Determinants of preference of source of injectable contraceptives among rural women in Uganda: a case study of Depo-Provera.

Understanding preference of source of contraceptive commodities is essential in enhancing the delivery of family planning services. This paper identifies the determinants of preferred source of Depo-Provera among rural women in Uganda. The analysis is based on data sourced from a Save the Children and Family Health International study involving 642 women who were introduced to the contraceptive three years prior to the evaluation. Data were analyzed at univariate, bivariate and multivariate levels. Private sources were the most preferred of Depo-Provera as compared to public sources. Preference for private sources was more likely among older women (p < 0.05), those who had never experienced stock-outs of Depo-Provera (p < 0.01), and those who had obtained their last injectable from private sources (p < 0.01). These findings support the strategy of community-based distribution of contraceptives in enhancing access and utilization of family planning services in Uganda.

Injected with controversy: sales and administration of injectable contraceptives in drug shops in Uganda.

CONTEXT: Informal drug shops are the first line of health care in many poor countries. In Uganda, these facilities commonly sell and administer the injectable contraceptive depot medroxyprogesterone acetate (DMPA), even though they are prohibited by law from selling any injectable drugs. It is important to understand drug shop operators' current practices and their potential to provide DMPA to hard-to-reach populations. METHODS: Between November 2007 and January 2008, 157 drug shops were identified in three rural districts of Uganda, and the operators of the 124 facilities that sold DMPA were surveyed. Data were analyzed with descriptive methods. RESULTS: Only 35% of operators reported that the facility in which they worked was a licensed drug shop and another 9% reported that the facility was a private clinic; all claimed to have some nursing, midwifery, or other health or medical qualification. Ninety-six percent administered DMPA in the shop. Operators gave a mean of 10 injections (including three of DMPA) per week. Forty-three percent of those who administered DMPA reported disposing of used syringes in sharps containers; in the previous 12 months, 24% had had a needle-stick injury and 17% had had a patient with an injection-related abscess. Eleven percent said they had ever reused a disposable syringe. Overall, contraceptive knowledge was low, and attitudes toward family planning reflected common traditional biases. CONCLUSION: Provision of DMPA is common in rural drug shops, but needs to be made safer. Absent stronger regulation and accreditation, drug shop operators can be trained as community-based providers to help meet the extensive unmet demand for family planning in rural areas.