Depo Provera still widely used in Africa Despite ban due to Adverse Side Effects

depo provera

depo provera

I find a lot of the things that women on Kilimani Mums face book page very inspiring for posts and further research. Sometimes as women we think we are alone in certain struggles until we go for that girls night out or chama or join a women’s FB group and realize that, we are not the only ones.

I had written a post some time back on the truth about contraceptives. Needless to say, some of my readers noted that my article had an anticlimax ending to it and called me out on that. I fell short of condemning certain Family planning methods because I neither had the evidence nor expert opinion to back my claims.

Kilimani Mums discussion on Dep provera
A Kilimani Mums discussion on Dep provera

That was  until I read this Facebook post from one of the women on the Kilimani mums Facebook group that I realized that my bias on many forms of contraceptives was justified.

Women are suffering out here. Learned or not, we are going through the same problems with  mis-information, side effects such as prolonged periods, excessive weight gain, low libido among others and trouble conceiving when we finally decide to have another child. The very fact that our bodies are different with varying levels of  hormones and genetic predisposition, makes some of these FP methods work very well for some of us and becoming a living nightmare to others.

I have always wondered why the heavy task of ensuring that a couple does not get unplanned babies is always left with the woman over and above being the primary care giver in the house hold. There is a time a guy friend of mine mentioned that he was contemplating doing a vasectomy though the wife was opposed to it. They already have 3 kids and were not planning on having any more. I found that rather odd as I would find that to be quite considerate of my husband when and if we decide we are not having any more kids.

It is important to have that talk with your spouse. How many kids you want and whether vasectomy is an option he would be willing to take when you have had all the kids you want.

Family planning is hard and most of the methods react very badly with women. Have you ever noticed that most women are usually very slim  before getting married then suddenly after they are married, have a kid, they balloon and suddenly start looking like mamas. I had always wondered why women ‘jiachilia’ (not go back to their size). I did not wonder for long. Soon as our first born came, I no longer felt like I owned my body. As soon as I started breastfeeding her, I was advised to consider a FP method at month 3. The doctor’s advise was, “even if you are breastfeeding, some women do conceive”. I put considerable weight and it has taken lots of walking, diet control and other a lot of support from my husband to shed that baby fat & new weight gained due to hormonal change.

Doris a Medical practitioners offers some advise on use of Depo provera
Doris a Medical practitioners offers some advise on use of Depo provera

Some of us, myself included don’t do adequate research beyond the standard info given by doctors on the side effects of these methods especially after giving birth to our first born. I have since come to learn that very few FP methods lack side effects. These are the  natural birth control methods. Unfortunately, a lot of women are never given proper advise due to selfish interests from pharmaceutical companies seeking to push alternatives that are more profitable to health care givers. How else would you explain the Depo Provera being so readily available in all government health facilities and sometimes being the only FP method of choice available to most women both in urban and rural areas when the side effect are so prevalent?

The other problem to choice of FM method is usually the cost element. I wanted the new type of coil that is non-metal but the thing was going for about Ksh 15,000 (USD 172), I calculated how many diapers that would be for my baby and instead chose a 3 month Depo injection. That was in 2010, I am sure the cost has now come down.

Almost every women who commented on this particular post on Kilimani Mums has had a nasty experience with Depo. Some put on so much weight or get all puffed up on the face that they went into depression, others lost interest in sex completely whereas others tried unsuccessfully for several years to conceive after using it causing anxiety in their marriage.

The worst effect according to many of the women on the group and also from Doris who is a Medical Practitioner is the inability to conceive soon after using Depo and for some women, even upto 5 years after.

In 2014, an organisation called the African Diaspora called for the ban of Depo Provera for use on Africa. Zimbabwe banned the use of Depo-Provera on it’s citizens while Kenya recommended Depo-Provera can be used only with women 30 years and older and/or have at least four children. The Rebecca project (2013) has highlighted the challenges of the use of Depo-Provera on African women. In many developed countries where Depo-Provera is still being used, women provide informed consent before it can be administered to them.

Despite the pre-conditions given in Kenya for Depo to be used only on women above 30 or with at least four children, those guidelines are never adhered to. I was less than 30  with only 1 child when I was put on Depo for 3 months and a subsequent 6 months afterwards.

These are the known side effects of Depo provera
1) Significantly reduces bone mineral density,
2) Doubles the risk of breast cancer,
3) Increasing a woman’s susceptibility to HIV/AIDS seven-fold, due to the fact that the high dose of progesterone in Depo Provera induces thinning of the vaginal epithelium (lining); therefore, condoms should be used during every sexual encounter,
4) Causes blood clots and strokes, and
5) Contributes to miscarriages and sterility.

As women, we need to be more informed on these FP methods to ensure that they do not mess up our bodies. The internet is our greatest source for this information and we have every right to reject the strongly suggested methods that health care givers offer. No doctor should force you to use a  method you are not comfortable with and without your consent.

What has been your experience with your FP method of choice?

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  1. LC Reply

    >>These are the known side effects of Depo provera
    1) Significantly reduces bone mineral density, – Statistically significantly, but it’s a small effect, doesn’t worsen after the first year of use and resolves within 2 years of discontinuation. You’re not going to get osteoporosis from Depo.
    2) Doubles the risk of breast cancer, – No it doesn’t. Smoking does, poor diet does, being overweight does.
    3) Increasing a woman’s susceptibility to HIV/AIDS seven-fold, due to the fact that the high dose of progesterone in Depo Provera induces thinning of the vaginal epithelium (lining); therefore, condoms should be used during every sexual encounter, – No it doesn’t. But not using condoms with someone who is HIV positive will give you HIV eventually. Depo actually thickens cervical mucus and reduces the risk of Gonorrhea and Chlamydia, so it actually lowers your risk of PID and your risk of becoming infertile because of those infections. Only condoms stop HIV.
    4) Causes blood clots and strokes, and – Again, no it doesn’t. You are thinking of Estrogen-containing birth control methods. Depo is a Progesterone-only method.
    5) Contributes to miscarriages and sterility. – No it doesn’t.

    Actual side-effects of Depo that I talk to patients about:
    1. The most common side effect is irregular bleeding (mostly spotting) for 3-6 months, which usually resolves. A small number of people have ongoing spotting, and I usually switch them to other birth control
    2. Weight gain – about 1/3rd of people experience weight gain. It is different from person to person, but it is the same amount of weight gain for every year of use. If you gain 0.5kg in the first year, you’ll gain 0.5kg in the second year. If you gain 10kg, it will be the same in the next year too. I see this more commonly in African patients, and the cause is unclear.
    3. It takes a long time for periods and fertility to return to normal after the last injection. Usually 4-6 months, but I have seen it take a year in rare cases. It is important that women know this. That said, fertility does eventually return.

    Depo is highly available in Africa not because the pharmaceutical companies are making a lot of money from it, but because it is actually very cheap. Implants like Nexplanon, Mirena, Skyla and Paraguard are very expensive everywhere in the world and require a doctor to place them (which needs sterile conditions, local anaesthetic, equipment), but Depo just needs a needle and a vial.

  2. Pingback: Depo Provera- An Injectable Contraceptive – OneOnward

  3. Lucy Reply

    Depo has not yet been banned in Zimbabwe . There was ano effort to engage women on effects of hormonal contraceptives last year but I used Depo at some.point. Mood.swings,had next child.after 5 years but the worst was hearing voice es in my head telling child…was seriously losing it.It was then that hubby started researching about it.I never used it again

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