The Latest DMPA-SC Self-Injection Research
The MOH requested that FHI 360 and the University of Malawi‒Polytechnic explore how people who self-inject dispose of used DMPA-SC units, in order to inform the anticipated national scale-up. The goal of the study, which was funded by the Children’s Investment Fund Foundation (CIFF), was to identify which waste disposal methods and training approaches are acceptable and feasible and can help address method discontinuation, as injectables are one of the most common methods discontinued within a year. This research also captured youth experiences with self-injection, as nearly half of the self-injectors interviewed were youth (ages 15‒19 years).
The study’s results showed that most participants planned to dispose of used units according to instructions, which advised storing used units in puncture-proof containers and returning them to health workers at facilities or in the community. However, despite their desire to follow directions, most participants said they would have preferred to dispose of units in latrines because they worried about needlestick injuries to others, and because it was convenient. Despite their concerns about needles, no participants reported that either they or others experienced such an injury. The study also found that very few clients practiced before self-injecting for the first time, though most youth and half of adults said they would have liked to. Sometimes, informational self-injection leaflets—which included a calendar—were not provided during training, which affected clients’ ability to remember when to re-inject. Youth found self-injection acceptable, feasible, and beneficial; most preferred the privacy of individual versus group training.
Among other recommendations, researchers suggested that youth-friendly waste management options should be considered, and all clients should be offered the opportunity to practice injecting on something, such as a condom filled with salt or sugar, before they self-inject for the first time. Offering those trained in a group the opportunity to self-inject privately should be considered out of respect for privacy, especially for youth. For more information, review an in-depth description of the study results and recommendations.