Missed opportunity for self-injectable contraception awareness and adoption: Insights from client exit interviews in Uganda and Nigeria

Using data from facility exit interviews with clients seeking family planning services in public health facilities in Uganda and Nigeria, we develop a visual information cascade to identify potential missed opportunities for the provision of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) self-injection services. More than a third of respondents in Uganda (31.2%) and Nigeria (40.5%) reported not receiving any information about the self-injection contraceptive from a provider during family planning service provision. This was despite a stated desire to learn about the method that the client expressed during the exit interview after the facility visit. The cascade also highlights missed opportunities to provide adopters who self-injected with additional doses to take home, which is one of the method's core attributes as a self-managed contraceptive method. Using subcutaneous depot medroxyprogesterone acetate self-injection method as a case study, we demonstrate the utility of constructing a description of contraceptive counseling and service cascade for identifying potential gaps in quality and person-centeredness of service delivery, aiming to enhance the overall family planning experience for clients in these regions.