The Guttmacher Institute recently published a report on the sale of injectable contraceptives in Uganda. Unlike in the United States where this form of hormonal birth control is used by a small portion of the population, depot medroxyprogesterone acetate (DMPA) – also known as the Depo Provera shot – is quite popular in this East African country. Use of injectable birth control is prevalent in this community for a variety of reasons ranging from convenience (the shot is required only four times each year, or every three months), to its capacity to be kept secret (unlike condoms, women do not need a partner’s cooperation to make DMPA effective and unlike the pill, there is no need to keep any sort of supplies in the home where a reluctant partner may find them). DMPA can be taken while breastfeeding and is 99 percent effective in preventing pregnancy when used correctly. It is also relatively inexpensive (each dose costing the equivalent of about 70 cents), and can often be obtained for free at the government health centers.
Unfortunately, though it has many benefits, the shot is also associated with several negative side effects. Moreover, in speaking with Ugandan women during my own research, a majority of those taking DMPA experienced disproportionately severe side effects of the drug when compared to their American counterparts. Women in the United States who choose Depo as their main form of contraception frequently report side effects of amennorhea or dysmenorrhea (the prolonged absence of a period – which many women actually list as a big plus), weight gain and increased anxiety or depression, especially for those with a history of mental health issues. However, these adverse reactions differ greatly from those usually seen by Ugandan women: heavy bleeding (to the point of collapse), headaches and backaches and excessive weight loss.