A prospective cohort study to assess the acceptability of Sayana Press among 18–49-year-old women in Nepal

Objective: We compared acceptability and continuation of Sayana Press, a subcutaneous formulation of depot-medroxyprogesteone acetate (DMPA) in a Uniject injection system, to intramuscular (IM) DMPA,among both current users of DMPA-IM and new users in Nepal.Study Design: We recruited women seeking injectable contraception at 14 public health facilities in Nepal selected for geographic diversity. We enrolled women who self-selected either Sayana Press or DMPA-IM and used structured interviews to obtain baseline demographics and assess satisfaction and continuation rates at 1, 3, and 6 months.Results: Seven hundred ninety-four women (71%) selected and received Sayana Press, while 318 women(28.6%) selected and received DMPA-IM. One hundred and seventy-eight (48%) women continuing Sayana Press injection reported that they experienced “no possible side effects” compared to 29 (22%) among DMPA-IM selectors during the previous 6 months. The continuation rate of Sayana Press at 6 months was higher than DMPA-IM (Sayana Press 46.5% vs DMPA-IM 34.4%; p < 0.001). Selection of Sayana Press method (ORadj. 1.74; 95% confidence interval 1.32–2.3) and approval from husband (ORadj. 1.59; 95% confidence interval 1.21–2.09) were associated with injection continuation.Conclusion: Sayana Press is acceptable to women in Nepal with the preference for Sayana Press over DMPA-IM (higher proportion chose the method when counseled and given the option, better continuation).Implications: The potential for self-injection with Sayana Press may have implications for continuation and opportunity for future research and strategies to roll out this innovative technology must be explored.