In January 2024, a delegation of Ethiopian health specialists, including representatives from the Ministry of Health, Population Services International (PSI) Ethiopia, and the Ethiopian Society of Obstetricians and Gynecologists (ESOG), visited Nigeria to learn about the implementation and scale-up of DMPA-SC self-injection (SI). The visit aimed to gather insights and best practices that could inform Ethiopia's own efforts to introduce and expand the use of DMPA-SC for self-injection, an initiative that has been in the exploratory phase since early 2020.

Depot medroxyprogesterone acetate subcutaneous (DMPA-SC) is a contraceptive injection administered under the skin. It is a lower-dose alternative to the traditional intramuscular (IM) DMPA injection, with 104 mg compared to 150 mg. DMPA-SC is delivered through a prefilled, ready-to-inject system, making it convenient for self-administration and community-based distribution. This method is not only safe and highly effective in preventing pregnancy but also has the potential to significantly improve contraceptive access and method choice for women, especially in underserved areas.

Nigeria's successful integration of DMPA-SC SI into their national family planning program offers valuable lessons for Ethiopia. Nigeria, like Ethiopia, faces challenges such as diverse populations, natural disasters, internal conflicts, and disease outbreaks. Despite these challenges, Nigeria has made significant progress in expanding contraceptive options and improving access to sexual and reproductive health care by adopting and implementing WHO’s Self-Care Guidelines.

During the visit, the Ethiopian delegation observed the practical application of DMPA-SC SI in various settings, including policy formulation, stakeholder engagement, training, and service delivery. The key takeaways from the visit include:

Nigeria’s success underscores the importance of a favorable policy environment and strong advocacy efforts. The development and endorsement of national self-care guidelines and task-shifting policies were critical to the scale-up of DMPA-SC SI. Engaging a wide range of stakeholders, including government agencies, NGOs, and professional associations, was essential for coordinated efforts and sustained progress.

Nigeria implemented standardized training curricula and low-cost training approaches, training over 29,000 providers across various states. Integrating DMPA-SC into national family planning training curricula ensured that providers were well-equipped to support self-injection. DMPA-SC was integrated into routine forecasting and quantification processes, and distributed to all state stores. Effective service delivery was supported by robust monitoring systems, including data collection and analysis through national health information systems.

Tailored social and behavior change communication materials were developed to increase awareness and acceptance of DMPA-SC. These efforts were crucial in driving demand and ensuring high continuation rates among users. Proper disposal of used DMPA-SC units was emphasized, with recommendations for puncture-proof containers and appropriate disposal methods to ensure safety and environmental protection.

Ethiopia is poised to benefit greatly from the insights gained during the learning visit to Nigeria. By adopting similar strategies, Ethiopia can enhance its family planning services, particularly through the introduction and scale-up of DMPA-SC SI. The Ethiopian Ministry of Health, in collaboration with partners like PSI and ESOG, is committed to creating a supportive policy environment, building provider capacity, engaging stakeholders, and developing effective monitoring and demand generation strategies.

The Ethiopian Society of Obstetricians and Gynecologists (ESOG) is committed to playing a pivotal role in the introduction and scale-up of DMPA-SC SI in Ethiopia. ESOG will focus on advocacy efforts to ensure a favorable policy environment, provide training and capacity-building support to healthcare providers, and contribute to the development of tailored educational materials. By leveraging its expertise and networks, ESOG aims to promote the adoption of self-care practices and improve access to contraceptive options for women across Ethiopia.

The learning visit to Nigeria provided invaluable insights that will guide Ethiopia in enhancing its family planning services through the introduction of DMPA-SC self-injection. With the collaborative efforts of the Ministry of Health, PSI, ESOG, and other stakeholders, Ethiopia is well-positioned to expand access to contraception, improve health outcomes, and empower women to take charge of their reproductive health.