Self-administered injectable contraceptives face provider hesitancy despite availability

Self-administered injectable contraceptives have been available in the United States for more than two decades, yet a new study has found only about a quarter of reproductive health experts prescribe it - and many are unaware it's even an option. 

Researchers surveyed 422 clinicians who regularly prescribe birth control and found that only about a third of those who were aware of the option prescribe it. The providers said they were concerned about their patients' ability to self-inject, the medication's availability at pharmacies, and the lack of standardized approaches to counseling and prescribing it.

The study is the first to document the barriers that prevent widespread adoption of self-administered injectable contraception. It was published Jan. 8 in the journal Obstetrics & Gynecology.

Since most physicians don't know that this is an option, patients don't know about it. It's safe, effective, and puts the control in patients' own hands. We should be talking about and offering it to patients without biases."

Jennifer Karlin, MD, PhD, a UCSF associate professor of Family and Community Medicine and the paper's senior author

Depot medroxyprogesterone acetate (DMPA) is an injectable form of progestin, which is a synthetic form of the natural hormone progesterone. The drug prevents pregnancy for up to three months by stopping ovulation, thickening cervical mucus, and thinning the uterine lining. 

DMPA is available in two injectable forms: an intramuscular injection, marketed under the name Depo Provera, that can only be administered by a provider, and one that is injected just under the skin. This subcutaneous version can be easily self-injected, like the now popular injectable GLP-1 weight-loss drugs.

The drug has been associated with potential side effects, such as reduced bone mineral density, weight gain, and a benign brain tumor called meningioma. While the overall risk of these side effects is low, it is important that clinicians discuss the risks and benefits with their patients.

The subcutaneous version, approved in 2004, is officially labeled for administration by a clinician, but doctors have been training patients to self-inject safely for many years. Self-injectable contraception is more commonly used globally, particularly in sub-Saharan Africa. It became more widely used in the U.S. during the COVID-19 pandemic, and the study found more than half the prescribers surveyed learned about it between 2020 and 2022. 

Both international and national guidelines recommend making this option accessible to all patients, but the study found that providers in states with restricted abortion access were less likely to prescribe it. Other obstacles include insufficient educational materials, lack of staff support, and limited time for consulting with patients.

To make the option more widely available, the authors recommend an education campaign for clinicians about self-administration of injectable contraceptives. They also advocate for FDA approval of the version of the injectable that can be self-administered, as well as ensuring that insurance cover it and streamlining clinic workflows.