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New boost to family planning methods

Injectable contraceptives could become more popular among women in India in the days to come, as part of the Government’s national family planning programme. More women may have the option of taking injectable contraceptives following the Government’s proposal to include injectable contraceptive Depot MedroxyProgesterone Acetate, or DMPA, in the national family planning programme.

Most gynaecologists come across many women who, due to limited access to contraceptives, face unwanted pregnancy – and, thereby, morbidity related to pregnancy and abortion. According to the World Health Organisation, every eight minutes a woman in a developing nation will die of complications arising from an unsafe abortion. For every woman who dies of pregnancy-related causes, an estimated 20 women experience acute or chronic morbidity, often with tragic consequences. Introduction of new contraception methods in the public health system will, therefore, allow women to select methods based on their specific needs and preferences.

An injectable contraceptive is a shot that can offer pregnancy protection for up to three months. It is a simple, safe, and reversible family planning method than can be administered discreetly. The method is especially convenient for women who cannot remember to take a pill everyday or negotiate with their partner for using a condom. However, it is essential to visit a doctor for the first screening and counselling on eligibility and potential side effects.

DMPA is a progestogen shot, usually administered in the arm, hip or buttocks. It thickens the cervical mucus which stops the sperms from reaching the egg. It also makes the womb lining thinner and prevents the release of an egg. Progestogen is similar to the natural hormone progesterone, which is released by a woman’s ovaries during her menstrual cycle.

Injectables are 99.7 per cent effective in preventing pregnancy. As per current WHO recommendations on the use of injectable contraception, for women aged 18 to 45 years of age, there should be no restrictions on the use of DMPA, including no restrictions on the duration of its use (medical eligibility criteria Category 1). Among adolescents (menarche to less than 18 years) and women over 45 years, the advantages of using DMPA generally outweigh the theoretical safety concerns regarding fracture risk (MEC Category 2). There are no restrictions on the use of hormonal contraceptives, including DMPA for women at high risk of HIV (MEC Category 1). Women and couples at high risk of HIV acquisition should also be informed about and have access to HIV preventive measures, including male and female condoms irrespective of the family planning method they choose.

These hormonal contraceptives are safe and suitable for nearly all women, including women who are breastfeeding, who have or have not had children, and even those who may just have had an abortion or miscarriage. DMPA has a high acceptability as it is provided by an injection every three months, which can be given outside clinical facilities. Women who are HIV positive can also safely use injectables. However, it should be noted that injectables do not provide protection against any sexually transmitted diseases including HIV. Therefore, a condom must be used for protection against these diseases.

This injection must be taken within seven days of menstrual bleeding or within the first seven days after a miscarriage or abortion. In case of breastfeeding mothers, the injection can be taken after six weeks of childbirth, and within six weeks after childbirth in case of non-breastfeeding mothers. Till the woman does not wish to have babies, she can continue to take these injections after every three months. An important point to note, however, is that the injection has to be discontinued nine to 10 months prior to planning a baby, as the conception may take some time.

All contraceptives have side effects. Therefore, women should be counselled about DMPA’s side-effects and provided a leaflet or other material to inform them about DMPA’s mode of action. Some women may experience lighter or irregular bleeding while in some cases there may be no menstruation. Other possible side effects may include headache, dizziness, breast tenderness, and weight gain. Most side effects usually become less or stop within the first few months of using the injectable.

Source : The Pioneer (via Syndication)

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