I do not have any experience with depo provera, except several years
ago when I was working in Africa.  They had just started using it where
I was, but only gave the injection, if I remember correctly, at the
first postpartum visit at 6 weeks.  Very little was known about the
effects on nursing.

        As far as I know, depo provera is not being used much in Canada, if at
all.  I have real concerns about using any hormonal medication before
the mother's milk supply is well established, a condition which exists
when the mother is getting the injection before leaving hospital.  But
as far as I know, there has never been any studies on milk supply when
depo provera is given.  Perhaps there are, but one wonders how milk
supply is measured.  Were LC's or someone else knowledgeable about
breastfeeding management involved in the studies?

        There is a whole philosophical issue here.  It seems to me that giving
depo provera within a day or two of birth is assuming that women are
children, and cannot make decisions about their fertility.  After all,
even bottle feeding women are not likely to get pregnant within 6 weeks
of birth.  What exactly is the rush?  Most women, if given the necessary
information will take responsibility for birth control, since they know
they cannot count on men to do so.

        It is typical, of course, that physicians and family planning people do
not believe in LAM.  They probably all know a nursing mother who got
pregnant even while exclusively breastfeeding.  The fact that women get
pregnant on the pill or after tubal ligation does not stop anyone from
recommending it.  No answer, I guess, until health workers start
understanding breastfeeding.

Jack Newman, MD, FRCPC