FPA India welcomes the introduction of three new modern, reversible contraceptives injection DMPA (Antara), Centchroman Pill (Chhaya) and Progestin Only Pill (PoP) in the National Family Planning Programme. This is indeed a step in the right direction to expand contraceptive choice and make modern contraceptives accessible and affordable to women to meet their reproductive health goals. The roll-out of these new contraceptives has been initiated in a phased manner across public health facilities in the country by the Ministry of Health and Family Welfare since last year.
On the occasion of World Population Day, FPA India Mumbai Branch, in collaboration with the Public Health Department of the Municipal Corporation of Greater Mumbai, has launched ‘Antara’ a three-monthly progestin-only contraceptive injection, at the Awabai Wadia Health Centre.
It is our endeavour to support health care providers in the public as well as private health sector in delivering high quality injectable contraceptive services so that eligible clients can choose and use contraceptives with confidence to enhance the quality of their reproductive and sexual lives.
This contraceptive injection is composed of a synthetic female hormone (progestin) known as Depo Medroxy Progesterone Acetate (DMPA). Every dose of the injection contains 150 mg of DMPA as an aqueous suspension of one ml and needs to be given every three months as an intramuscular injection.
When the prescribed dosing schedule is followed, injection DMPA is considered to have a failure rate of less than one pregnancy per 100 women using the method over the first year. The effectiveness largely depends on regular and timely follow-up visits for re-injection. As commonly used, pregnancy rate is about 3 pregnancies per 100 women over a year.
Like for every other reversible, modern method of contraception, clients will be counselled about the safety, reversibility, effectiveness, dosage, repeat injection visits, side-effects and warning signs of ‘Antara’ (inj DMPA, also known as Depo-Provera) and also informed that they are free to switch to any other method any time they wish to.
‘Antara’ should be made widely available to women who need an effective contraceptive method and who may not be medically eligible to use other effective hormonal methods.Most women can safely use ‘Antara’, including women who breast-feed, as early as 6 weeks post-partum and if the woman is not breastfeeding, it can be administered within 6 weeks postpartum as well. Thus, this method of contraception can also be positioned to fulfill the unmet need for contraception by post-partum women who may be undecided yet about choosing a long term method to limit their family size or for those women who may indeed have short-term needs for an effective yet reversible, woman oriented method of contraception.
Supporting informed choice and voluntary decision-making
Every woman has the right to choose and use a method of contraception that is best suited to her needs and lifestyle. However it is also the duty of the service provider to screen her for medical eligibility to use that method and ensure that the method is safe for her. Women need to be educated and empowered so that they can control their fertility and have access to a wide range of contraceptives suited to their age and reproductive life stage. Careful profiling of the client and method-specific counselling cannot be emphasized more, before offering injectable contraceptives. Service providers need to be equipped with updated technical information, service delivery guidelines and job aids so that they are able to offer an informed choice of injectable contraceptives and quality services to support use.
The FPA India experience with Injectable DMPA
FPAI believes in and has strongly advocated for expansion in the basket of contraceptive choices in the National Family Planning Programme, so that poor and needy women are not denied of choice due to affordability issues. Injectable DMPA has been a part of the contraceptive method-mix provided through FPA India clinics for nearly two decades now, ever since this method was approved for use in India in the year 1993.
Providing injectable DMPA in the outreach during special service delivery sessions, capacity building of various cadres of service providers through technical updates with an emphasis on counselling skills, development of a comprehensive tool kit for various cadres of service providers to support informed choice of injectable contraceptives, training of providers in using the tool kit and sharing of best practices have contributed to a steady uptake of this method from FPA India service delivery points.