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In: Zatuchni GL, Goldsmith A, Shelton JD, Sciarra JJ, ed. Long-acting contraceptive delivery systems. Philadelphia, Pa., Harper and Row, 1984. 1-19. (PARFR Series on Fertility Regulation)Depo-Provera (depomedroxy-progesterone acetate, or DMPA) and NORPLANT (the Population Council's registered trade name for subdermal implants) are focused on in this literature review. Over the past 17 years, more than 1 million individual doses of Depo-Provera have been supplied in Thailand. Currently 6,000 women a month use the method. Depo-Provera has proved outstandingly successful in Bangladesh for years. The basic disadvantage of long-acting steroid systems is that return to fertility is slow and unpredictable. Other disadvantages include menstrual distrubances and weight gain. Acceptability of injectable contraceptives has been studied primarily by the World Health Organization (WHO). In 1976, the Task Force on Acceptability of Research and Family Planning explored preferences among 3 routes of contraceptive administration: 1)oral; 2)intravaginal; and 3)injection. The study was conducted in Indonesia, Korea, Pakistan, and Thailand. Although the oral route was generally preferred by most women, many respondents still chose the injectable. A WHO III multicentered trial comparing the use, effectiveness, side effects and bleeding patterns of Depo-Provera and norethisterone enanthate (NET-EN) was terminated after only 1 year because of excessively high pregnancy rates with NET-EN. A total sample of about 250 women in Manila and Alexandria were interviewed. Results indicated that the 2 most important considerations were effectiveness and menstrual bleeding. Depo-Provera did not affect menstruation. Various types of subdermal implants releasing a contraceptive Silastic implant, is placed beneath the skin of the forearm or upper arm and provides 5 or more years' protection against pregnancy. The 6 capsules are not biodegradable and require surgical removal under local anesthesia.
Preventive Medicine. 1977; 6:65-73.Researchers are realizing the need to deal with the psychosocial factors affecting the success of family planning programs. This paper looks at research into the notion of acceptability, defined as the quality of being attractive or satisfactory, specifically, the acceptability of fertility regulating methods to users. Social scientists have done little in this field because of lack of researchers and of methodological instruments and because they have concentrated on how to distribute new contraceptive technology rather than on assessing preferences and altering the technology to fit the people. Recently, research has increased, most of it coordinated by the World Health Organization Task Force on Acceptability of Fertility Regulating Methods, established in 1973. The assumptions of the Task Force are that research should aim at developing a range of methods for different needs rather than one "ideal" method; that users evaluate methods in terms of multiple attributes and the Task Force should, therefore, concentrate on the weighing of intrinsic attributes; and that an interdisciplinary approach is required. Current research in several countries focuses on 3 approaches: 1) preferences in a free-choice situation, assessed in interviews with users in normal family planning programs; 2) studies in conjunction with clinical trials of new fertility regulating methods; and 3) field surveys on perceptions of selected attributes of hypothetical methods. This article gives the methodological advantages and disadvantages of each approach. Results of the research will begin to be available in early 1977.