Evaluation of women using depot medroxy progesterone acetate in 10 family planning centers in Ankara and Adana

70 VII. SUMMARY Expanding the method mix has been regarded as an effective strategy in the improvement of quality and achievements of the family planning programme, which has been carried on in our country for approximately 30 years. As a long- acting hormonal contraceptive, DMPA has been implemented in many countries for years and has been introduced in Turkey as a pilot implementation in 1996. This study has been conducted in 10 family planning centers in Ankara and Adana; to define the demographic characteristics of DMPA users, factors affecting method choice, side effects, complications and satisfaction between March 1996 and August 1997. 58% of DMPA users were under 30 and 32.8% had finished secondary school or higher. Mean number of pregnancies were 3 while mean number of living children were 2. Mean number of induced abortions were 1. 61.3% of DMPA users did not want any other children. 80% of them switched DMPA from another method, approximately half of which were traditional methods. The main reason for choosing DMPA was the difficulties in using other methods. The effectiveness of the method and the expectation of less side effects also led the users to choose DMPA. 66% of the users started DMPA in the interval period. While the percentage of users having no complaint about the method was 9.5% in nonprogrammed visits, it was 61.2% in programmed ones. This percentage gradually increased with the number of programmed visits. The most important complaint was irregular bleeding. In nonprogrammed visits, 82% of the users complained of irregular bleeding while this percentage dropped to 31.1% in programmed visits. The frequency of irregular bleeding gradually decreased with the number of programmed visits.71 Most of the users had experienced irregular bleeding. The percentage of users who did not report irregular bleeding was only 7.2% in nonprogrammed visits, however, it increased to 28.4% in programmed visits. When weight gain, systolic and diastolic blood pressures were analysed, no significant difference could be found between women who used DMPA for 6 months and for one year. DMPA users has been followed for 5 injection periods. 57.1% of the users came for the second injection and 23.6% received four injections, thus avoided pregnancy for one year. Among women for whom a quitting form was filled, 76.8% stated that they quitted DMPA because of changes in menstruel cycle. Other main reasons were concerns about health (7.5%) and headache (4.5%). 58.1% of the quitters did not want any other child while 30.2% did not switch to another method. Consequently, the expansion of DMPA as a highly effective method is likely to contribute the improvement of family planning programme. However, high discontinuation rates suggest the importance of better counselling.