Breaking down biases against user-administered injectable contraceptives with Jennifer Karlin, MD

In this Contemporary OB/GYN video interview, Jennifer Karlin, MD, PhD, associate professor at the University of California, San Francisco, expanded on findings from the recently published O & G Open mixed-methods study evaluating provider awareness and prescribing patterns for self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC).^1,2

The study, which surveyed 422 family planning professionals and conducted 34 interviews, found that although 74.5% of clinicians were aware of DMPA-SC as a self-administered contraceptive option, only 34.8% actively prescribed it. Positive predictors of awareness included reproductive health fellowship training, obstetrics and gynecology specialization, high-volume contraceptive clinics, and Title X or Planned Parenthood affiliation. Barriers included internal medicine specialization, pharmacy-based practice settings, and limited contraceptive formularies. Significant predictors for prescribing, among those aware, included being gender diverse or male, having established workflows, and state Medicaid/private insurance coverage. Conversely, practicing in states with abortion restrictions was a negative predictor of prescribing.

Karlin emphasized that barriers can be rooted in provider-level assumptions that do not reflect patient experience.

“A lot of providers will say, ‘My patients are going to be scared of needles… they’re going to be too nervous to give it to themselves,’” she explained. “But what we’ve learned in other work is that some people do have needle fears at the beginning, and after they use it over time, that fear goes away—and there are so many other benefits that overcome that fear.”

Karlin noted other benefits for user-administration, including reduced travel, no need for childcare, fewer work disruptions, and greater privacy.

Karlin highlighted that many provider concerns—such as confirming pregnancy before injection or teaching self-injection technique—are manageable using tools already common in other injectable medication categories, from infertility treatments to GLP-1 therapies.

“Prior to this study, a lot of the conversation that we would have with providers was, ‘Well, what about your other patients who are doing infertility treatment? Those are injectables. Why do we not worry about those patients in the same way?’” Karlin said. “Some of the reasons for that, that came out in our qualitative studies, are, again, just biases that we have around people who use contraception, and particularly around this injectable contraception historically.”

References:

1. Chase C, An-Lin C, Creason L, Karlin J. Barriers and facilitators to expanding user-administered injectiable contraceptives in the United States. O & G Open. 3(1):e141. February 2026. doi:10.1097/og9.0000000000000141
2. Fitch J. Jennifer Karlin, MD, PhD, explains barriers, biases for user-administered injectable contraceptives. Contemporary OB/GYN. Published January 16, 2026. Accessed January 19, 2026. https://www.contemporaryobgyn.net/view/jennifer-karlin-md-phd-explains-barriers-biases-for-user-administered-injectable-contraceptives