By Diepiriye S. Kuku-Siemons

Depo Medroxyprogesterone Acetate (DMPA) is one of the most widely researched and documented safe and reliable means of contraception. DMPA is 99.7% effective and lasts up to three months, making it a viable alternative to oral contraception and http://www.fhi.org/en/RH/Pubs/booksReports/methodaction.htm IUDs . Long-acting injectable contraceptives such as DMPA remove the daily tensions surrounding reproductive and sexual health, especially for those who find other methods impractical. Although proven safe and effective, the oral contraceptive pill is impractical for many and does not address the myriad of circumstances and concerns of many couples. Due to a variety of health concerns and individual needs, IUDs are clinically unsafe for many women. Expanding the basket of choices of contraceptives promotes the praxis of reproductive rights.

There are a plentitude of circumstances in which couples in the prime of their fertility may wish to delay pregnancy. For example, young, urban career-oriented couples may choose DMPA as a highly effective means of long-term fertility control. Young couples struggling to meet the needs of existing children may find DMPA a convenient and easy-to-use contraceptive method of choice. Other young couples may be eager to have their first child, yet wish to postpone further offspring. In these cases contraceptives serve as a 'spacing' method, permitting women and their spouses to concentrate on pursuing studies/training or rigorous career paths. 'Spacing' also represents a responsible and mature attitude towards fertility, cultivating better and more informed parenting.

Clinical, demographic and social science professionals alike conclude that an unmet need for contraceptives monopolizes a great deal of women's time. Time spent dealing with fertility reduces precious time for responsible and effective parenting, care-taking of elders, income generation and self-development. DMPA specifically addresses a constraint of parenthood- namely time and stress management. Poverty exacerbates these constraints where reduced access to health care services as well as education and training all work to limit life-choices.

Risky choices

A recent study in the Indian Journal of Pediatrics of pregnant women from six urban slums revealed an 80.6% prevalence of anemia. The researchers concluded that in most instances, anemia resulted from inadequate dietary intake of iron, of which 90.9% of study participants fell far short of the daily recommended allowance. DMPA may reduce menstrual bleeding and promote a slight weight gain, making it a wholly beneficial and life-enhancing alternative. Other non-contraceptive benefits of DMPA include a reduction of pain associated with endometriosis as well as the palliative treatment of certain http://www.who.int/reproductive-health/hrp/progress/33/news33_2.en.htm cancer.

Lactating mothers too often struggle with post-partum health, while at the same time seeking a reliable means of contraception that does not place her child at risk. The combined oral contraceptive pill is not a viable alternative for lactating mothers who harbor concerns over the effects of the quantity or quality of their breast milk. Lactating mothers may shoulder responsibilities towards her newborn child, existing children, spouse and other kin, rendering the daily attention and inflexibility of oral contraceptives an unnecessary hassle. DMPA has no adverse effects on breast milk while providing security and reassurance unparalleled.

Rights to Resources

Reproductive rights theorizes access to treatment and care, while reproductive justice works towards ensuring quality, safety, and practical access for women in a myriad of socio-economic circumstances. Purporting contraceptive choices as a reproductive right overlooks the varying circumstances which mediate a woman's personal agency and ability to decide. To transition from reproductive rights to reproductive justice it is necessary to expand the basket of choices to address the unmet needs for contraception and birth spacing as well as their practicality.

The utility of DMPA gives credence not only to reproductive health as a right, but also to reproductive justice by broadening the element of choice to a wider array of women, particularly those living in poverty or otherwise disenfranchised. Far too little research interrogates the intersection of poverty and unmet needs for pragmatic, safe and effective contraceptives. In real terms, poverty reduces access to education/training as well as quality health care. The unmet needs for contraception across all social-economic strata indicates an urgent necessity to re-examine these linkages in the form of expanding knowledge resources and availability of choices. Enhancing the basket of contraceptive choices can drastically enhance the lives of women in particular, and families in general, especially those traditionally disenfranchised.