Magalona Sophia, Wood Shannon N, Makumbi Frederick, OlaOlorun Funmilola M, Omoluabi Elizabeth, Pierre Akilimali Z, Guiella Georges, Cover Jane, Anglewicz Philip
Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.
Contracept X. 2022 Apr 8;4:100075. doi: 10.1016/j.conx.2022.100075. eCollection 2022.
To measure trends in the supply of DMPA-SC in public and private health facilities and compare with other prominent modern methods.
We used repeated cross-sectional data from service-delivery-point surveys in six settings: Burkina Faso, Democratic Republic of Congo (Kinshasa and Kongo Central), Nigeria (Kano and Lagos), and Uganda, each with 3-5 rounds of data collected between 2016 and 2020. We analyzed trends in DMPA-SC availability using percent of service delivery points offering the method and percent experiencing stockouts; trends were compared with those for DMPA-IM, IUD, implants, and other short-acting methods, by facility type.
All settings showed increased offering of DMPA-SC over time for both private and public facilities. Larger proportions of public facilities provided DMPA-SC compared to private facilities (66%-97% vs 16%-50% by 2019-2020). DMPA-SC was provided by fewer facilities than DMPA-IM (90%-100% public, 34%-69% private by 2019-2020), but comparable to implants (83%-100% public, 15%-52% private by 2019-2020) and IUDs (55%-91% public, 0%-44% private by 2019-2020). Trends of DMPA-SC stock varied by setting, with more consistent stock available in private facilities in the DRC and in public facilities in Burkina Faso and Nigeria. Uganda showed decreasing stock in public facilities but increasing stock in private facilities.
DMPA-SC availability has been increasing since its introduction in sub-Saharan Africa, yet significant gaps in stock exist. Countries should consider alternative distribution models to address these issues.
Our findings may help inform countries about the need to monitor DMPA-SC availability and to consider solutions that ensure contraceptive options are available to women who need them and disruptions to contraceptive use are minimized.
衡量公共和私营卫生机构中醋酸甲羟孕酮皮下注射剂（DMPA-SC）的供应趋势，并与其他主要的现代避孕方法进行比较。
我们使用了来自六个地区服务提供点调查的重复横断面数据，这六个地区分别是布基纳法索、刚果民主共和国（金沙萨和刚果中央）、尼日利亚（卡诺和拉各斯）以及乌干达，每个地区在2016年至2020年间收集了3至5轮数据。我们通过提供该方法的服务提供点百分比和经历缺货的百分比来分析DMPA-SC的可及性趋势；并按机构类型将这些趋势与醋酸甲羟孕酮注射剂（DMPA-IM）、宫内节育器（IUD）、植入剂及其他短效避孕方法的趋势进行比较。
所有地区的公共和私营机构中，随着时间推移，DMPA-SC的提供情况均有所增加。与私营机构相比，提供DMPA-SC的公共机构比例更高（到2019 - 2020年时，分别为66% - 97%和16% - 50%）。提供DMPA-SC的机构比提供DMPA-IM的机构少（到2019 - 2020年时，公共机构中分别为90% - 100%和34% - 69%），但与植入剂（到2019 - 2020年时，公共机构中为83% - 100%，私营机构中为15% - 52%）和宫内节育器（到2019 - 2020年时，公共机构中为55% - 91%，私营机构中为0% - 44%）相当。DMPA-SC的缺货趋势因地区而异，在刚果民主共和国的私营机构、布基纳法索和尼日利亚的公共机构中，库存更为稳定。乌干达的公共机构库存减少，但私营机构库存增加。
自引入撒哈拉以南非洲地区以来，DMPA-SC的可及性一直在增加，但库存仍存在显著差距。各国应考虑采用其他配送模式来解决这些问题。
我们的研究结果可能有助于告知各国，有必要监测DMPA-SC的可及性，并考虑采取确保有需求的女性能够获得避孕选择且将避孕使用中断降至最低的解决方案。
