A new study by researchers at Planned Parenthood reveals that self-administration of depot medroxyprogesterone acetate (DMPA), known in the United States as Depo-Provera or the shot, helped people continue using the contraceptive method. At a time when the Trump administration and congressional leaders seek to deny and disrupt access to contraception and reproductive health care, this research adds to a growing body of evidence showing that people are more likely to continue using a method when it’s readily available to them.
Advance provision of multiple doses of the shot, which can be injected by patients themselves, could help in achieving reproductive justice (in particular, the rights to choose to become pregnant or not). With several doses in hand (each lasting 12 weeks), a patient will still have contraception and be able to use it even if they lose their health insurance coverage or their local clinic is forced to close.
Although the shot has a troubled past—involving forced use among communities of color—it has some potential to advance reproductive autonomy. As Julia Kohn, national director of research at Planned Parenthood Federation of America, pointed out in a phone interview, this study initially came about because staff at Planned Parenthood Gulf Coast in Texas, seeing a high number of clients who have chosen the shot as their preferred method, requested to teach clients to self-administer. “We opted to do this as a research study to gather evidence to help people across the country. It’s a ground-up study that came from the local community,” said Kohn. “This was about making the shot more accessible for people who have already chosen this method.”
Published in the Contraception journal, the study included more than 300 women ranging in ages from 16 to 44. Participants selected into the self-administration group were taught to self-inject by clinic staff. Those who successfully self-injected at the clinic site were given three doses, self-administration supplies, and printed instructions to take with them.
Study results reveal that DMPA continuation after one year was greater in the self-administration group (69 percent) than in the group that had to return to the clinic to receive their injection (54 percent). Among those who did self-administer, 97 percent said it was very or somewhat easy to do and 87 percent would recommend self-administration of DMPA to a friend.
In the study, participants of all races found self-administration of DMPA to be easy and convenient to use. Kohn told Rewire, “Women across racial and ethnic groups were equally likely to find self-administration of the shot feasible and acceptable. Satisfaction was the same across racial/ethnic groups and there was no difference in continuation across racial/ethnic groups.”
The results are promising and could open new paths for contraceptive provision in the United States. Currently, many contraceptive users have to fill prescriptions monthly or for DMPA users, go to their care provider for an injection every 12 weeks. Things like transportation, taking time off work, or inconvenient clinic hours could serve as barriers to someone continuing their desired method.
Overseas, Sayana Press (another DMPA product) is specifically labeled for self-administration and is marketed to the African continent, where the shot is widely used and where many people would like to use contraception but do not have physical or financial access to it. PATH, an international health organization, and its partners first made it available outside of research settings in 2016. It’s currently being made available to certain countries for distribution through their national family planning programs.
Self-administered DMPA could serve to increase reproductive autonomy and support contraceptive continuation among people across the world who have difficulty accessing care in a clinical setting or simply prefer not to. Reproductive autonomy is especially important for groups of people in the United States whom the government and scientists targeted for research, reproductive coercion, and sterilization—especially low-income people and people of color.
DMPA has a troubled history involving people of color. In 1992, the Chicago Tribune reported that Depo-Provera was tested on thousands of Black women in Atlanta in the 1960s and ’70s without their informed consent. A 2010 report by the Urban Indian Health Institute shared that Depo-Provera was also given to American Indian/Alaska Native women without their informed consent. Advocates like the National Black Women’s Health Project, now known as the Black Women’s Health Imperative, opposed the U.S. Food and Drug Administration’s approval of Depo-Provera in the ’90s, and some Black advocates continue to decry that it is specifically targeted to Black women to harm them. DMPA has been linked to cancer (but there’s more research to be done), bone density loss, and HIV.
Despite this history, or possibly because of overmarketing to certain groups, users of DMPA are more likely to be women of color and women who rely on public health insurance. About 10 percent of all Black contraceptive users relied on Depo-Provera between 2011 and 2013 —the most of any reported racial category. A 2010 report shares that American Indian/Alaska Native women ages 15-24 were three times more likely to have used Depo-Provera than white women. Depo-Provera use is also highest among people insured by Medicaid or public health insurance, compared to those with private or other types of health insurance coverage.
Given its dark past and the fact that DMPA is widely used among low-income people and people of color, both in the United States and overseas, it’s important to find new ways to ensure these populations have access to their contraceptive method of choice. Self-administration is one way to do that.
But who pays for self-administration and how might that work with providers? Right now, the answers to those questions remain to be seen. Currently, insurance coverage of advance or extended supplies of contraception vary state by state with no federal requirement for supply beyond a single dose. While Planned Parenthood intends to incorporate the study findings into its medical standards and guidelines so all of its affiliates can offer self-administration of DMPA, insurance coverage is one of the next challenges to overcome.
Kohn says Planned Parenthood intends to work with providers and advocates on the issue of insurance coverage.