Makerere University assessing factors affecting contraceptive self-injection (SI) uptake among women in Uganda.

Abstract

Depot medroxyprogesterone acetate subcutaneous (DMPA-SC) self-injection is a self-care family planning intervention that improves women's autonomy and access to contraception. However, evidence on factors influencing its uptake in Uganda remains limited. This study assessed the predictors of DMPA-SC self-injection uptake among women of reproductive age in Uganda. A cross-sectional analytical study was conducted using secondary data from 243 women who received DMPA-SC self-injection training through a Population Services International Uganda (PSIU) programme between May and June 2023. Descriptive statistics summarized participant characteristics, while Fisher's Exact Test assessed bivariate associations between selected predictors and DMPA-SC self-injection uptake. Variables significant at the bivariate level were included in an adjusted Firth penalized logistic regression model to identify independent predictors of uptake. A bootstrap sensitivity analysis with 5,000 resamples was performed to assess the robustness of the model estimates. Overall, 97.1% of the women adopted DMPA-SC self-injection. At the bivariate level, knowledge, confidence, awareness of side effects, and training/support were significantly associated with uptake. In the adjusted Firth regression model, awareness of side effects was the only independent predictor of uptake (adjusted OR = 104.30, p = 0.002). Bootstrap analysis demonstrated that this association remained stable across repeated resampling, supporting the robustness of the findings. The study concludes that awareness of side effects plays a critical role in promoting DMPASC self-injection uptake among trained women. Strengthening counselling on potential side effects and their management should therefore be prioritized within family planning programmes to promote informed decision-making and improve uptake. Future studies should use larger and more representative samples to validate these findings and assess determinants of continued self-injection use.