Uganda study finds self-injectable contraception boosts women’s decision-making

11 February 2026, 3:12 pm

By Byamukama Alozious

A new 12-month cohort study conducted in Eastern and Northern Uganda has found that women who choose to self-inject the contraceptive DMPA-SC experience a measurable increase in their decision-making power over family planning, although the effect appears strongest within the first six months.

The study, titled “Is choosing self-injectable contraception associated with enhanced contraceptive agency? Findings from a 12-month cohort study in Uganda”, was published in the journal Contraception in January 2026. It was led by researchers from the University of California, San Francisco, and Makerere University School of Public Health. The full open-access study is available via Contraception on ScienceDirect: https://doi.org/10.1016/j.contraception.2026.111366.

DMPA-SC is a three-month injectable contraceptive that women can administer themselves at home. The World Health Organization (WHO) has recognised self-injection as a key self-care intervention, recommending it as part of efforts to expand access and reproductive autonomy. WHO guidance on self-care interventions can be accessed here: https://www.who.int/publications/i/item/9789240000909.

In simple terms, the researchers investigated whether giving women the option to inject themselves—rather than relying on a health worker—actually increases what experts call “contraceptive agency.” This refers to a woman’s ability to make informed decisions about preventing pregnancy and to act on those decisions confidently.

The study followed 1,828 women aged 15 to 45 who had recently chosen a new contraceptive method. Of these, 216 opted for self-injection, while the remainder selected other methods such as implants, IUDs, or provider-administered injections. Researchers measured changes in agency using a validated tool known as the Agency in Contraceptive Decisions Scale.

At the start of the study, agency scores were already relatively high in both groups. However, by six months, women who chose self-injection showed a statistically significant increase in their sense of control and confidence. On average, their agency scores rose by 0.10 points on a 0–3 scale compared to women who chose other methods.

More specifically, women who opted for self-injection reported greater improvements in two areas: awareness of reproductive rights and confidence in making contraceptive decisions. “Small improvements in agency over six months among women choosing self-injection but not other methods corroborate its empowering potential,” the authors wrote.

In layman’s terms, this means that women who chose to self-inject felt more confident and in control of their reproductive choices, at least in the short term.

However, by the 12-month mark, the difference between the two groups had largely disappeared. The researchers suggest that real-world challenges—such as stockouts of the drug, lack of privacy at home, or unsupportive partners—may limit the long-term empowering effect of self-injection if broader structural barriers are not addressed.

The study was conducted between 2022 and 2024 in districts including Iganga, Mayuge, Kole, Lira, and Oyam. Ethical approval was granted by UCSF, Makerere University, and the Uganda National Council for Science and Technology. Funding was provided by the Gates Foundation.

Importantly, the researchers emphasise that self-injection should not replace other contraceptive methods but be offered alongside them. “Greater improvement in agency over time with choosing self-injection compared to other contraceptive methods suggests self-injection may be uniquely empowering and should be offered alongside other contraceptive options,” the study concludes.

Uganda introduced DMPA-SC self-injection in 2017 as part of efforts to expand access to family planning. According to the DMPA-SC Access Collaborative, the country has been scaling up community distribution through Village Health Teams. More information on Uganda’s scale-up journey can be found here: https://fpoptions.org/wp-content/uploads/Uganda-DMPA-SC-country-brief-PATH-JSI-2021.pdf.