Self-administered injectable contraception has been available in the United States for over two decades, yet a recent study reveals that only about a quarter of reproductive health experts prescribe it. Surprisingly, many are unaware of its existence as a viable option. This finding was published on January 8 in the journal Obstetrics & Gynecology, marking the first documentation of barriers to the widespread adoption of this contraceptive method in the U.S.
“Since most physicians don’t know that this is an option, patients don’t know about it,” said Dr. Jennifer Karlin, a UCSF associate professor of Family and Community Medicine and the study’s senior author. “It’s safe, effective, and puts the control in patients’ own hands. We should be talking about and offering it to patients without biases.”
Understanding the Barriers
Researchers surveyed 422 clinicians who regularly prescribe birth control and found that only about a third of those aware of the self-administered option actually prescribe it. The reasons for not prescribing it varied, including concerns about patients’ ability to self-inject, uncertainty about medication availability in pharmacies, and a lack of standardized approaches to counseling patients and deciding when to prescribe it.
Depot medroxyprogesterone acetate (DMPA) is a synthetic form of the natural hormone progestin, delivered via injection. It prevents pregnancy for up to three months by halting ovulation, thickening cervical mucus, and thinning the uterine lining. DMPA is available in two forms: an intramuscular injection, known as Depo Provera, which must be administered by a healthcare provider, and a subcutaneous version that can be self-injected, similar to popular injectable GLP-1 weight-loss drugs.
Global Usage and Potential Side Effects
The subcutaneous version, approved in 2004, is officially labeled for clinician administration, but many physicians have been training patients to self-inject safely for years. Globally, self-injectable contraception is more prevalent, especially in sub-Saharan Africa. Its use increased in the U.S. during the COVID-19 pandemic, with more than half of the surveyed prescribers learning about it between 2020 and 2022.
While the drug is associated with potential side effects such as reduced bone mineral density, weight gain, and a benign brain tumor called meningioma, the overall risk remains low. It is crucial for clinicians to discuss these risks and benefits with their patients to ensure informed decision-making.
Challenges and Recommendations
Both international and national guidelines advocate for making self-administered injectable contraception accessible to all patients. However, the study found that providers in states with restricted abortion access were less likely to prescribe it. Additional obstacles include insufficient educational materials, lack of staff support, and limited time for patient consultations.
“To make the option more widely available, the authors recommend an education campaign for clinicians about self-administration of injectable contraceptives,” the study suggests.
Furthermore, the authors advocate for FDA approval of the self-administered version and ensuring insurance coverage, along with streamlining clinic workflows to accommodate this option.
Looking Forward
The move towards greater awareness and adoption of self-administered injectable contraception represents a significant shift in reproductive health care. By empowering patients with more control over their contraceptive choices, healthcare providers can foster a more inclusive and patient-centered approach.
As the conversation around reproductive health continues to evolve, the insights from this study highlight the importance of education and policy changes to support broader access to innovative contraceptive methods. The implications of these changes could lead to improved health outcomes and greater autonomy for individuals seeking reproductive health services.
