A study reveals that many clinicians remain unaware of self-administered injectable contraception, despite its decades-long availability.
Self-administered injectable contraceptives have been an option in the United States for more than 20 years, but a new study shows they remain rarely prescribed. Only about one in four reproductive health clinicians currently offer them, and many providers are not aware that self-injection is even possible.
The researchers surveyed 422 clinicians who routinely prescribe birth control. Among those who knew about self-administered injectable contraception, only around one-third said they actually prescribe it. Clinicians pointed to several concerns, including whether patients could safely give themselves injections, difficulties finding the medication at pharmacies, and the absence of clear, standardized guidance for counseling and prescribing.
This study is the first to systematically identify the obstacles limiting broader use of self-administered injectable contraception. The findings were recently published in the journal Obstetrics & Gynecology.
“Since most physicians don’t know that this is an option, patients don’t know about it,” said Jennifer Karlin, MD, PhD, a UCSF associate professor of Family and Community Medicine and the paper’s senior author. “It’s safe, effective, and puts the control in patients’ own hands. We should be talking about and offering it to patients without biases.”
How Injectable Contraception Works
Depot medroxyprogesterone acetate (DMPA) is a form of injectable progestin, a synthetic version of the hormone progesterone. It provides pregnancy protection for up to three months by preventing ovulation, thickening cervical mucus, and thinning the uterine lining.
There are two injectable forms of DMPA. One is an intramuscular shot sold under the brand name Depo Provera, which must be given by a healthcare provider. The second is injected just beneath the skin and can be safely self-administered, similar to commonly used injectable GLP-1 medications for weight loss.
The drug has been associated with potential side effects, such as reduced bone mineral density, weight gain, and a benign brain tumor called meningioma. While the overall risk of these side effects is low, it is important that clinicians discuss the risks and benefits with their patients.
The subcutaneous version, approved in 2004, is officially labeled for administration by a clinician, but doctors have been training patients to self-inject safely for many years. Self-injectable contraception is more commonly used globally, particularly in sub-Saharan Africa. It became more widely used in the U.S. during the COVID-19 pandemic, and the study found more than half the prescribers surveyed learned about it between 2020 and 2022.
Structural and Policy Barriers
Both international and national guidelines recommend making this option accessible to all patients, but the study found that providers in states with restricted abortion access were less likely to prescribe it. Other obstacles include insufficient educational materials, lack of staff support, and limited time for consulting with patients.
To make the option more widely available, the authors recommend an education campaign for clinicians about self-administration of injectable contraceptives. They also advocate for FDA approval of the version of the injectable that can be self-administered, as well as ensuring that insurance covers it and streamlining clinic workflows.
Reference: “Barriers and Facilitators to Expanding User-Administered Injectable Contraceptives in the United States” by Chase Clark, An-Lin Cheng, Laura Creason and Jennifer Karlin, 8 January 2026, O&G Open.
DOI: 10.1097/og9.0000000000000141
The work was supported by a grant from the Society of Family Planning (SFPRF16).
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University of California – San Francisco
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