Open AccessThe Role of Subcutaneous Depot Medroxyprogesterone Acetate in Equitable Contraceptive Care
Author(s) -
Audrey M Burlando,
Anne N. Flynn,
Sarah Gutman,
Arden McAllister,
Andrea H. Roe,
Courtney A. Schreiber,
Sarita Sonalkar
Publication year - 2021
Publication title -
obstetrics and gynecology (new york. 1953. online)/obstetrics and gynecology
Language(s) - English
Resource type - Journals
eISSN - 1873-233X
pISSN - 0029-7844
DOI - 10.1097/aog.0000000000004524
Subject(s) - medicine , medroxyprogesterone acetate , medical prescription , health care , population , family medicine , gynecology , nursing , environmental health , hormone , economics , economic growth
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, health care professionals have made swift accommodations to provide consistent and safe care, including emphasizing remote access to allow physical distancing. Depot medroxyprogesterone acetate intramuscular injection (DMPA-IM) prescription is typically administered by a health care professional, whereas DMPA-subcutaneous has the potential to be safely self-injected by patients, avoiding contact with a health care professional. However, DMPA-subcutaneous is rarely prescribed despite its U.S. Food and Drug Administration approval in 2004 and widespread coverage by both state Medicaid providers and many private insurers. Depot medroxyprogesterone acetate users are disproportionately non-White, and thus the restriction in DMPA-subcutaneous prescribing may both stem from and contribute to systemic racial health disparities. We review evidence on acceptability, safety, and continuation rates of DMPA-subcutaneous, consider sources of implicit bias that may impede prescription of this contraceptive method, and provide recommendations for implementing DMPA-subcutaneous prescribing.