See related articles by Burke et al. and Callahan et al.

With more than 74 million users, injectable contraceptives are one of the most widely used methods of contraception globally and remain the most prevalent method in sub-Saharan Africa.1 Depo medroxyprogesterone acetate (DMPA) is the most commonly used injectable contraceptive and is available in both a 3-month intramuscular formulation (DMPA-IM, 150 mg/ml) administered by providers and a 3-month subcutaneous formulation (DMPA-SC, 104 mg/0.65 ml), which is preloaded into a Uniject and can be either administered by providers or self-administered. Although both DMPA formulations are widely used, discontinuation is common; clients frequently cite concerns about side effects (e.g., contraceptive-induced menstrual changes) and delays in expected return to fertility.2,3 Adequate counseling can ease such concerns.4 However, for clients experiencing negative side effects, counseling cannot alleviate the symptoms. These clients have the unenviable choice of either continuing despite distressing side effects, switching to another method that is possibly less effective, or discontinuing and facing the risk of unintended pregnancy.

To meet the family planning needs of these individuals and others who do not want to become pregnant but have concerns about hormonal method use, it is critical to facilitate access to a wider range of methods, including through the development of new nonhormonal contraceptive options. Recognizing that research and development of promising new products will take time, it is also important to refine existing products to increase accessibility, affordability, acceptability, and satisfaction. Although studies that yield incremental improvements to existing contraceptive methods will not address every method-related concern, this research may reduce some of the barriers users face to access and continue using their chosen method. This work can include studies to: