Self-injected Depot–Medroxyprogesterone Acetate Subcutaneous (DMPA-SC) Uptake in Nigeria: A Paradigm Shift
Abstract:
Self-injection
of DMPA-SC method is one of the Government of Nigeria’s (GON) national family planning
goals to address the unmet need for contraception. Some studies on DMPA-SC/SI have demonstrated its feasibility to
improve modern contraceptive uptake. However, there is a gap in the predictors of
method uptake and continuation across self-injecting and provider-administered in
Nigeria. This study explored the uptake of self-injection DMPA-SC contraceptives
among women in two geopolitical zones of Nigeria. The study employed 20 focused group discussions
(FGDs) and 40 In-depth interviews (IDIs). Self-structured pretested questionnaire
to elicit information from 844 women registered for Family Planning in selected
health facilities. Descriptive statistics were calculated and multivariate logistic
regression was used to model determinants of DMPA-SC/SI family planning uptake.
Six months of Secondary Data from the Health Management Information system (HMIS)
was used to triangulate the trends in uptake. About
97.6% reported ever heard DMPA-SC/SI family planning method; 78.4% reported its
uptake; while 88.5% reported ever heard of self-injection as an option of family
planning method. Data for each State showed a remarkable increase in uptake of DMPA-SC/SI. The motivations to use DMPA-SC/Self Injection were
ease of accessibility, convenience, and self-administer/care. Factors that encourage the uptake of DMPA-SC/SI
were; health benefits, the prevailing economic situation and its effectiveness.
Findings from the study showed that interventions that deploy health education,
awareness, social mobilization, advocacy, policy implementation, and public sensitization,
making contraceptive services available for free, will increase the uptake of DMPA-SC/SI
in the study areas.
References:
[1] United Nations,
Department of Economic and Social Affairs, Population Division. Contraceptive
Use by Method 2019: Data Booklet. UN. Epub ahead of print December 10, 2019.
DOI: 10.18356/1bd58a10-en.
[2] Kantorová V, New
JR, Biddlecom A, et al. Setting Ambitious yet Achievable Targets Using
Probabilistic Projections: Meeting Demand for Family Planning. Stud Fam Plann
2017; 48: 223–233.
[3] Sedgh G, Ashford
LS, Hussain R. Unmet Need for Contraception in Developing Countries: Examining
Women’s Reasons for Not Using a Method. N Y Guttmacher Inst 2016; 93.
[4] Thapa P, Pokharel
N, Shrestha M. Knowledge, Attitude and Practices of Contraception among the
Married Women of Reproductive Age Group in Selected Wards of Dharan
Sub-Metropolitan City. J Contracept Stud 2018; 03: 18.
[5] National
Population Commission (NPC) [Nigeria] and ICF. 2019. Nigeria Demographic and
Health Survey 2018, https://www.dhsprogram.com/pubs/pdf/FR359/FR359.pdf (2019,
accessed October 24, 2020).
[6] Okunade K,
Daramola E, Ajepe A, et al. A 3-year review of the pattern of contraceptive use
among women attending the family planning clinic of a University Teaching
Hospital in Lagos, Nigeria. Afr J Med Health Sci 2016; 15: 69.
[7] Singhal S. Impact
of Injectable Progestogen Contraception in Early Puerperium on Lactation and
Infant Health. J Clin Diagn Res. Epub ahead of print 2014. DOI:
10.7860/JCDR/2014/7775.4110.
[8] Beson P, Appiah R,
Adomah-Afari A. Modern contraceptive use among reproductive-aged women in
Ghana: prevalence, predictors, and policy implications. BMC Women’s Health
2018; 18: 157.
[9] Starbird E, Norton
M, Marcus R. Investing in Family Planning: Key to Achieving the Sustainable
Development Goals. Glob Health Sci Pract 2016; 4: 191–210.
[10] Schrumpf LA,
Stephens MJ, Nsarko NE, et al. Side effect concerns and their impact on Women’s
uptake of modern family planning methods in rural Ghana: a mixed-methods study.
BMC Women’s Health 2020; 20: 57.
[11] Darroch JE. Adding
It Up: Investing in Contraception and Maternal and Newborn Health,
2017—Estimation Methodology. N Y Guttmacher Inst 2018; 97.
[12] PATH. DMPA-SC
self-injection supports women to use injectable contraception longer. F Poptionspathorg
ǀ Wwwpathorgdmpa-Sc 2018; 2.
[13] Cover J, Namagembe
A, Tumusiime J, et al. Continuation of injectable contraception when
self-injected vs. administered by a facility-based health worker: a
nonrandomized, prospective cohort study in Uganda. Contraception 2018; 98:
383–388.
[14] Kohn JE, Simons
HR, Della Badia L, et al. Increased 1-year Continuation of DMPA among women
randomized to self-administration: results from a randomized controlled trial
at Planned Parenthood. Contraception 2018; 97: 198–204.
[15] Liu J, Shen J,
Diamond-Smith N. Predictors of DMPA-SC continuation among urban Nigerian women:
the influence of counseling quality and side effects. Contraception 2018; 98:
430–437.
[16] Ahuru RR. The
influence of women empowerment on maternal and childcare use in Nigeria. Int J
Healthc Manag 2019; 1–10.
[17] Cochran WG.
Professor of Statistics, Emeritus Harvard University. 10.
[18] Yaya S, Uthman OA,
Ekholuenetale M, et al. Women empowerment as an enabling factor of
contraceptive use in sub-Saharan Africa: a multilevel analysis of
cross-sectional surveys of 32 countries. Reprod Health 2018; 15: 214.
[19] Adebowale SA,
Ajiboye BV, Arulogun O. Patterns and Correlates of Condom Use among Unmarried
Male Youths in Nigeria: NDHS 2008. Afr J Reprod Health 2017; 17: 149–159.
[20] Ahuru R, Nzoputam
C. Barriers to use of modern contraceptive among reproductive-age women in rural
communities in Delta State, Southern Nigeria. 2020; 9: 15–32.
[21] Aliyu AA, Dahiru
T. Reproductive Health and Family Planning Services in Africa: Looking beyond
Individual and Household Factors. In: Amarin Z, Abduljabbar H (eds) Family
Planning and Reproductive Health. IntechOpen. Epub ahead of print December 2,
2020. DOI: 10.5772/intechopen.92138.
[22] Burke HM, Chen M,
Buluzi M, et al. Effect of self-administration versus provider-administered
injection of subcutaneous depot medroxyprogesterone acetate on continuation
rates in Malawi: a randomised controlled trial. Lancet Glob Health 2018; 6:
e568–e578.
[23] Kanwal N,
Muttappallymyalil J, Al-Sharbatti S, et al. Contraceptive Utilisation Among
Mothers of Reproductive Age in Ajman, United Arab Emirates. Sultan Qaboos Univ
Med J 2017; 17: e50–e58.
[24] Olugbenga-Bello
AI, Adebimpe WO, Akande RO, et al. Health risk behaviors and sexual initiation
among in-school adolescents in rural communities in southwestern Nigeria. Int J
Adolesc Med Health 2014; 26: 503–510.
[25] Solanke BL.
Factors influencing contraceptive use and non-use among women of advanced
reproductive age in Nigeria. J Health Popul Nutr 2017; 36: 1.
[26] Abasiattai A,
Udoma E, Ukeme E. Depot medroxyprogesterone injectable contraception at the
University of Uyo Teaching Hospital, Uyo. Ann Afr Med 2010; 9: 81.
[27] Mairiga AG, Kyari
O, Audu B, et al. Socio-clinical characteristics of modern contraceptives users
at the University of Maiduguri Teaching Hospital. Niger J Clin Pract 2007; 10:
152–155.
[28] Ochako R, Mbondo
M, Aloo S, et al. Barriers to modern contraceptive methods uptake among young
women in Kenya: a qualitative study. BMC Public Health 2015; 15: 118.
[29] Do M, Kurimoto N.
Women’s Empowerment and Choice of Contraceptive Methods in Selected African
Countries. Int Perspect Sex Reprod Health 2012; 38: 023–033.
[30] Yaya S, Uthman OA,
Ekholuenetale M, et al. Effects of birth spacing on adverse childhood health
outcomes: evidence from 34 countries in sub-Saharan Africa. J Matern Fetal
Neonatal Med 2020; 33: 3501–3508.
[31] Sedgh G, Hussain
R. Reasons for Contraceptive Nonuse among Women Having Unmet Need for
Contraception in Developing Countries. Stud Fam Plann 2014; 45: 151–169.
[32] Chimah U, Lawoyin
T, Ilika A, et al. Contraceptive knowledge and practice among senior secondary schools’
students in military barracks in Nigeria. Niger J Clin Pract 2016; 19: 182.
[33] Gage AJ. Sexual
Activity and Contraceptive Use: The Components of the Decisionmaking Process.
Stud Fam Plann 1998; 29: 154.