ArticleContraception2018
Continuation of injectable contraception when self-injected vs. administered by a facility-based health worker: a nonrandomized, prospective cohort study in Uganda.
Article in Contraception, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Getting Up to Date with What Works: A Systematic Review on the Effectiveness and Safety of Task Sharing of Modern Methods in Family Planning Services.BioMed research international · 2023Pooled it
- Self-administration of injectable contraception: a systematic review and meta-analysis.BMJ global health · 2019Pooled it
- Factors Affecting Continued Use of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC): A Secondary Analysis of a 1-Year Randomized Trial in Malawi.Global health, science and practice · 2019Trial
- Understanding clients' and providers' perspectives on the implementation of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) for self-injection programming in Nigeria.BMJ global health · 2026Article
- Consistency of on-the-job training implementation for subcutaneous depot medroxyprogesterone acetate in Ghana and associated healthcare worker knowledge transfer: A cross-sectional mixed-methods study.PLOS global public health · 2026Article
- Beyond Early Attrition: Access Barriers as the Leading Documented Reason for Stopping Monthly Norethisterone Enanthate/Estradiol Valerate Among Established Users in China: A Retrospective Cohort Study.International journal of women's health · 2026Article
- Return to fertility after subcutaneous depot medroxyprogesterone acetate: a narrative review.BMJ sexual & reproductive health · 2025Review
- Feasibility and acceptability of DMPA-SC self-injection in Addis Ababa, Ethiopia: a mixed-methods study.Reproductive health · 2025Article
- The case for investing in provider-administered subcutaneous DMPA: a costing study.BMJ global health · 2025Article
- Introduction to the special supplement, unlocking the potential of self-injectable contraception: evidence from coordinated investments.BMC women's health · 2025Article
- Injectable contraceptive continuation and user experiences in Punjab, Pakistan: a non-randomized prospective cohort study protocol.BMC women's health · 2025Article
- Challenges and opportunities in coordinating investments across countries and channels to expand access to a new contraceptive method.BMC women's health · 2025Article
- Development and Validation of the Agency in Contraceptive Decisions Scale in Uganda and Nigeria.Studies in family planning · 2025Article
- Factors associated with the acceptability of self-injection training by clients receiving DMPA-SC services from community pharmacies and patent and proprietary medicine vendors in Nigeria.BMC women's health · 2025Article
- Behavioral Drivers Influencing Women's Decision to Use Self-Injectable Contraception Provided by Community Health Surveillance Assistants in Rural Malawi.Women's health reports (New Rochelle, N.Y.) · 2025Article
- Examining the relationship between reproductive empowerment and contraceptive self-injection: Tackling the endogeneity problem.PloS one · 2025Article
- Women's Perspectives on the Unique Benefits and Challenges of Self-Injectable Contraception: A Four-Country In-Depth Interview Study in Sub-Saharan Africa.Studies in family planning · 2024Article
- Self-care interventions for women's health and well-being.Nature medicine · 2024Review
- Determinants of DMPA-SC self-care/self-injectable contraceptive uptake among modern contraceptive users in Burkina Faso: findings from the 2021 demographic and health survey.Frontiers in global women's health · 2024Article
- Choices and Challenges: Visualizing Contraceptive Use Dynamics Data in 15 Low- and Middle-Income Countries.Global health, science and practice · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe purpose of this study was to compare 12-month continuation rates for subcutaneous depot medroxyprogesterone acetate (DMPA-SC) administered via self-injection and DMPA-IM administered by a health worker in Uganda. STUDY
designWomen seeking injectable contraception at participating health facilities were offered the choice of self-injecting DMPA-SC or receiving an injection of DMPA-IM from a health worker. Those opting for self-injection were trained one-on-one. They self-injected under supervision and took home three units, a client instruction guide and a reinjection calendar. Those opting for DMPA-IM received an injection and an appointment card for the next facility visit in 3 months. We interviewed participants at baseline (first injection) and after 3 (second injection), 6 (third injection) and 9 (fourth injection) months, or upon discontinuation. We used Kaplan-Meier methods to estimate continuation probabilities, with a log-rank test to compare differences between groups. A multivariate Cox regression identified factors correlated with discontinuation.
resultsThe 12-month continuation rate for the 561 women self-injecting DMPA-SC was .81 [95% confidence interval (CI) .78-.84], and for 600 women receiving DMPA-IM from a health worker, it was .65 (95% CI .61-.69), a significant difference at the .05 level. There were no differences in pregnancy rates or side effects. The multivariate analysis revealed that, controlling for covariates, self-injecting reduced the hazard for discontinuing by 46%. A significant interaction between injection group and age suggests that self-injection may help younger women continue injectable use.
conclusionsThe significant difference in 12-month continuation between women self-injecting DMPA-SC and women receiving DMPA-IM from a health worker - which remains significant in a multivariate analysis - suggests that self-injection may improve injectable contraceptive continuation. IMPLICATIONS: While injectable contraceptives are popular throughout much of sub-Saharan Africa, they have high rates of discontinuation. This study is the second from an African country to demonstrate that self-injection may improve injectable continuation rates and may do so without increasing the risk of pregnancy or adverse events.
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Registered trials
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