Original Research ArticlesFactors affecting continuation rates of DMPA
Introduction
The most recent publications reporting 12-month continuation rates for depot medroxyprogesterone acetate (DMPA) users in the United States are disappointing: 34%,1 35%,2 and 42%.3 Continuation rates from earlier publications range from a low of 23%4 to 61% in an African population.5 The rates vary among populations, but the reasons for discontinuing do not; menstrual disturbances are the single major medical reason given for terminating use.6, 7 Although we know why women stop using DMPA, only limited information is available on the role that services play on the length of use. For example, a DMPA acceptor who has a good experience with her provider may be more likely to return for subsequent injections than a woman who had negative experiences. As side effects are the most common reasons for discontinuing, women who are not warned of possible menstrual changes, for example, might be more inclined to stop using DMPA compared to women who are fully informed. Thus, information received at the time of the first injection may dictate, to some extent, the continued use of the method.
Although it may seem obvious that good information leads to better continuation rates, the hypothesis has been examined only minimally. One study designed to measure the impact of counseling on DMPA continuation showed that women receiving intensive structured counseling used the method longer compared to women receiving regular counseling.8 In an attempt to improve dismal rates of continuation, researchers in Pittsburgh, PA, tested a strategy to provide intensive reminders for reinjection dates9; they found that only 43% of women receiving them were still using DMPA after 12 months, compared to 45% of women in the no-reminder group. Although it has been suggested in numerous publications that good counseling is the key in maintaining high DMPA continuation rates,10, 11, 12 this has never been explored vigorously with attention to specific provider practices and information shared at the time of the first injection.
Section snippets
Materials and methods
We conducted a prospective study in 30 government health centers in Bolivia that were introducing DMPA. The purpose of the research was to document use patterns, to measure continuation rates, and to study factors associated with continued method use. Women were invited to participate in the study if they wanted to use DMPA, did not have any contraindications to its use, did not receive a DMPA injection in the previous 3 months, and if they were residents of the facility’s catchment. A total of
Results
Of the participants, two-thirds desired no more additional children; >40% had four or more children; 57% were lactating at the time of admission; and only one-third had used a modern method previously (Table 1).
Most participants received services from a female nurse and >50% received services from a physician (Table 2). Before receiving an injection, providers informed many women about alternative methods of contraception. For example, more than three-quarters of the DMPA acceptors were told
Discussion
Although there will always be users who discontinue early, the results from this study suggest that providers can increase the length of use of DMPA. First, DMPA acceptors need complete and accurate information on possible side effects. Continuous long-term pregnancy protection is preferred to sporadic and unsatisfactory use of a variety of contraceptives; the more known at the time of adopting a method, the greater likelihood of sticking with it. Providers who emphasize only the positive
Acknowledgements
CARE funded this study and Family Health International (FHI) provided technical assistance. The source funding on this project for both institutions was the United States Agency for International Development (USAID); The work of FHI was conducted under contract CCP-A-00-95-00022-02. We are grateful to the DMPA users who participated in this study and the CARE-hired interviewers, Elia Farfán and Susana Acuña. We thank David Grimes, John Stanback, and Paul Feldblum of FHI for their helpful
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Predictors of DMPA-SC continuation among urban Nigerian women: the influence of counseling quality and side effects
2018, ContraceptionCitation Excerpt :Compared to IUDs and other long-term methods, continuation of injectable contraceptives is more difficult to maintain. Even as injectable contraceptives are gaining popularity in low-resource settings [22–24], especially for young women [25], continuation on injectable contraception is low in many settings [26,27]; discontinuation typically occurs within one year with estimated rates of up to 77%, and particularly high rates of drop-off observed after the first and second injections [3,26,28,29]. In one study in Nigeria, more than 50% of sampled women using DMPA-IM did not continue within one year [30].
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