The user’s perspective on injectables – injectable contraceptives

The user’s perspective on injectables – injectable contraceptives – includes related information

Women’s attitudes toward progestin-only injectables largely reflect their feelings about the privacy and convenience of injections and menstrual bleeding disruptions. These feelings in turn reflect not only the attributes and physiological effects of the method but also women’s knowledge and understanding of the method, personal needs, contraceptive experience, partners’ attitudes, and cultural norms. Family planning providers can better counsel and advise clients if they are aware of these differing attitudes and physiological responses. Similarly, communication programs must understand people’s attitudes and reactions in order to devise effective messages.

The New User

Women choose injectables because:

* They want a highly effective, reversible contraceptive.

* They want a long-acting method but not one that lasts for years. They do not want to take a pill every day.

* They have faith in the effectiveness of injectable medication because of the well-known efficacy of injectable antibiotics and the success of campaigns with injected penicillin, such as yaws eradication.

* They may like amenorrhea, especially if they usually have heavy menstrual flows and cramping.

* They want a contraceptive that can be used privately, a method that can be obtained quickly at the clinic and requires no supplies around the house.

* They want a method that does not require action at the time of sexual relations.

* They want a reliable and safe method that can be used during breastfeeding.

* They have talked with friends or relatives who are using injectables satisfactorily (14, 20, 23, 46, 54, 62, 95, 146, 160, 162, 198, 217, 350).

In interviews women in places as different as Bangladesh and the US mention many of these advantages (14, 62):

Bangladesh

.. with pills you have to have a dose every day, and

there’s a chance of your forgetting. With injectables,

you don’t have such worries. The field worker keeps

track of when I’m supposed to take my shots and comes

and gives them to me herself And since it’s a woman

who’s giving me the shots, my family doesn’t object.

One of my husband’s relatives once said to me, injectables

are good I’ve been using them for three years.

Come with me and you’ll be able to get an injection,

too. There won’t be any trouble.’ So talked to my

husband and after he agreed, I began using injectables.

Many others have followed me. Even my sister-in-law

uses injectables now.

I started using injectables after I had two children in

quick succession.

United States

I got pregnant when I was 13 and had my baby when I

was 14. I did not use any birth control when I got

pregnant. Depo is much easier than taking the pill every

day. I’m not good at remembering to take pills.

I decided to use the Depo shot because it was very easy.

You just come back every three months. I didn’t decide

to take the Pill because I am on medication for seizures.

I thought I would forget to take the pills.

I was a poor pill taker. I thought barrier methods were

inconvenient and messy.

The Continuing User

Users’ attitudes toward injectables are reflected in discontinuation rates. The most common reason for stopping injectables is side effects. In a WHO trial of DMPA, for example, half of users discontinued after one year: about one-third stopped because of side effects–for example, menstrual disruption, headaches, dizziness, or weight gain–and the rest stopped for personal reasons or were lost to follow-up (342).

Women’s attitudes toward side effects, particularly menstrual disruption, are varied and complex (111, 115, 278, 324, 327). Irregular bleeding is inconvenient for many women who do not have sexual relations while menstruating (327). Muslim women often discontinue injectables because their religion forbids them to pray, fast, read from the Koran, or have sexual relations during vaginal bleeding. Amenorrhea may make some women think that they are pregnant or that a drug powerful enough to take away monthly bleeding is unhealthy in other ways. Many people have the false idea that, if a woman does not menstruate, poisonous blood collects in her body (327).

Such attitudes are not universal. Many users in Jamaica, Indonesia, and Thailand, for example, accept menstrual disruption (115). For many users the benefits effective contraception clearly outweigh the disadvantages of side effects. A Bangladeshi woman commented:

We are very poor. So we won’t be able to survive if

we have too many children. That’s why use Depo,

even though it does give me a little trouble (62). For some women amenorrhea and weight gain are advantages of injectables. A US woman using DMPA commented:

I became amenorrheic after one month of use. I love

that. I haven’t had periods for five years and it has

been great. I worried the first month that might be

pregnant. I talked with my doctor about it and was

reassured. Before Depo I had dysmenorrhea [painful

menstruation] and now it has disappeared–no

bloating, cramps, or weight gain (275). Women in Egypt, Nepal, the Philippines, Sierra Leone, and Thailand have reported that they like weight gain experienced with progestin-only injectables (11,117,241,270,298).

Counseling can help women who choose injectables to adapt to the side effects (see p. 18). Counseling may be so important to clients, in fact, that they are willing to for it. In the 1970s the McCormick Family Planning Program, which pioneered use of DMPA in Thailand, offered the injectable for a small fee, while the public family planning program in the same area offered free services. Program staff observed that many DMPA users preferred to pay the small fee because of the good counseling that they received with each injection in the McCormick program (20).

RELATED ARTICLE: Survey of Service Providers

Service providers in 10 countries responded to a Population Reports questionnaire asking about their perception of injectables, their clients’ perceptions, difficulties and benefits of providing injectable services, medical eligibility requirements for the use of injectables, and lessons learned. Their answers have been used extensively in this report, particularly in “The User’s Perspective.” Bangladesh: Sabera Rahman, Mohammadpur Fertility

Services and Training Centre Guatemala: Roberto Santiso Galves, Asociacion Pro

Bienestar de la Familia de Guatemala

(APROFAM) Hong Kong: Margaret Kwan, Family Planning Association

of Hong Kong Kenya: C.N. Kamau and Margaret N. Thuo, Family

Planning Association of Kenya Madagascar: Manitra Andriamasinoro, Fianakaviana Sambatra Philippines: Jovencia B. Quintong, Family Planning Services,

Department of Health Sierra Leone: Willie E. Taylor, Planned Parenthood Association

of Sierra Leone Sri Lanka: Sriani Basnayake, Family Planning Association

of Sri Lanka Sudan: Ahmed M. Youssif, Sudan Family Planning

Association Thailand: Sombhong Pattawichaiporn, Planned Parenthood

Association of Thailand

Interviews with users of injectables in Bangladesh were conducted by Achintya Das Gupta, Yasmin Khan, Marufa Khanam, Khadija Bilkis, Rashida Sultana, and Tawfique N. Hamid, all staff members of the Bangladesh office of Johns Hopkins Population Communication Services.

COPYRIGHT 1995 Department of Health

COPYRIGHT 2004 Gale Group