WHO reaffirms DMPA's safety!
By Diepiriye S. Kuku, MPH
More than 16 million women worldwide use DMPA (Depot Medroxy Progesterone Acetate) which is the third most prevalent form of reversible contraception.
DMPA has been one of the most extensively researched drugs with an accumulated clinical research experience of more than 3 million months and over 1000 published scientific papers and reviews since the 1960's.
In India, increasing the choices related to contraception is critical for programs striving to cater to unmet family planning needs. According to a study on DMPA undertaken by the United Nations Population Fund, India (UNFPA) in October, 2004, "Over the past few decades, there has been a substantial increase in the use of contraceptives in India." As per the Rapid Household Survey results (2002), use of modern contraceptives is nearly 46 percent. Another 6 percent of couples use traditional methods. Despite impressive gains, several issues continue to hinder progress. A significant proportion of pregnancies continue to be unplanned: Contraceptive needs of millions of couples remain unmet; several population groups, such as adolescents and men, continue to be ignored or underserved; and contraceptive choices remain conspicuously absent, as is quality care within the program. The National Population Policy (2000) affirms the Government's commitment to address unmet demands of contraceptives by making safe, effective contraceptives accessible to people.
A perusal of method-mix clearly shows a burdening of women insofar as contraception in general, and a bias towards female sterilization. Overall, sterilization accounts for three-quarters of contraceptive use. The current use of reversible methods is low at 10 percent. Use of injectable contraceptives is negligible, although in many countries in the world injectables contribute significantly to helping couples to achieve their reproductive intentions.
There is empirical evidence to indicate that the addition of any new method in the program will increase contraceptive uptake. Research clearly suggests that a choice of several contraceptive methods is more likely to result in contraceptive use. As quality improves and more methods become available, more couples use contraceptives. For each additional method that is widely available in a country, contraceptive prevalence increases by an average of 3.3 percentage points. Recent studies have shown that 28 percent of Indian women do not want more than two children and 9 percent of all recent births/pregnancies are unplanned. Further, 13 percent women reported that they would like to wait for two years before bearing another child. Thus there is significant unmet need for spacing and reversible methods of contraceptive.
DMPA fills all the above gaps and can be considered as an additional contraceptive choice for Indian women. There is no method of contraception free of non-contraceptive effects. In the case of DMPA the most common concerns are related to changes in bleeding pattern, return of fertility and the schedule of injections for continued protection from pregnancy. The fact is that many women take relief in the reduced menstrual cycles. The key to all these concerns is proper counseling by providers to inform and reassure users about the bodily changes that occur and the return to fertility after discontinuation of the method.
Recently however, issues relating to loss of bone mineral density (BMD) with use of DMPA have been raised. Women in India and around the world lose BMD during pregnancy and lactation. This loss is reversible and not significant enough to cause osteoporosis. Studies have reported that BMD is typically regained postpartum following resumption of menstruation, although whether it returns to pre-pregnancy values has yet to be established.
The World Health Organization (WHO) recently released a statement on Hormonal contraception and Bone health that recommended that there should be no restriction on the long - term use of the combined oral contraceptive and the 3-monthly contraceptive injection, DMPA, among women aged 18 to 45 who are otherwise eligible to use the method.
According to the statement, hormonal contraceptives including the injectables are highly effective and widely used. These contraceptives have important contraceptive and non-contraceptive health benefits. Ultimately, most women choose the health benefits of using a contraceptive over the insignificant risks associated with contraceptive use.
Injectable contraceptives are positioned as highly effective, safe, reversible contraceptives, most appropriately suited for delaying pregnancy after marriage and also to maintain the desired spacing between children.
More than 16 million women worldwide use DMPA (Depot Medroxy Progesterone Acetate) which is the third most prevalent form of reversible contraception.
DMPA has been one of the most extensively researched drugs with an accumulated clinical research experience of more than 3 million months and over 1000 published scientific papers and reviews since the 1960's.
In India, increasing the choices related to contraception is critical for programs striving to cater to unmet family planning needs. According to a study on DMPA undertaken by the United Nations Population Fund, India (UNFPA) in October, 2004, "Over the past few decades, there has been a substantial increase in the use of contraceptives in India." As per the Rapid Household Survey results (2002), use of modern contraceptives is nearly 46 percent. Another 6 percent of couples use traditional methods. Despite impressive gains, several issues continue to hinder progress. A significant proportion of pregnancies continue to be unplanned: Contraceptive needs of millions of couples remain unmet; several population groups, such as adolescents and men, continue to be ignored or underserved; and contraceptive choices remain conspicuously absent, as is quality care within the program. The National Population Policy (2000) affirms the Government's commitment to address unmet demands of contraceptives by making safe, effective contraceptives accessible to people.
A perusal of method-mix clearly shows a burdening of women insofar as contraception in general, and a bias towards female sterilization. Overall, sterilization accounts for three-quarters of contraceptive use. The current use of reversible methods is low at 10 percent. Use of injectable contraceptives is negligible, although in many countries in the world injectables contribute significantly to helping couples to achieve their reproductive intentions.
There is empirical evidence to indicate that the addition of any new method in the program will increase contraceptive uptake. Research clearly suggests that a choice of several contraceptive methods is more likely to result in contraceptive use. As quality improves and more methods become available, more couples use contraceptives. For each additional method that is widely available in a country, contraceptive prevalence increases by an average of 3.3 percentage points. Recent studies have shown that 28 percent of Indian women do not want more than two children and 9 percent of all recent births/pregnancies are unplanned. Further, 13 percent women reported that they would like to wait for two years before bearing another child. Thus there is significant unmet need for spacing and reversible methods of contraceptive.
DMPA fills all the above gaps and can be considered as an additional contraceptive choice for Indian women. There is no method of contraception free of non-contraceptive effects. In the case of DMPA the most common concerns are related to changes in bleeding pattern, return of fertility and the schedule of injections for continued protection from pregnancy. The fact is that many women take relief in the reduced menstrual cycles. The key to all these concerns is proper counseling by providers to inform and reassure users about the bodily changes that occur and the return to fertility after discontinuation of the method.
Recently however, issues relating to loss of bone mineral density (BMD) with use of DMPA have been raised. Women in India and around the world lose BMD during pregnancy and lactation. This loss is reversible and not significant enough to cause osteoporosis. Studies have reported that BMD is typically regained postpartum following resumption of menstruation, although whether it returns to pre-pregnancy values has yet to be established.
The World Health Organization (WHO) recently released a statement on Hormonal contraception and Bone health that recommended that there should be no restriction on the long - term use of the combined oral contraceptive and the 3-monthly contraceptive injection, DMPA, among women aged 18 to 45 who are otherwise eligible to use the method.
According to the statement, hormonal contraceptives including the injectables are highly effective and widely used. These contraceptives have important contraceptive and non-contraceptive health benefits. Ultimately, most women choose the health benefits of using a contraceptive over the insignificant risks associated with contraceptive use.
Injectable contraceptives are positioned as highly effective, safe, reversible contraceptives, most appropriately suited for delaying pregnancy after marriage and also to maintain the desired spacing between children.
posted by Diepiriye at 2:32 AM
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