This article examines the determinants of first-time use durations of the injectable contraceptive Depo Medroxy Progesterone Acetate (DMPA) for rural Bangladeshi women. The method's side effects were defined by 200 first-time users in Matlab district during lengthy, open-ended interviews. Women with many children used the method longer than did women of low parity. Those who experienced side effects had shorter use durations than those who did not, and those who cited heavy bleeding as their main problem discontinued use soonest. Women whose husbands approved of family planning had significantly longer use durations than those whose husbands disapproved. Respondents who adopted DMPA because of perceived positive aspects of the drug used it longer than those who chose it for other reasons. Results of the study underscore the importance of viewing side effects in a specific social and cultural context. Expanded side-effects counseling for women and their husbands is needed.
PIP: During March-May 1990, in-depth interviews were conducted with 200 women who first accepted the injectable contraceptive depo-medroxyprogesterone acetate (DMPA) between July and August 1988 from the Maternal and Child Health and Family Planning program of the International Centre for Diarrhoeal Disease Research, Bangladesh in the rural Matlab district. The researchers analyzed the data to examine the determinants of first-time use durations of DMPA. 90% of the women chose DMPA because of negative experiences or fears of such experiences with other methods. Women who reported bleeding and nonbleeding side effects were more likely to have shorter use durations than those who reported no side effects (rate ratio [RR] = 1.83 and 3.07, respectively). Women who had heavy bleeding had the shortest use duration (median, 9 vs. 20 months for no problems). Amenorrhea was rarely considered to be the most significant problem linked to DMPA use. Women who chose DMPA because of its perceived positive aspects were more likely to have longer use duration than those who did not choose it for its positive aspects (RR = 0.38). Women who chose DMPA based on the community health worker's advise were more likely to have shorter use durations than those who did not choose it based on their advice (RR = 2.48). Women whose husbands approved of family planning were more likely to have longer use duration than those whose husbands did not approve (RR = 0.72). Multiparous women used DMPA longer than did those with less than 3 children (RR = 0.56 for 3-5 children and 0.36 for =or 6 children). These findings emphasize the importance of considering side effects in a social and cultural context to determine why they are important to women and which side effects are perceived as problematic and which are not. They also show the need to improve pre-use counseling and side effect management and to seek the support of husbands towards family planning.