Tappis Hannah, Qayyum Kanwal, Bryce Emily, Fatima Aisha, Christofield Megan, Haider Huma, Ameen Afshan, Gardezi Syed Muhammad Akbar, Rafay Fazal, Assad Fauzia
Jhpiego, Baltimore, Maryland, USA.
Jhpiego, Islamabad, Pakistan.
BMC Womens Health. 2025 Sep 7;25(Suppl 1):427. doi: 10.1186/s12905-025-03969-9.
Evidence from multiple pilots and post-introduction scale-up initiatives have demonstrated that self-administered subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) has potential to improve contraceptive continuation rates and expand contraceptive access to populations with limited utilization of facility-based health services. Only a few of these studies have been conducted in South Asian countries, and none where most contraceptive use is of non-hormonal methods that require limited to no contact with the health system, leaving policymakers in countries like Pakistan with limited context-specific evidence to guide decisions on whether, how, and for whom to introduce DMPA-SC.
A prospective cohort study will be conducted in 41 health facilities and surrounding communities in Punjab, Pakistan. The primary objective of the study is to compare the 12-month contraceptive continuation rate for women who receive DMPA-SC with that for women who receive intramuscular depot-medroxyprogesterone acetate (DMPA-IM). The secondary objectives are to compare characteristics and experiences of participants who opt for DMPA-SC with those of women who opt for DMPA-IM, which must be administered by a health worker. Additionally, a sub-study is planned to assess how well women opting for self-injection of DMPA-SC adhere to standards for commodity storage, injection timing, injection technique and waste disposal.
This research offers an opportunity to contribute to global efforts to reduce inequities in access to contraceptive method choices, while generating actionable evidence to inform health sector decision-making in Pakistan. Although study sites are limited to health facilities where a woman's first self-injection of DMPA-SC is supervised by a nurse, midwife, medical officer, Lady Health Visitor, Family Welfare Worker or Family Welfare Councilor, the research protocol and findings will provide a foundation for future studies testing alternative service provision and self-injection support models.
Registered on clinicaltrials.gov as an observational study (NCT05774626).
多项试点研究及引入后扩大规模举措的证据表明，自我注射皮下醋酸甲羟孕酮（DMPA-SC）有潜力提高避孕持续率，并将避孕服务扩大到利用基于医疗机构的卫生服务有限的人群。这些研究中只有少数在南亚国家开展，而且在大多数避孕方法为非激素方法且与卫生系统接触有限或无需接触卫生系统的地区均未开展相关研究，这使得巴基斯坦等国的政策制定者缺乏针对具体情况的证据来指导关于是否引入、如何引入以及为谁引入DMPA-SC的决策。
将在巴基斯坦旁遮普省的41个医疗机构及周边社区开展一项前瞻性队列研究。该研究的主要目的是比较接受DMPA-SC的女性与接受肌肉注射醋酸甲羟孕酮（DMPA-IM）的女性的12个月避孕持续率。次要目的是比较选择DMPA-SC的参与者与选择必须由卫生工作者注射的DMPA-IM的女性的特征和经历。此外，计划开展一项子研究，以评估选择自我注射DMPA-SC的女性在商品储存、注射时间、注射技术和废物处理标准方面的遵守情况。
这项研究为全球减少避孕方法选择机会不平等的努力做出贡献提供了契机，同时生成可采取行动的证据，为巴基斯坦卫生部门的决策提供参考。尽管研究地点仅限于女性首次自我注射DMPA-SC由护士、助产士、医务人员、女性健康访视员、家庭福利工作者或家庭福利顾问监督的医疗机构，但研究方案和结果将为未来测试替代服务提供和自我注射支持模式的研究奠定基础。
在clinicaltrials.gov上注册为一项观察性研究（NCT05774626）。
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