Evidence-Based Guidance for Self-Administration of Injectable Contraception

The requirement of in-person visits every 3 months for a health care provider to administer intramuscular depot medroxyprogesterone acetate (DMPA-IM) is a significant barrier to its use, particularly in the wake of the coronavirus pandemic. Time and travel costs as well as scheduling conflicts also negatively impact the receipt of subsequent contraceptive injections, which can result in unintended pregnancies. Subcutaneous depot medroxyprogesterone acetate (DMPA-SC) can be self-administered by individuals at home, expanding contraceptive access, convenience, and reproductive autonomy. With 30% less progestin, DMPA-SC improves upon the DMPA-IM formulation while retaining efficacy. As part of comprehensive contraceptive counseling, health care providers should consider offering DMPA-SC to eligible individuals interested in self-administration. Using a case study approach, evidence-based recommendations are reviewed for the off-label use of self-administered DMPA-SC in the United States.