Publication:

Influence of educational status on compliance and psychological outcomes of injectable contraceptive use among postpartum mothers

Background Injectable depot Medroxyprogesterone acetate (DMPA) is a progestogen-only contraceptive widely used in the postpartum period. Despite its efficacy, there is limited regional data on compliance patterns and psychological impacts associated with its use among postpartum women in Eastern India. The objectives were to assess the clinical and biochemical adverse drug reactions of DMPA, analyze compliance levels in relation to educational status and evaluate psychological outcomes using the CES-D depression scale in postpartum mothers.

Methods This cross-sectional observational study included 107 postpartum women attending the Antara Clinic under the Department of Community Medicine, Medical College, Kolkata. Inclusion criteria were women aged 18–45 years who received at least one DMPA injection within the past year. Compliance was determined through DMPA card review. Depression was evaluated using the CES-D scale and lipid profiles were analyzed.

Results The mean age of participants was 27.14±4.28 years. Of the total, 50% had received their first injection, 36% the second, and 15% three or more. ADRs were reported in 91% of participants, predominantly menstrual abnormalities (64%), weight gain (40%), and headache (10%). Amenorrhea was more common among ≥3 injection recipients (43%). Compliance was observed in 56% of participants and was significantly associated with educational status; 83% of those with secondary or higher education showed good compliance (p<0.001; OR=18.5). Discontinuation was most commonly due to irregular spotting (30%). Depression scores (CES-D≥16) were significantly higher in those receiving ≥3 injections (81%) (p=0.001; OR=7.616).

Conclusion The study highlights a significant association between educational status and compliance with DMPA use. Pre-treatment counselling, especially for women with lower educational levels, is crucial to improving adherence and managing adverse outcomes.