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Injectable Contraception Coho...

Injectable Contraception Cohort Study in Punjab, Pakistan

Last Updated: 2025-07-22

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

1009 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-01-18

Study Completion Date

2025-06-30

Brief Summary

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The aim of this study is to assess the value proposition of expanding contraceptive options available to women in Punjab, Pakistan to include subcutaneous depot medroxyprogesterone acetate (DMPA-SC).

Specific objectives are:

1. To compare 12-month continuation rates for DMPA-SC and intramuscular DMPA (DMPA-IM) among married women 18- 49 years of age in two districts of Punjab, Pakistan
2. To understand how characteristics and experiences of DMPA-SC and DMPA-IM users differ.
3. 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

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Detailed Description

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Depot medroxyprogesterone acetate (DMPA) is a highly-effective, injectable contraceptive method that requires injections every 11 to 17 weeks. It is available in both intramuscular (IM) and subcutaneous (SC) formulations, which are therapeutically equivalent and have similar safety profiles. DMPA-IM has been included in the method mix for most countries for many years. DMPA-SC is a newer formulation being added to the method mix in select settings. Studies demonstrate that self-administration of subcutaneous DMPA (DMPA-SC) outside clinical settings is safe, effective, feasible, acceptable, and can improve continuation, and a recommendation in favor of self-injected DMPA-SC is included in WHO guidelines on self-care interventions for health and well-being.

The Bill and Melinda Gates Foundation is funding implementation research in multiple countries to understand how self-injection of DMPA-SC can best be introduced to specific markets to expand the contraceptive options available to women and girls, health system characteristics, the demand for self-injection when DMPA-SC is offered alongside a range of other methods, and women's and girl's ability to start and continue use. Jhpiego has received funding to conduct one of these 'market tests' in Punjab, Pakistan.

The aim of this study is to assess the value proposition of expanding contraceptive options available to women in Punjab, Pakistan to include subcutaneous depot medroxyprogesterone acetate (DMPA-SC).

Specific objectives are:

1. To compare 12-month continuation rates for DMPA-SC and intramuscular DMPA (DMPA-IM) among married women 18- 49 years of age in two districts of Punjab, Pakistan
2. To understand how characteristics and experiences of DMPA-SC and DMPA-IM users differ.
3. 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

Conditions

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Contraceptive Usage

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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DMPA-SC

All married women of reproductive age who receive family planning counseling at a participating health facility and who choose to receive injectable contraception will be given an option of either DMPA-IM (current health worker administered standard of care) or DMPA-SC (new administration method, with option for self-injection after completing training). Those opting for DMPA-SC will receive training on self-injection procedures and an opportunity to practice injection procedures on a model (e.g. condom filled with salt) to demonstrate confidence and proficiency to inject herself under the supervision of a healthcare provider. Clients will then be shown how to use a calendar to determine when their next injection is due, and provided a calendar/reminder card, job aids that illustrate self-injection steps (including safe disposal of needles), and 3 doses of DMPA-SC to take home for future use.

Contraceptive usage

Intervention Type BEHAVIORAL

Continued use of injectable contraception, administered on a quarterly basis

DMPA-IM

Contraceptive usage

Intervention Type BEHAVIORAL

Continued use of injectable contraception, administered on a quarterly basis

Interventions

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Contraceptive usage

Continued use of injectable contraception, administered on a quarterly basis

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* Married women aged 18-49 years
* Decide to use injectable contraception and meet WHO medical eligibility criteria for injectable use
* Want to avoid pregnancy for at least 12 months
* Live within study districts
* Are willing to be contacted by study team members via telephone and/or in-person

Exclusion Criteria

* Women under age 18 and above 49
* Unmarried women
* Hope to become pregnant within next 12 months
* Do not reside within study districts
* Are not willing to be contacted by study team members via telephone or in-person
* Lack cognitive capacity to give informed consent or complete interviews

Minimum Eligible Age

18 Years

Maximum Eligible Age

49 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Hannah Tappis, DrPH

Role: PRINCIPAL_INVESTIGATOR

Jhpiego

Locations

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