Despite their availability, self-administered injectable contraceptives are met with reluctance from providers

Despite their availability, self-administered injectable contraceptives are met with reluctance from providers

Self-administered injectable contraceptives have been available in the United States for more than two decades, but a new study finds that only about a quarter of reproductive health professionals prescribe them — and many don't know it's even an option.

Researchers surveyed 422 doctors who regularly prescribe contraceptives and found that only about a third of those who were aware of this option prescribe them. Providers said they were concerned about their patients' ability to inject themselves, the drug's availability in pharmacies and the lack of standardized approaches to counseling and prescribing.

The study is the first to document the barriers to widespread adoption of self-administered injectable contraception. It was published in the magazine on January 8thObstetrics and gynecology.

Because most doctors don't know this is an option, patients don't know about it. It is safe, effective and puts patients in control. We should talk about it and offer it to patients without prejudice.”

Jennifer Karlin, MD, PhD, associate professor of family and community medicine at UCSF and senior author of the article

Depot medroxyprogesterone acetate (DMPA) is an injectable form of progestin, 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, sold under the name Depo Provera, which can only be administered by a doctor, and an injection, which is injected directly under the skin. This subcutaneous version can be easily self-injected, like the now popular injectable GLP-1 weight loss medications.

The drug has been linked to potential side effects including reduced bone mineral density, weight gain and a benign brain tumor called meningioma. Although the overall risk of these side effects is low, it is important that doctors discuss the risks and benefits with their patients.

The subcutaneous version, approved in 2004, is officially approved for administration by a doctor, but doctors have been training patients to safely inject themselves for many years. Self-injectable contraceptives are becoming more widely used worldwide, particularly in sub-Saharan Africa. It became more widely used in the US during the COVID-19 pandemic, and the study found that more than half of prescribers surveyed learned about it between 2020 and 2022.

Both international and national guidelines recommend making this option available to all patients. However, the study found that providers in states with limited access to abortions were less likely to prescribe them. Other barriers include inadequate educational materials, lack of staff support, and limited time for patient counseling.

To make this option more widely available, the authors recommend an educational campaign for physicians about self-administration of injectable contraceptives. They also support FDA approval of the self-administered version of the injectable, ensuring insurance covers it and streamlining clinic workflows.

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