Published: 2016-12-27

Feasibility of injectable Depot medroxyprogesterone acetate in a semi urban camp setting

Ruchira Nautiyal, Rajeev Bijalwan, B. Maithili, Latika N. Sinha


Background: The contraceptive method mix in India has been dominated by female sterilization for a long time. Initiatives have been taken to make Depot medroxyprogesterone acetate (DMPA) available through the public sector of the country. Considering the privacy, safety and efficacy of this long acting method, the study was undertaken to evaluate the acceptance of DMPA in field camps amongst semi urban population.

Methods: A cross sectional evaluation study was carried out with married women who accepted DMPA from the basket of contraceptives offered to them. Selection was facilitated by adequate counseling. After counseling, the clients were followed up during subsequent doses for a year for the acceptance and side effects. A checklist was filled comprising detailed history and other variables. The data was expressed in number and percentage and statistical analysis was done on SPSS -19.

Results: The mean age of 45 eligible women who accepted DMPA was 26.5 years .Fifty one percent of women were primiparous and forty two percent were lactating during the study period. Majority (80%) were self-motivated to receive subsequent injections. There was no pregnancy in DMPA users. The commonest adverse effect was amenorrhea (49%) followed by irregular spotting (32%) and menorrhagia (14%). Fourteen subjects discontinued DMPA after one or two injections but 58.5% acceptors considered this a good method for birth spacing and wanted to continue it for a longer period.

Conclusions: DMPA remains a valid, safe and confidential but neglected contraceptive in India. There is a need to create an awareness program for common people and also to build a supportive environment for users at all levels.


DMPA, Contraceptives, Injectable contraceptive, Progesterone contraceptives

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Taneja DK, Banerjee B. Demographic and health Information of India.12th ed.New Delhi:Doctors Publications. 2014;Health Policies and programmes in India; pp.38-40.

Ministry of Health and Family Welfare (MOHFW) and United Nations Population Fund, India. Contraceptive updates: Reference manual for doctors. 2005;New Delhi: MOHFW, Government of India

Family Health International (FHI). Types, availability, and use of injectables. FHI Briefs2010; India Brief 3. New Delhi: Family Health International.

International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005–06: India: Volume 1. Mumbai: IIPS.

Sarojini NB, Murthy L. Why women’s groups oppose injectable contraceptives. Indian J Med Ethics. 2005;2(1):8-9.

Otayli N. Progestogen - Only Injectable contraceptives and bone health, IPPF Medical Bulletin. 2006;40(2):5-6

Lande R, Richey C. Expanding services for injectables. Population Reports.2006; Series K, No. 6. Baltimore: Info project, John Hopkins Bloomberg School of Public Health.

Department of Economic and Social Affairs,PopulationDivision2011.World contraceptive use2011.NewYork:United Nations.Available at:

World Health Organisation (WHO). Medical eligibility criteria for contraceptive use: A WHO family planning cornerstone. 2010;Geneva: WHO.

Trussell J. The essentials of contraception: efficacy, safety, and personal considerations. In: Hatcher RA, Trussell J, Stewart F, Nelson A, Cates W, Guest F, Kowal D editor. Contraceptive technology: eighteenth revised edition. New York, NY: Ardent Media. 2004:221-52.

Rai L, Prabakar P. Injectable depot medroxyprogesterone - a safe and an effective contraception for an Indian setting,” Health and Population Perspectives and Issues. 2007;30(1):12-23.

Danli S, Qingxiang S, Guowei S. A multicentered clinical trial of the long-acting injectable contraceptive Depo Provera in Chinese women.Contraception. 2000;62(1):15-8.

Aktun H, Moroy P, Cakmak P, Yalcin HR, Leyla M. Use of a Long-acting Progestin Injectable Contraceptive in Turkish Women, Contraception. 2005;72(1):24-7.

Khan ME, Dixit A, Ahmad J. Introduction of DMPA in public health facilities of Uttar Pradesh and Rajasthan. An evaluation .Project brief .New Delhi, India: Population council, 2015.

Singhal S, Sarda N, Gupta S. Impact of injectable Progestogen Contraception in early puerperium on Lactation and Infant health. J Clin Diagn Res. 2014;8(3):69-72.

Krishna U, Mandlekar A and Raote V .Long-Acting Injectables - Acceptability and Efficacy in our Family Welfare Programmeme, J ObstetGynecol India. 1999;49(6):40-6.

United Nations Population Fund, India. Expandingcontraceptive options: experiences of users and providers with progestin only injectable contraceptive –DMPA. Findings of a multi-centric study. New Delhi, India: UNFPA; 2004.

Nelson AL. Counseling issues and management of side effects for women using depot medroxyprogesterone acetate contraception. J Reprod Med. 1996;41(5 suppl ):391-400.

Adetunji J. Rising popularity of injectable contraceptives in sub-Saharan Africa, African Population Studies. 2011;25(2):587-604.

Vaughan B, Trussell J. Discontinuation and resumption of contraceptive use: Results from the 2002 National Survey of Family Growth, Contraception. 2008;78(4):271-83.

Hirve S Injectables as a Choice–Evidence-based Lesson. Indian J Medical Ethics. 2005;11(1):12-3.

Wu SC, Garceau RJ, Jiangs,Yang QZ, Wang WZ. Effect of pretreatment counseling on discontinuation rates in chinese women given Depot Medroxypregesterone acetate for contraception. Contraception. 1996;53(6):357-61.

Strategies to improve adherence and acceptability of hormonal methods of contraception .Cochrane database syst Rev. 2013;10:CD004317.

Hubacher D, Goco N, Gonzalez B, Taylor D. Factors effecting continuation rates of DMPA. Contraception. 1999;60;(6):345-51.

Canto De Cetina, Canto P, Ordonezluna M. Effect of Counseling to Improve Compliance in Mexican Women receiving Depot Medroxyprogesterone Acetate, Contraception. 2001;63(3):143-6.

Tiwari S, Vishwanath S, Singh H. DMPA provision in PSS clinics in Uttar Pradesh: cost and prices. Technical paper 10. New Delhi, India, Population council and Parivar Seva Sanstha; 1997.

Shapiro S, Rosenberg L, Hoffman M, Truter H. Risk of Breast Cancer in Relation to the Use of Injectable Progestogen Contraceptives and Combined Estrogen/Progestogen Contraceptives, Am J Epidemiol. 2000;151:396-403.

Gold MA, Bachrach LK. Contraceptive use in teens: a threat to bone health? Journal of Adolescent Health. 2004;35:427-9.

Johnson CC, Burkman RT, Gold MA, Brown RT, Harel Z, Bruner A, et al. Longitudinal study of depot medroxyprogesterone acetate (Depo-Provera) effects on bone health in adolescents: study design, population characteristics and baseline bone mineral density. Contraception. 2008;77(4):239-42.

Kaunitz AM, Arias R, McClung M. Bone density recovery after depotmedroxyprogesterone acetate injectable use.Contraception. 2008:67-77.

Guilbert ER, Brown JP, Kaunitz AM, Wagner MS. The use of depot medroxyacetate in contraception and its potential impact on skeletal health. Contraception. 2009;79(3):166-77.

Gbolade B, Ellis S, Murby B, Randall S and Kirkman R .Bone Density in Long-term Users of Depot Medroxyprogesterone Acetate, Br J Obstet Gynecol. 1998;105:790-4.

Trussell J. Choosing a contraceptive: efficacy, safety, and personal considerations. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Stewart FH, Kowal D editor. Contraceptive technology: nineteenth revised edition. New York, NY: Ardent Media. 2007:19-47.

WHO. Technical consultation on the effects of hormonal contraception on bone health.Geneva:WHO;2007.Availaible at:

American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. ACOG Committee Opinion No.415:depot medroxyprogesterone acetate and bone effects. Obstet Gynecol. 2008;112(3):727-30

Phadke A. A Thorough Critique of Depo-provera - Book Review. Indian J Medical Ethics. 2005;11(1):30.