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

Abstract

Background: India was the first country in the world to launch a family planning programme, as early as 1952, with the main aim of controlling its population. 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. In this study, we evaluated patients in reproductive age group 18-35 years who were willing to use injectable DMPA as a method of contraception to study the acceptance, compliance and efficacy of injection depot medroxyprogesterone acetate as contraception.Methods: It is a prospective observational study carried out at Government medical college Miraj on 150 patients who fulfil the inclusion criteria. The postpartum, interval and postabortal categorisation of patients done and they are councelled about the benefits and side effects and drawbacks of DMPA. Injection is given deep intramuscularly after written informed consent and a DMPA card is given to beneficiary. Follow up date explained and patients are observed for follow up and any evidence of bleeding weight gain or any other side effects of DMPA are noted.Results: The mean age of subjects was 24.48±3.494 years. 2) 3.3% of the patients were nullipara, primi para 46.7%, 36% were second para, 11.3% were third para and 2.7% were fourth par. 3) After 1st injection, 47.3% patients were lost to follow-up i.e., they did not turn up for their second dose of injection. 4) Out of 150 patients who accepted the injection as contraception, only 79 patients turned up for their 2nd injection after 3months, out of which only 37 patients turned up for their 3rd dose of injection after 6 months and only 5 patients turned up for their 3rd injection. Thus showing that the compliance is poor among this study population. 5) At 2nd injection, 39.2% discontinued due to amenorrhea, 10.7% discontinued due to irregular bleeding, 18.5% due to weight gain and 31.6% due undergoing permanent method. 6) No patients who came for follow up reported any pregnancies during the course of injection, therefore the efficacy of injection depot medroxy-progesterone acetate, as a method of contraception is 100% in this study.Conclusions: The DMPA is a good method of long acting reversible method of contraception with good acceptance and efficacy with less compliance.

Relationship between Demographic Factors, Knowledge, and Injection Contraceptive Acceptors’ Visit Compliance

“…The characteristics of these respondents were identified based on age, reasons for using contraceptive injection, education, knowledge, work status, husband's support, number of children, and compliance with injection contraceptive visits. Of the 96 respondents, 55 (57.3%) were aged over 35 years, similar to study conducted by Mulyaningrum was 40%, not much different [12]; and different from the Mane and Rokade and Mason's et al studies, where the age of the respondent is in the range of 25 years [4], [13]. Twenty-six respondents stated that they used the contraceptive injection because they wanted to stop having children, two respondents had health reasons that did not allow them to become pregnant, and the other respondents wanted to have pregnancy spacing.…”

“…Injectable contraceptive acceptor in the working area of Laren PHC, which has several children >2 only 28 (29.1%) respondents, can be interpreted those respondents are obedient on the BKKBN program two children are enough [14]. As many as 57.3% of injectable contraceptive acceptors who were respondents complied with reinjection visits; most other respondents did not attend the reinjection visits at the health service because they were still menstruating [12], while others are due to amenorrhea or irregular menstruation [4], and changes in body weight [12], [15]. In line with the previous research, the inaccuracy of birth control injectable visits is influenced by the belief in the community that menstruation is an obstacle to receive injectable contraceptives [4].…”

“…As many as 57.3% of injectable contraceptive acceptors who were respondents complied with reinjection visits; most other respondents did not attend the reinjection visits at the health service because they were still menstruating [12], while others are due to amenorrhea or irregular menstruation [4], and changes in body weight [12], [15]. In line with the previous research, the inaccuracy of birth control injectable visits is influenced by the belief in the community that menstruation is an obstacle to receive injectable contraceptives [4]. https://oamjms.eu/index.php/mjms/index…”

“…Indonesian Demographic and Health Survey on contraceptives usage data showed that injection had the highest drop-out rate (31.9%), followed by Pills (11.9%), coitus interruptus (4%), and implant (2.4%) [3]. Mane's study on injection contraceptive in India had a high dropout rate as well, on the second visit, 39.2% [4]. The data of Indonesian Demographic and Health Survey in 2017 showed that the rate of contraceptive dropouts is still high, at 34%.…”