USAID-Supported Research Influences International Family Planning Guidelines

Based in part on USAID-supported research, the World Health Organization has changed its recommendation on the timing of re-injection for depot medroxyprogesterone acetate (DMPA). The new guidelines encourage health care providers to allow a four-week grace period — rather than the previous two-week grace period — for a woman to return for her next injection of this popular hormonal contraceptive.

Although DMPA injections should ideally be repeated every 13 weeks, women are often late for their re-injections. In many cases, a woman who is late is denied her next injection until she menstruates, which can result in method discontinuation and even an unwanted pregnancy during the waiting period. In addition, women who are denied immediate re-injections are forced to make at least one more clinic visit, which may be time-consuming or expensive.

A study published in 2007 by scientists at Family Health International, the University of Cape Town, and Walter Sisulu University in South Africa showed that among some 400 DMPA users in Eastern Cape province, more than a third of the women who were late for their scheduled re-injections were sent home. More than half of these women were given no alternative method of contraception.

More recent research from Family Health International and its partners in Uganda, Zimbabwe, and Thailand shows that it is safe to extend the grace period from two to four weeks. The study followed more than 2,000 DMPA users for up to two years and found that the risk of pregnancy was no higher for the women who received their re-injections four weeks late than it was for those who received their injections two weeks late.

The extended grace period — if widely adopted — could prevent more unwanted pregnancies and help boost continuation rates for DMPA. Current one-year continuation rates are typically reported to be no higher than 60 to 70 percent.

To read more about the evidence supporting the World Health Organization's new guidelines, click here.

Sources
Steiner MJ, Kwok C, Stanback J, Byamugisha JK, Chipato T, Magwali T, Mmiro F, Rugpao S, Sriplienchan S, Morrison C. Injectable contraception: what should the longest interval be for reinjections? Contraception 2008;77(6):410-414.

Baumgartner JN, Morroni C, Mlobeli RD, Otterness C, Myer L, Janowitz B, Stanback J, Buga G. Timeliness of contraceptive reinjections in South Africa and its relation to unintentional discontinuation. Int Fam Plan Perspect 2007;33(2):66-74.