Prevalence and continuation of injectable contraceptives : evidence from extension project areas of ICDDR,B

Although injectables are considered clinical methods and delivered only by paramedics at the Health and Family Welfare Centers (FWCs) and satellite clinics in the national family planning (FP) program, domiciliary injectable programs have also been in operation in many NGO areas and special projects. This paper attempts to assess the effectiveness of injectables as a method of FP in terms of prevalence and continuation. The study was conducted in International Center for Diarrheal Disease Research, Bangladesh (ICDDR/B) Maternal Child Health/Family Planning (MCH-FP) extension project areas, where a domiciliary injectable program has been in operation since 1984. The data were extracted from the Sample Registration System, the longitudinal surveillance system of the project, as well as from the service records of Family Welfare Assistants (FWAs). The longitudinal data show a significant increase in the contraceptive prevalence rate, as well as in the use of injectables after the introduction of home delivery of injectables. The continuation rate for injectables was higher than for condoms and oral pills; the first method continuation rate was estimated at 74% at 6 months and 48% at 18 months. Over 50% of injectable users discontinued after 18 months. The all method continuation rate for injectables was, however, somewhat better than for the first method. The major reasons for drop-out of injectable contraceptive users were side-effects, switching over to other methods, and the absence of clients from homes. Each of the first two reasons accounted for one-fourth of the drop-out cases, while the last reason accounted for one-fifth. Amenorrhoea and bleeding were reported as the major side-effects causing the discontinuation of injectables. (Author abstract)