DMPA: acceptance and compliance in a tertiary care hospital in Mumbai, India

Abstract

INTRODUCTIONThe use of safe and effective contraception is the need of the hour in India, which has one of the world's largest and fastest growing population.1 Contraceptive advice is a vital component of good community health. An ideal contraceptive should suit an individual's personal, social, and medical needs. Socio-economic factors and education are some of the factors that play an important role in family planning acceptance. There are approximately 40 million women in India who would prefer to avoid becoming pregnant but are not practicing any form of contraception. In the Indian scenario, women have no role in making of reproductive decisions. According to NFHS-3, around 30% of the fertility in India was unwanted, indicating a huge gap between the demand and supply of family planning measures. The unmet need for contraception in the country as a whole is about 13%. The unmet need is high among women aged 15-19 years, and among those aged 20-24 years (15% for spacing and over 6% for limiting). Depot Medroxy Progesterone Acetate, or DMPA is a progestin-only method of contraception. It is a 3-monthly intramuscular injectable that delivers 150 mg of medroxyprogesterone acetate in microcrystalline suspension form that delays absorption of the hormone after the injection. It provides long acting, effective and reversible contraception.3 It is accepted by women who cannot remember to take OC pills regularly and by those who do not wish to insert an IUD. Theoretical concerns with early postpartum administration of DMPA remain that of infant safety, premature inhibition of lactation and its metabolic effects on mother. Studies indicate that ABSTRACT Background: The use of safe and effective contraception is the need of the hour in India, which has one of the world's largest and fastest growing population. Contraceptive advice is a vital component of good community health. Methods: The present study was conducted in one of the premier teaching medical institute of Mumbai. The aim of this study was to assess the acceptance and compliance of DMPA (Depot Medroxy Progesterone Acetate) among women attending family planning OPD. The study was conducted over the period of 3 years. Meticulous follow up was kept for all the women recruited in the study. Results: The study concluded that DMPA is highly effective contraceptive with low failure rate, when women are effectively counselled. Also, it should be made freely and easily available through health care facilities. Conclusions: It should be available as a first line method to all who wish to opt for reversible methods of contraceptive.

Study the acceptance, compliance and efficacy of injection depot medroxy progesterone acetate as contraception: a prospective observational study

“…In the study by Michelle Fonseca et al 2017, most of the women 146 (73%) had lost to follow up after 1 st injection. 11 While in a study conducted by Sirisha PSNRS 2017, 21.2% patients had lost to follow up after 1 st injection. 12 In the study, patients who came for 2 nd injection, 59.4% had amenorrhea, 22.6% had irregular bleeding and 18% had increased weight whereas patients who came for 3 rd injection, 65% had amenorrhea, 29.7% had irregular bleeding and 5% had increased weight.…”

Compliance with DMPA contraceptive injection repeat visits during the Covid 19 pandemic

“…In this study, women's knowledge about understanding contraceptives plays an important role in maintaining adherence to DMPA contraceptive use. A retrospective study in India of 200 DMPA injectable contraceptive users stated that persistent contraceptive use occurred in acceptors who had been effectively counseled (Fonseca et al, 2017a). This proves that the provision of effective education and counseling will increase mother's knowledge about the importance of contraception and can avoid the possibility of non-compliance in obtaining contraceptive services (Ogidi et al, 2019).…”

“…Several developing countries reported a decrease in the use of contraceptives by users of DMPA injection (Burlando et al, 2021;Osinowo et al, 2021) including in Indonesia (Herawati et al, 2020). The decline in DMPA injection repeat visits at health facilities also occurred in DKI Jakarta, which decreased by 25.9% in 2020 from the previous year (Fonseca et al, 2017b).…”

“…Based on World Contraceptive Use data in 2019, as many as 74 million women in the world aged 15-49 years (8%) use injectable contraception, while in Indonesia 23.2% which is the highest number of types of contraceptive methods used by women aged 15-49 (UNFPA, 2018). Due to the low failure rate of this type of DMPA contraceptive, it is categorized as a method of contraception with high effectiveness (Fonseca et al, 2017a;United Nations -Department of Economic and Social Affairs, 2019). The 3-month of DMPA injectable contraceptive is one of the contraceptive methods that has decreased in the number of users during the Covid-19 pandemic.…”

Gangguan Menstruasi Pada Akseptor Dmpa Tidak Terkait Imt

“…Efek samping yang sering dirasakan pada metode suntikan yaitu gangguan menstruasi. Hasil penelitian mengenai faktor penyebab dropout peserta keluarga berencana (KB) injeksi DMPA karena alasan efek samping berupa gangguan menstruasi dan perubahan berat badan yang dirasakan sebanyak 38% (Fonseca, 2017). Dampak yang ditimbulkan dari angka kejadian akseptor drop out yang semakin meningkat adalah terjadinya lonjakan pertumbuhan jumlah penduduk yang akan berdampak pada tingkat kesejahteraan, kualitas pendidikan, pembangunan dan kesehatan sehingga menurunkan kualitas penduduk suatu negara (BKKBN, 2013).…”