SC, a lower dose of Depo-Provera emerged in 2011 as a new option that could increase
access to contraception, especially at the community level in low-income countries as women
would be able to inject themselves in the home without visiting the health facility [3].
While Malawi reached a milestone and rolled out DMPA-SC in facilities across the country,
published literature is unclear on the extent to which women are self-injecting at home or in
the presence of a provider. This study builds upon randomized control studies that have been
done by Burke et al to explore the practices around self-injected DMPA-SC in a real world
setting as Malawi is scaling up distribution in the public sector.
Objectives
The main objective of this study is to assess the acceptability of self –injection of DMPA SC
among adolescent girls and young women. The specific objectives of the study are to assess
the attitudes and perceptions of adolescent girls and young women towards self-injected
contraceptive, to explore the interest for self-injection of DMPA-SC and to get the perceived
self-efficacy in using self-injected DMPA-SC. The study will also establish a profile of current
users of DMPA-SC and the proportion of those self-injecting to help guide implementation.
Methodology
The study is a cross sectional study that will use both qualitative and quantitative means of data
collection. Two facilities, one from a rural area (Ngoni Health Centre) and one from an urban
area (Area 25 Health Centre) have been identified as the study sites for this research. The study will use the theoretical framework of acceptability according to Sekhon – 2017 where the 7
components of the theoretical framework will be used. These are Affective attitude, Perceived
effectiveness, Burden, Ethicality, Coherence, Self-efficacy and opportunity cost. The study
will collect data from family planning registers to establish a profile of current users of DMPASC
while qualitative data which responds to the theoretical framework will be collected from
service providers and clients sampled through a client exit recruitment process. The
quantitative data will be managed and analyzed in Stata while the Qualitative data will be
analyzed following the themes aligned with Sekhon’s theoretical framework. The qualitative
data will managed in Nvivo. Appendix 8.6 provides details of the theoretical framework to be
used.
Expected findings and dissemination
It is expected that most users of DMPA SC chose to be injected by the provider and are women
under the age of 24. Insights into the reasons for Clients opting to be injected by the provider
despite undergoing counselling will show a need to build client competency in using DMPASC
to ensure more client self-inject compared to provider administration. The study findings
will help provide a baseline for identifying an implementation gap before scaling up. The
findings will be presented before the College of Medicine Research Ethics Board, Lilongwe
District Health Office and the Research dissemination conference.