Continuation of injectable contraceptives in Thailand
Narkavonnakit, T.; Bennett, T.; Balakrishnan, T.R.
Studies in Family Planning 13(4): 99-105
1982
ISSN/ISBN: 0039-3665 PMID: 6216633 DOI: 10.2307/1965705Document Number: 300642
The experience of a national sample of 624 Thai acceptors of Depo-Provera (DMPA) during 1976-77 was examined. The sample was drawn from the 142,071 women in the Thai National Family Planning Program who were new acceptors for DMPA during that period. Information was collected on duration of DMPA use, reasons for termination, side effects, and previous contraceptive use. The typical DMPA acceptor in the study sample was 28.5 years old and had 2.9 children. DMPA acceptors were similar to oral contraceptive and IUD acceptors in terms of age, parity, education, and desired family size, but differed in previous use of contraception: 46% of DMPA acceptors were never-users compared to 69.8% of pill and 58.7% of IUD acceptors. Continuation rates were calculated by the life table technique in which women are classified by months of use and use status at study cutoff date. The continuation rate was 83% at 6 months, 59% at 12 months, 39% at 24 months, and 31% at 30 months. The 6 and 12 month rates are roughly comparable to those found in the few international studies using the same method of rate construction, but the 18-36 month rates are far lower in the present study. The DMPA continuation rate at 6 months is comparable to that for the pill and IUD, but then declines (59, 64, and 75% at 12 months for DMPA, the pill, and IUD, respectively, and 31, 52, and 59%, respectively, at 30 months). Continuation rates increased with age until 40 years and then declined. There was a positive association with parity; the continutaion rate at 24 months was 33% among women with 0-2 children and 47% among those with 3-4 children. Women who did not desire more children showed higher continuation rates at every duration of use. Side effects were found to account for slightly more than half of all terminations, and bleeding was twice as important as all other side effects combined. One limitation of the study was that it included only women who received injections from hospital-based physicians and nurses. Previous research indicates that continuation rates are significantly higher among women who receive DMPA from midwifery centers. Current trends forecast a new acceptor load of 250,000 women/year in 1982-86. The results of this survey underscore a need to increase continuation rates through education on the probability and harmlessness of DMPA-associated menstrual disorders.