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. About 40 percent of the women who I spoke with in Uganda reported that they chose to stop using any form of contraception at all (in many cases putting their lives at risk, due to the increased danger of delivery complications experienced by women who give birth to more than four children), rather than deal with the health problems of the shot.
It is possible that the discrepancies in side effects generally noted by Ugandan and American women are related to significant lifestyle differences. For example, most Ugandan women who live in rural areas of the country spend their days doing extremely physically demanding agricultural work. Their diet is usually lower in protein, iron and calcium, predisposing them for complications from heavy bleeding.
I probably don’t have to explain why it is so dangerous that one of the only forms of contraception that is convenient, affordable, easily accessible and easy to conceal from a partner has such a detrimental impact on a woman’s health. But in case you want better clarification, let me also state that the high maternal mortality rate in Uganda has been linked in various research reports to high birth rate, poor access to family planning education and government policy that makes it very difficult for women to obtain high-quality reproductive health care.
Stay tuned for more information about controversial injectable contraceptives in Uganda and both the dangers of providing them to women, as well as the dangers of restricting their distribution.
Sources:
1. Stanback, John et al. “Injected with Controversy: Sales and Administration of Injectable Contraceptives in Uganda.” International Perspectives on Sexual and Reproductive Health. Volume 37 Number 1. March 2011. http://www.guttmacher.org/pubs/journals/3702411.html
2. www.rxlist.com /depo_provera-drug.htm. Federal Drug Administration. November 2010.