Continuation Rates of Self-administered Subcutaneous DMPA and Provider-administered Intramuscular DMPA in Patients Seeking Post-abortion contraception

The primary question that the proposed project will seek to answer is whether continuation rates for self-administered DMPA-SC and provider-administered DMPA-IM differ for patients seeking abortion services. Secondary questions that the project will address include which demographic and clinical factors are associated with continuation of DMPA and whether patient satisfaction differs between the two methods. We hypothesize that, similar to prior research investigating continuation rates in populations primarily seeking contraceptive services, patients using self-administered DMPA-SC will have higher continuation rates than patient using provider administered DMPA-IM. The project will be a prospective cohort study of patients at a large, free standing abortion clinic in Chicago, IL. Patients who indicate that they desire DMPA for post abortion contraception will be recruited. They will choose either provider-administered DMPA-IM or self-administered DMPA-SC. Patients in both groups will complete a baseline survey that will collect demographic characteristics including age, race, insurance status, income, education level, and marital status; and clinical characteristics including gestational age, type of abortion (either medical or surgical), obstetric history, and contraceptive history. Patients who choose self-administered DMPA-SC will receive self-injection teaching from study staff and will selfinject their first dose of DMPA-SC in the clinic. They will also receive a sharps box to take home. Patients who choose provider-administered DMPA-IM will receive their first dose of DMPA-IM in the clinic. Both groups will receive a prescription for the second and third doses of DMPA and will receive an injection calendar. Study participants will receive a reminder prior to the start of the injection window for their second and third doses. After the injection window for the second and third doses closes, participants will complete follow up surveys. These surveys will assess whether patients received the subsequent doses of DMPA, reasons for discontinuing DMPA for patients who did not receive a dose, pregnancy status, and patient satisfaction with DMPA use. Follow up will be primarily via secure text messaging application with phone calls and mail reserved for patients who cannot or prefer not to be contacted via text message. Patients will receive their initial dose of DMPA free of charge and will be compensated for their time upon completion of the initial and subsequent surveys.