Abstract

Objective

We compared acceptability and continuation of Sayana Press, a subcutaneous formulation of depot-medroxyprogesteone acetate (DMPA) in a Uniject injection system, to intramuscular (IM) DMPA, among both current users of DMPA-IM and new users in Nepal.

Study Design

We recruited women seeking injectable contraception at 14 public health facilities in Nepal selected for geographic diversity. We enrolled women who self-selected either Sayana Press® or DMPA-IM and used structured interviews to obtain baseline demographics and assess satisfaction and continuation rates at one, three, and six months.

Results

Seven hundred ninety-four women (71%) selected and received Sayana Press®, while 318 women (28.6%) selected and received DMPA-IM. One hundred and seventy-eight (48%) women continuing Sayana Press® injection reported that they experienced “no possible side effects” compared to 29 (22%) among DMPA-IM selectors during the previous 6-months. The continuation rate of Sayana Press® at 6-months was higher than DMPA-IM (Sayana Press® 46.5% vs DMPA-IM 34.4%; p<0.001). Selection of Sayana Press® method (ORadj. 1.74; 95% CI 1.32-2.3) and approval from husband (ORadj. 1.59; 95% CI 1.21-2.09) were associated with injection continuation.

Conclusion

Sayana Press® is acceptable to women in Nepal with the preference for Sayana Press® over DMPA-IM (higher proportion chose the method when counseled and given the option, better continuation).

Implications

Self-injection may have implications for continuation and opportunity for future research and strategies to roll out this innovative technology must be explored.

Keywords

Sayana PressContraceptionfamily planningsubcutaneous DMPADMPA-SC

A prospective cohort study to assess the acceptability of Sayana Press among 18-49-year-old women in Nepal – ScienceDirect