About 12 million couples throughout the world now use injectable contraceptives. Progestin-only injectables are the most widely used: DMPA (depot medroxyprogesterone acetate), known by the brand name Depo-Provera, provides three months of protection, and NET EN (norethindrone enanthate), known as Noristerat, two months. One-month injectables combine estrogen with progestin. The new monthly injectables Cyclofem and Mesigyna are well-tested alternatives to older monthlies.

Although the first injectables were developed soon after oral contraceptives, limited availability has constrained use in all but a few countries, such as Indonesia and Thailand. More than 100 countries have approved DMPA since the early 1960s, but political controversy and scientific uncertainty have held back injectables in some programs.

Now, research by the World Health Organization (WHO) and US regulatory approval of DMPA may mark the start of a new era for injectables. The WHO research reduced fears about DMPA causing cancer. Approval of DMPA by the United States Food and Drug Administration in 1992 made this injectable available in the US and allows the United States Agency for International Development (USAID) to offer DMPA to developing-country family planning programs.

Women experience a variety of side effects with injectables, however. Disruption of menstrual bleeding is common, and some women find it troublesome. Counseling helps women understand that the frequent or irregular bleeding and amenorrhea are not dangerous, and many continue to use injectables despite these bleeding changes. Cyclofem and Mesigyna disrupt menstrual bleeding less than DMPA and NET EN. Also, some women using injectables report weight gain, headaches, and dizziness.

• Provide accurate and balanced information and dispel unwarranted fears about injectables through mass-media communication for the public, testimony from satisfied users, client education, and counseling.
• Counsel to ensure informed choice and use. With information and encouragement from providers, women make their own choices among family planning methods. They also learn what to expect and how to use their method. Having chosen injectables, women need to know when they can get injections and to expect bleeding changes.
• Expand provision of injectables through pilot projects. Seminars can inform providers and policymakers. Pilot studies can gauge clients' responses and identify key communication and counseling issues.
• Ensure reliable supply. Order injectables six months to a year in advance, making accurate forecasts of demand. To avoid logistical problems, offer only one progestin-only injectable and, if there is a demand, one monthly injectable.
• Avoid unnecessary barriers to use of injectables, such as age and parity requirements or restricting the first injection to the first seven days of the menstrual cycle.
• Use needles and syringes safely. Used disposable equipment should be destroyed. Reusable equipment should be sterilized or high-level disinfected.
• Consider community-based distribution or social marketing of injectables. These approaches increase availability but require good training and attention to quality.