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April 18, 2000

Women's Continuation of the Depo-Provera Injectable Contraceptive

Which of the following factors were materially related to women's continuation of the Depo-Provera injectable contraceptive, according to a recent study from Bolivia? (Could be more than 1)

1. Client's age
2. Client's education
3. Client's marital status
4. Type of provider
5. More than 3 children
6. Client told about side effects such as amenorrhea
7. Client told to return to clinic if having problems
8. Client believed menstruation is necessary for good health

e, f, g and h are correct. In this study age, marital status, and education didn't matter for continuation. Neither did type of provider. As found in a number of other studies, however, whether the client was told about side effects was strongly correlated with continuation. This study went beyond that variable, to address whether the client was specifically told to return to the clinic if having problems (strongly positively correlated) and whether the client believed menstruation is necessary for good health (strongly negatively correlated). (The correlation with increasing parity probably just reflects increased motivation.)

Take-home lesson: Addressing bleeding side effects is crucial for injectable provision including:

• finding out and addressing clients' views and feelings about bleeding;
• discussing the bleeding side effects, including amenorrhea;
• inviting the client to return to the service site if she has problems.

References:
Hubacher et al. Factors affecting continuation rates of DMPA. Contraception 1999; 60:345-351.

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The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)

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