The restrictive guideline isa barrier in the expansion of injectable contraceptive, DMPA (Depot medroxyprogesterone acetate) up to health sub-center level in India: A short review of other country’s experience involving community health workers as the inj

Abstract

Background:Depot Medroxy Progesterone Acetate (DMPA) is a very popular contraceptive in manyAfrican Countries. Those countries successfully rolled out DMPA engaging Community Health workers (CHW) for the last several years. In India, ANMs (auxiliary nurse midwives) are not allowed to administer DMPA 1^st dose independently, though subsequent doses are allowed. Currently, in India, DMPA clients are screened by an MBBS doctor before administering 1^st dose by an ANMs or GNMs (general nurse midwives).

Objectives:To gather evidence on the competency of ANM in DMPA administration and client assessment and reviewing the safety, efficiency, and continuation rate of DMPA provided by CHWs.

Method: Review of online journals in Google Scholar and PubMed focusing on DMPA administration by Community Health Workers and generated evidence of safety, efficiency, continuation, and acceptability of services of CHW as DPMA provider.

Results: The safety, efficiency, acceptability, and continuation of DMPA injection are better if provided by community health workers in comparison to a health facility-based model where trained and professional nurses administer the DMPA.

Conclusion: whereas non-professional and poorly trained CHWs,are providing DMPA at doorsteps with increasing efficiency, safety, and continuations rate, the Government of India also should train and engage ANMs of all sub-centers to assess, administer and follow up of DMPA injections from the very first dose itself which not only expand the service to the community level and also enhance acceptance and continuity of the service and thereby reducing the unmet need and total fertility rate of the country