Shockingly, a widely available and empowering birth control option is being overlooked in the U.S. Despite being available for over two decades, self-administered injectable contraception is not being prescribed by the majority of reproductive health experts. A recent study reveals that only about a quarter of them prescribe it, and many are even unaware of its existence. This is a significant issue, as it limits patient choice and control.
The study, published in the journal Obstetrics & Gynecology on January 8th, sheds light on the barriers preventing the widespread adoption of this method.
"Since most physicians don't know that this is an option, patients don't know about it," explains Dr. Jennifer Karlin, a UCSF associate professor and the study's senior author. "It's safe, effective, and puts the control in patients' own hands. We should be talking about and offering it to patients without biases."
Researchers surveyed 422 clinicians who regularly prescribe birth control. The results were surprising: only about a third of those familiar with the self-administered option actually prescribe it. The reasons for this reluctance are varied. Some providers expressed concerns about patients' ability to self-inject, while others were unsure about pharmacy availability and the lack of standardized patient counseling approaches.
So, what exactly is this overlooked option? It's an injectable form of depot medroxyprogesterone acetate (DMPA), a synthetic version of the hormone progestin. This drug prevents pregnancy for up to three months by stopping ovulation, thickening cervical mucus, and thinning the uterine lining.
DMPA comes in two forms: an intramuscular injection, administered by a healthcare provider, and a subcutaneous version, which is injected just under the skin. The subcutaneous version allows for self-injection, similar to the increasingly popular injectable weight-loss drugs.
But here's where it gets controversial... The drug is associated with potential side effects, including reduced bone mineral density, weight gain, and a rare benign brain tumor called meningioma. While the overall risk is low, it's crucial that clinicians discuss these risks and benefits with their patients.
The subcutaneous version, approved in 2004, is officially labeled for clinician administration, but physicians have been training patients to self-inject safely for years. Interestingly, self-injectable contraception is more common globally, especially in sub-Saharan Africa. Its use in the U.S. saw an uptick during the COVID-19 pandemic, with over half the prescribers surveyed learning about it between 2020 and 2022.
Both international and national guidelines recommend making this option accessible to all patients. However, the study found that providers in states with restricted abortion access were less likely to prescribe it. Other obstacles include insufficient educational materials, a lack of staff support, and limited time for patient consultations.
To increase accessibility, the authors suggest an educational campaign for clinicians about self-administration. They also advocate for FDA approval of the self-administered version, insurance coverage, and streamlined clinic workflows.
The study was supported by a grant from the Society of Family Planning.
What do you think? Are you surprised by these findings? Do you believe that self-administered contraception should be more widely available? Share your thoughts in the comments below – let's start a conversation!
