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Re: Depo Provera: a critical analysis, Stephen Minkin, Women & Health, Vol. 5:49-69, Summer, 1980 [letter]
Women and Health. 1980 Winter; 5(4):85-7.The readers of "Women and Health" and the American public deserve to hear the other side of the argument in regard to Depo Provera. This physician, who has been responsible for the operation of a large family planning program in northern Thailand for 17 years, has been personally responsible for the administration of over a million injections of Depo Provera to almost 100,000 women, for a total usage of over 240,000 woman years. Many of these women have used this method for 10 years or longer. Surveillance of all family planning patients goes on continuously, with particular emphasis on the users and former users of depomedroxyprogesterone acetate (DMPA), the active component in Depo Provera. A large and unbiased component of this surveillance is the Chian Mai component of the worldwide, multicentered, 5-year case control World Health Organization study of homronal steroid contraception. At McCormick Hospital in Chiang Mai, clinic records have been maintained on every family planning acceptor since the program began in 1963, and every DMPA acceptor since the start of this method in 1965. The research shows the following: a method failure rate on the average of only 1 unintended pregnancy in every 142 women using the DMPA 3-month injection method for a full year; a good return to fertility rate with the outcomes of pregnancies and deliveries being normal; and a rate of congenital anomalies not significantly different from that observed in former pill or IUD users or in non-contracepting mothers. There has been no increase in endometritis, endometrial cancer, inhibition of milk supply of nursing mothers, or detectable harm to the infants of mothers receiving DMPA injections. The alleged "marked increase in breast and cervical cancer rates in Chiang Mai, Thailand," as indicated by Minkin in his testimony before the Congressional Committee on September 9, 1980, is a misinterpretation of a WHO report and is contrary to fact. There has been no indication that women on DMPA or their nursing infants suffer an increased incidence of infections or cancers of any kind.