# Barriers and Facilitators to Expanding User-Administered Injectable Contraceptives in the United States

## TL;DR

This study explores factors influencing the use of user-administered contraceptive injections among healthcare professionals in the U.S.

## Contribution

The study identifies professional, institutional, and policy-level barriers and facilitators to prescribing user-administered subcutaneous DMPA.

## Key findings

- Only 34.8% of healthcare professionals actively prescribed subcutaneous DMPA despite 74.5% awareness.
- Awareness and prescribing were influenced by professional specialization, institutional setting, and state policies.
- Gender diversity and insurance coverage were significant facilitators for prescribing subcutaneous DMPA.

## Abstract

Addressing barriers and implementing facilitators across domains can guide efforts to expand access to subcutaneous depot medroxyprogesterone acetate for user-administration and mitigate disparities in contraceptive provision.

To identify facilitators and barriers to prescribing subcutaneous depot medroxyprogesterone acetate (DMPA) for user administration.

This mixed-methods study comprised surveys (N=422) and interviews (N=34) with family planning experts, defined as health care professionals who see at least three contraceptive visits a month, regarding their awareness, knowledge, and practice of prescribing subcutaneous DMPA for user administration.

We found that 74.5% of professionals reported awareness of subcutaneous DMPA for user administration, but only 34.8% actively prescribed it. Professionals who completed a fellowship in reproductive health, specialized in obstetrics and gynecology, saw a higher number of visits for contraception in a setting with a larger number of pregnancy-potential patients, or worked at a clinic with Title X funding, Planned Parenthood, or a freestanding clinic were more likely to be aware of subcutaneous DMPA for user administration. Negative predictors of awareness included internal medicine specialization, working in a pharmacy, and having a fewer number of contraception options available. Significant predictors for prescribing subcutaneous DMPA if aware of the option include being gender diverse or male, having access to subcutaneous DMPA–specific clinical workflows, and having state Medicaid and private insurance coverage for subcutaneous DMPA. Negative predictors for prescribing if aware include living in a state with abortion restrictions.

Our data among experts in contraceptive care highlight that awareness is associated by professional- and institutional-level factors and barriers between awareness of subcutaneous DMPA for user administration and provision that are primarily institutional and systemic. Facilitators for awareness and provision of subcutaneous DMPA for self-administration span multiple domains, including professional's perceived patient barriers, professional demographics, institutional challenges, and government policies.