Contraceptive Use Dynamics among Women Receiving DMPA-SC at Public Health Facilities in Oyo, Niger, and Lagos States, Nigeria: A Prospective Cohort Study

Julius Njogu, Population Services International
Claire Rothschild, Population Services International
Fauzia Tariq, Population Services International
Jewel Gausman, Guttmacher Institute
Robin Swearingen, Population Services International
Oluwaseun Adeleke, Society for Family Health-Nigeria
Susan Ontiri, International Centre for Reproductive Health Kenya

Background: Despite widespread introduction of subcutaneous depot medroxyprogesterone (DMPA-SC) as a self-injectable (SI) contraceptive method, little evidence exists on users’ dynamic behaviors and experiences of DMPA-SC use to optimize policy and practice. Methods: We enrolled women seeking DMPA-SC from 15 public health facilities in Nigeria’s Oyo, Lagos, and Niger States. Participants were interviewed at enrollment and in 3 follow-up surveys at 17-week intervals. We conducted descriptive statistics at each survey wave and estimated 12-month cumulative incidence of DMPA-SC-specific method discontinuation by fitting competing-risk survival models. Results: Among 1,005 participants, 516 (51%) were initiating DMPA-SC at enrollment. Among these, 12-month cumulative DMPA-SC discontinuation was 69.3%. Discontinuation was significantly 18% lower among participants practicing SI versus those receiving it as provider-administered method at enrollment (subhazard ratio 0.82, 95% confidence interval: 0.68, 1.00; p=0.045). At first follow-up, two-thirds of DMPA-SC SI users reported receiving no additional units for home-based SI. Over follow-up, home-based SI was practiced less frequently than either provider-administered or facility-based DMPA-SC SI. Discussion: Home-based DMPA-SI was relatively rare in this cohort of Nigerian women, which is at odds with the method’s hypothesized value proposition and may be driven by policies and preferences that limit provision of units for home use.

Keywords: Family Planning and Contraception, Longitudinal studies

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