Feasibility of injectable Depot medroxyprogesterone acetate in a semi urban camp setting

Background: The contraceptive method mix in India has been dominated by female sterilization for a long time. Initiatives have been taken to make Depot medroxyprogesterone acetate (DMPA) available through the public sector of the country. Considering the privacy, safety and efficacy of this long acting method, the study was undertaken to evaluate the acceptance of DMPA in field camps amongst semi urban population.Methods: A cross sectional evaluation study was carried out with married women who accepted DMPA from the basket of contraceptives offered to them. Selection was facilitated by adequate counseling. After counseling, the clients were followed up during subsequent doses for a year for the acceptance and side effects. A checklist was filled comprising detailed history and other variables. The data was expressed in number and percentage and statistical analysis was done on SPSS -19.Results: The mean age of 45 eligible women who accepted DMPA was 26.5 years .Fifty one percent of women were primiparous and forty two percent were lactating during the study period. Majority (80%) were self-motivated to receive subsequent injections. There was no pregnancy in DMPA users. The commonest adverse effect was amenorrhea (49%) followed by irregular spotting (32%) and menorrhagia (14%). Fourteen subjects discontinued DMPA after one or two injections but 58.5% acceptors considered this a good method for birth spacing and wanted to continue it for a longer period.Conclusions: DMPA remains a valid, safe and confidential but neglected contraceptive in India. There is a need to create an awareness program for common people and also to build a supportive environment for users at all levels

Taking stock of 10 years of published research on the ASHA programme: Examining India’s national community health worker programme from a health systems perspective

Background: As India’s accredited social health activist (ASHA) community health worker (CHW) programme enters its second decade, we take stock of the research undertaken and whether it examines the health systems interfaces required to sustain the programme at scale. Methods: We systematically searched three databases for articles on ASHAs published between 2005 and 2016. Articles that met the inclusion criteria underwent analysis using an inductive CHW–health systems interface framework. Results: A total of 122 academic articles were identified (56 quantitative, 29 mixed methods, 28 qualitative, and 9 commentary or synthesis); 44 articles reported on special interventions and 78 on the routine ASHA program. Findings on special interventions were overwhelmingly positive, with few negative or mixed results. In contrast, 55% of articles on the routine ASHA programme showed mixed findings and 23% negative, with few indicating overall positive findings, reflecting broader system constraints. Over half the articles had a health system perspective, including almost all those on general ASHA work, but only a third of those with a health condition focus. The most extensively researched health systems topics were ASHA performance, training and capacity-building, with very little research done on programme financing and reporting, ASHA grievance redressal or peer communication. Research tended to be descriptive, with fewer influence, explanatory or exploratory articles, and no predictive or emancipatory studies. Indian institutions and authors led and partnered on most of the research, wrote all the critical commentaries, and published more studies with negative results. Conclusion: Published work on ASHAs highlights a range of small-scale innovations, but also showcases the challenges faced by a programme at massive scale, situated in the broader health system. As the programme continues to evolve, critical comparative research that constructively feeds back into programme reforms is needed, particularly related to governance, intersectoral linkages, ASHA solidarity, and community capacity to provide support and oversight

Feasibility of injectable Depot medroxyprogesterone acetate in a semi urban camp setting

Background: The contraceptive method mix in India has been dominated by female sterilization for a long time. Initiatives have been taken to make Depot medroxyprogesterone acetate (DMPA) available through the public sector of the country. Considering the privacy, safety and efficacy of this long acting method, the study was undertaken to evaluate the acceptance of DMPA in field camps amongst semi urban population.Methods: A cross sectional evaluation study was carried out with married women who accepted DMPA from the basket of contraceptives offered to them. Selection was facilitated by adequate counseling. After counseling, the clients were followed up during subsequent doses for a year for the acceptance and side effects. A checklist was filled comprising detailed history and other variables. The data was expressed in number and percentage and statistical analysis was done on SPSS -19.Results: The mean age of 45 eligible women who accepted DMPA was 26.5 years .Fifty one percent of women were primiparous and forty two percent were lactating during the study period. Majority (80%) were self-motivated to receive subsequent injections. There was no pregnancy in DMPA users. The commonest adverse effect was amenorrhea (49%) followed by irregular spotting (32%) and menorrhagia (14%). Fourteen subjects discontinued DMPA after one or two injections but 58.5% acceptors considered this a good method for birth spacing and wanted to continue it for a longer period.Conclusions: DMPA remains a valid, safe and confidential but neglected contraceptive in India. There is a need to create an awareness program for common people and also to build a supportive environment for users at all levels