Self-administration of injectable contraceptives: a systematic review.

Abstract

The contraceptive injectable is a safe and effective method that is used worldwide. With the variety of injectable delivery systems, there is potential for administration by the woman herself. Self-administration of the contraceptive injectable is the subject of this systematic review. To assess how effective and safe the contraceptive injectable method is when women themselves perform/administer it, compared with when the usual healthcare providers administer it. We searched PubMed, Popline, Cochrane, CINAHL, and Embase for articles with subject headings or text words related to 'self-administration' and 'contraception'. Studies that compared the administration of the contraceptive injectable by the woman herself versus administration by the healthcare provider were included. Outcomes of interest were continuation rates, safety, and the women's overall satisfaction with the contraceptive provider and method. We undertook data extraction, descriptive analysis, and assessment of risk of bias. Three studies met the inclusion criteria. The best available evidence shows that there may be little or no difference in continuation rates when women self-administer contraceptive injections (326 per 1000 women; 95% CI 192-554 per 1000 women) compared with administration by healthcare providers (304 per 1000 women). Safety was not estimable as no serious adverse events were reported in any of the studies. With regards to overall satisfaction towards the provider and the method, the effect of the intervention was uncertain. Findings suggest that with appropriate information and training the provision of contraceptive injectables for the woman to self-administer at home can be an option in some contexts. This review assessed the continuation rates and safety of self-administration of the contraceptive injection.