Project takes a shot at contraceptive access

Checking your next patient’s chart, you see that the young woman uses depot medroxyprogesterone acetate (DMPA, Depo-Provera, Pfizer, New York City) for birth control. When you ask about her last injection, she tells you she missed her scheduled shot because she was out of town.

What if women could expand their access to getting DMPA shots by having re-injections administered by trained pharmacists? The Oakland, CA- based Pharmacy Access Partnership is looking at just such an arrangement through its demonstration program, Health Step.

The Health Step program allows specially trained pharmacists to partner with physicians and clinics so that established DMPA patients can get re-injections at their regular provider or at a participating pharmacy, explains Nicole Monastersky, MPH, partnership program manager. Since summer 2003, this injectable contraception program has been well received by collaborating physicians, clinic staff, and pharmacists, and it is available in 12 counties in California, she states.

According to the partnership, pharmacists are routinely providing injections of other drugs and many schools of pharmacy now require that graduates be trained to administer injections. Forty-one states now allow pharmacists to administer immunizations; they can give shots for such disease states as influenza, pneumococcal, hepatitis, diphtheria, pertussis, and tetanus.1

"Pharmacies are open in the evening and weekends and can offer highly convenient and accessible services," says Monastersky. "These changes are starting to make pharmacies a viable option to perform a resupply’ function for women on injectable contraceptives in much the same way that they resupply women on oral contraceptives."

Contraceptive injections are a popular form of birth control for many California women. About 25% of women using hormonal methods select contraceptive injections to prevent pregnancy, according to information from the state’s Family PACT (Planning, Access, Care, Treatment) program, which provides family planning clinical services at no cost to low-income residents.2

The Health Step program begins at the clinic or physician’s office, where the patient is screened for contraceptive contraindications and provided with education and instructions for method use. Women who choose DMPA as their preferred method are informed of the new Health Step pharmacy access option and if interested, they are provided with a prescription with refills, an injection card, and information about designated pharmacy locations.

Through collaboration with the Sacramento-based Pharmacy Foundation of California, the partnership has developed a variety of training mechanisms to help pharmacists incorporate the administration of injection-based contraceptives into their practices.

A distance-based learning program is available on the Internet (, and the partnership schedules occasional live clinical training on injectable contraception, which includes patient management and injection technique. The partnership also maintains a California toll-free hotline [(800) 323-1336] and web site for the Health Step program, The web site includes resources and educational material, as well as locations of participating providers and pharmacies.

"Convenience is important for many women — particularly working women — by offering women several access options, providers are recognizing this need," says Monastersky. "Enhanced access may also make it easier for patients to maintain contraceptive adherence and thus avoid unintentional pregnancy."


1. American Pharmacists Association. Fact Sheet. April 15, 2004. Available at:

2. Family PACT. Fact Sheet On Family Planning Methods and Services. Accessed at:


For more information on the Health Step program, contact: