Chris Auer relates the following in an overview of various studies on
Depo-Provera:
'Contraception 9/2000 This focused on teen compliance with depo follow-up.
The show rate for coming back every 3 months for a shot (with teens) ranges
from 30-45%. "Intensive reminders" did not increase return rate. Most quit
using it r/t irregular bleeding.'
This could mean that the health care service has placed a high priority on
hormonal contraception, likely at the expense of attention to establishment
of BF, and that fewer than half, possible fewer than one third, of the
mothers, enjoyed the benefit of the contraceptive for more than three
months. If one did a study comparing this intervention (Depo-Provera post
partum) with intensive BF support prenatally and especially in the post
partum period, I wonder what the difference in pregnancy rates after six
months would be between the two groups. My hunch is it would be small.
As there may be a possibility that progestins post partum can adversely
affect the sensitivity of alveolar cells to prolactin (I haven't read
Hartmann's research, so this is based on Chris' post) it is even more
imperative that we include that on the risk side of the equation.
Dahlberg K: Some effects of depo: Observations in the nursing infant and the
long-term user. Int J gynaecol Obstet 1982: 20: 43-48.
If this study contained 20 mothers in all, 10 treated and 10 controls, and
four different schedules for giving Depo-Provera were used, I would discount
any reports of a difference in frequency of anything at all in the babies.
We are talking about two or three babies in each group. It is practically
meaningless to compare them. As observations, perhaps they are interesting,
in deciding how many babies to include in each arm of a larger study which
could give unequivocal answers to some of these questions.
Even if I have misunderstood, and there were 10 babies in each intervention
group and 10 controls for each of them, we are talking about 80 babies. For
clinical or statistical significance there would have to be a LOT more.
Again, I realize there are overwhelming circumstances impinging on young
women, and these can make it seem as though contraception is the only
appropriate priority when your workday is an unending chain of such cases.
That is why it is important to know how effective the intervention is. If
55-70% of teenagers don't even come back for the injection at three months,
it may not be effective enough to justify neglecting the alternatives. As
it seems likely that contraceptive services in the US will be less available
in the next four years, conscientious professionals who care about mothers
and babies will want to put their efforts where they will do the most good.
Personally, (putting on flameproof suit now) I'm glad to be in a country
where punishment for sexual activity is not part of any serious political
agenda.
Rachel Myr
Kristiansand, Norway
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