title: Progestin-only contraception: injectables and implants.
abstract: Progestin-only contraceptive injectables and implants are highly effective, longer-acting contraceptive methods that can be used by most women in most circumstances. Globally, 6% of women using modern contraception use injectables and 1% use implants. Injectables are the predominant contraceptive method used in sub-Saharan Africa, and account for 43% of modern contraceptive methods used. A lower-dose, subcutaneous formulation of the most widely used injectable, depot-medroxyprogesterone acetate, has been developed. Implants have the highest effectiveness of any contraceptive method. Commodity cost, which historically limited implant availability in low-resource countries, was markedly lowered between 2012 and 2013. Changes in menstrual bleeding patterns are extremely common with both methods, and a main cause of discontinuation. Advice from normative bodies differs on progestin-only contraceptive use by breastfeeding women 0-6 weeks postpartum. Whether these methods are associated with HIV acquisition is a controversial issue, with important implications for sub-Saharan Africa, which has a disproportionate burden of both human immunodeficiency virus (HIV) and maternal mortality.
authors.affiliation: Engender Health, and Department of Maternal and Child Health, University of North Carolina Gillings School of Public Health, 440 Ninth Avenue, New York, NY 10001, USA. Electronic address: Rjacobstein@engenderhealth.org.
authors.forename: Roy
authors.initials: R
authors.lastname: Jacobstein
authors.affiliation: United States Agency for International Health (USAID), and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health 1201 Pennsylvania Ave NW, Suite 315, Washington, DC 20004, USA.
authors.forename: Chelsea B
authors.initials: CB
authors.lastname: Polis
mesh_terms: D001942:Breast Feeding; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D004343:Drug Implants; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D007279:Injections, Subcutaneous; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D011247:Pregnancy; D045167:Progesterone Congeners / Q000008:administration & dosage
chemical_list: D003271:Contraceptive Agents, Female; D003692:Delayed-Action Preparations; D004343:Drug Implants; D045167:Progesterone Congeners; D017258:Medroxyprogesterone Acetate
keywords: HIV; depot-medroxyprogesterone acetate (DMPA); hormonal contraception; hormonal implants; injectable contraception; progestin-only contraception