The DMPA Advantage
By Diepiriye S Kuku
1. How will this work in the Indian scenario, especially as women's groups are strongly against DMPA and other hormonal methods citing dangerous, adverse side effects on women. Also, what impact could this have on HIV/STI infection possibilities?
A. The majority of Indian women still have little or no say in matters regarding when to start her family, deciding on the number of children the couple may wish to have and when to have them, or for that matter, what contraceptive method to adopt to prevent an unwanted pregnancy. The result is a high rate of infant and maternal mortality, key indicators of a society's economic and sociological health.
Certainly there is first a need to clear doubts, myths and misconceptions about contraceptives available to the women and efforts should be made to enable women to exercise rights of choice pertaining to reproductive health.
Many scientifically unfounded myths have prevented women in India from using injectables or any other hormonal method as a preferred contraceptive.
MYTH: The menstrual changes it causes in the woman's body are extremely harmful.
REALITY: DMPA is a hormonal contraceptive. This birth control drug works by temporarily preventing ovulation as it thins the lining of the uterus. The result is a reduction in the production of menstrual blood in the body. This is a biological/ pharmacological reaction and not a health issue. Both fertility and the menstrual cycle returns to normality after the effects of the last injection are over.
These changes are common and harmless. They do not mean that she is pregnant or sick and certainly not that bad blood is building up inside her. Little or no bleeding can make some women healthier, and can greatly lower the risk of anaemia.
MYTH: DMPA increases susceptibility to STIs, particularly HIV
REALITY: Only condoms provide protection against HIV/AIDS/STIs! Moreover, there is no substantial evidence linking injectables and increased susceptibility.
Usage of injectable contraceptives in India is steadily increasing as more people become aware that they can determine the spacing and timing of their fertility. Importantly, more women assert their power to make decisions about their own bodies. In addition, the misinformation surrounding this product has added to the low usage. DMPA it is ideal for spacing, which is an unmet contraceptive requirement for many women in India today. One of the most studied and tested drugs worldwide;DMPA actually holds many health benefits for the woman, beyond helping to determine fertility and regulating menstruation.
There is a great deal of room for improvement. The sporadic health and contraceptive awareness campaigns run by government bodies should become more consistent: Private health care delivery agencies and centers are uniquely positioned to respond quickly to the unmet needs for contraception and should be held accountable to societal demands. Private and public partnerships can increase the avenues by which to build awareness and educate the women about the myriad of safe options available for making reproductive choices.
2. Are women likely to find it more difficult to insist on condom use because they are on contraceptives already?
A. Women should find it easier to insist on using a condom even if they are already on contraceptives. One empowered partner demands another! The leadership of women who take responsibility for their bodies provides an example and the demand for their partners to act accordingly. Any efforts to empower Indian women to advance reproductive justice must involve men in the education, selection and use of safe methods of contraception; men must also be empowered to accept and expect a more empowered and participatory partner capable of making contraceptive decisions. Using both hormonal contraceptives and condoms not only provides women with non–contraceptive benefits like prevention of cancer of the ovaries and cancer of the lining of the womb, it also gives the couple the time, convenience and space to nourish their relationship as two responsible adults. From those healthy relationships spawn healthier families and in turn a healthier society.
About the Author
Diepiriye S. Kuku-Siemons, MPH (Tulane) is a researcher/writer/consultant based in New Delhi, pursuing a PhD in Sociology focusing on urban sexuality and globalization. His primary areas of interest are Reproductive Health Justice and Public Health Communications.
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