The role of Depo Provera in the Indonesian family planning program

Abstract

The purposes of this study are to examine the acceptability of Depo Provera (DP) as a possible alternative contraceptive in Indonesia; to investigate the side effects commonly experienced by Indonesian women and to examine how they tolerate these side effects. The analysis is based on three sources: the results of a field work case study in Jakarta, Bandung and Yogyakarta of 1985; the contraceptive continuation module of the family planning modular survey of 1982; and family planning service statistics reports. Since the decision of the US Food and Drug Administration (FDA) not to grant approval for the use of DP as a contraceptive in the United States, in 1978, debates and controversy have been going on up to the time of writing. This decision made thousands of women afraid of getting cancer or fearful that DP will impair their fertility. Because of this controversy, the usage of DP as a contraceptive is being carefully monitored by IPPF and WHO through multinational comparative studies in 15 developed and developing countries around the world. Evidence is mounting from world wide experience, that DP is a satisfactory contraceptive with several advantages and some disadvantages but no more serious side effects than those found in oral contraceptives. The field study demonstrated the acceptability of DP among respondents. The greatest obstacle to use was the cost of the drug. Most respondents postponed their follow-up injections for that reason, but still they did not drop-out. They used other methods to avoid pregnancy during their period without DP. These respondents would gladly have another injection when they had money to pay for the service (and the drug). The selection of DP by respondents was mostly through self evaluation, comparison and consideration (most of the respondents have used one or another methods in the past), and the decision appeared to be a solid decision, not just "follow the leader". The respondents also indicated that they could tolerate the side effects. It appeared that they easily managed menstrual disturbances, while most respondents were happy about the most common side effect, amenorrhoea, because it allowed them to avoid the "monthly trouble" caused by menstruation in disrupting their daily religious activities. They also benefited through avoiding anaemia, and some respondents preferred DP for post-partum use, because it does not suppress breast milk production. In summary, the study found DP to be an acceptable form of contraception. It is perceived by Indonesian women and practitioners as a safe and reliable alternative to existing birth control techniques.