Conditions in rural nepal for which depot-medroxyprogesterone acetate initiation is not recommended: Implications for community-based service delivery

The presence of medical conditions that might affect the use of depot-medro xyprogesterone acetate (DMPA) as a contraceptive method was assessed in a r ural district in Nepal. A general health survey was conducted in nonpregnan t and noncontracepting women aged 15-44 years to determine the presence of any health problems. The survey included a general assessment interview by nonphysicians, followed by formal medical histories and physical exams by f emale gynecologists. Possible pregnancy (nine cases) and abnormal uterine b leeding (one case) were the only conditions identified in which DMPA should not be used, based on the World Health Organization (WHO) Medical Eligibil ity Criteria for Contraceptive Use. Five additional cases of cardiovascular problems, in which DMPA initiation is not usually recommended, were also d etected. Recently developed checklists based on the WHO criteria for DMPA u se would have identified all of these health conditions. This checklist wou ld allow the safe delivery of DMPA at the community health worker level, an d increase the availability and accessibility of DMPA in rural Nepal. CONTR ACEPTION 1999;60:31 (C) 1999 Elsevier Science Inc. All rights reserved.