title: Conditions in rural Nepal for which depot-medroxyprogesterone acetate initiation is not recommended: implications for community-based service delivery.
abstract: The presence of medical conditions that might affect the use of depot-medroxyprogesterone acetate (DMPA) as a contraceptive method was assessed in a rural district in Nepal. A general health survey was conducted in nonpregnant 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 female gynecologists. Possible pregnancy (nine cases) and abnormal uterine bleeding (one case) were the only conditions identified in which DMPA should not be used, based on the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use. Five additional cases of cardiovascular problems, in which DMPA initiation is not usually recommended, were also detected. Recently developed checklists based on the WHO criteria for DMPA use would have identified all of these health conditions. This checklist would allow the safe delivery of DMPA at the community health worker level, and increase the availability and accessibility of DMPA in rural Nepal.
authors.affiliation: Children/US, Himalayan Field Office Kathmandu, Nepal.
authors.forename: C
authors.initials: C
authors.lastname: Rai
authors.forename: S
authors.initials: S
authors.lastname: Thapa
authors.forename: J
authors.initials: J
authors.lastname: Day
authors.forename: L
authors.initials: L
authors.lastname: Bhattarai
authors.forename: S
authors.initials: S
authors.lastname: McMullen
authors.forename: R
authors.initials: R
authors.lastname: Jha
authors.forename: S
authors.initials: S
authors.lastname: Shrestha
authors.forename: S
authors.initials: S
authors.lastname: Bastola
authors.forename: R
authors.initials: R
authors.lastname: Rivera
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services; D003271:Contraceptive Agents, Female; D000075202:Contraindications; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D017258:Medroxyprogesterone Acetate; D009390:Nepal; D012424:Rural Population; D014944:World Health Organization
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate