Recently a prolific colleague, Kimberly Durdin-James,IBCLC brought up the epidemic of mothers, particularly low-income, minority mothers being given Depo provera in the hospital before lactation is established and before discharge. Women who have received breastfeeding information, been encouraged to breastfeed and have DECIDED to breastfeed who are now, unable to breastfeed. Lactation consultants will tell you story after story of mothers who struggle to bring in any milk supply at all after receiving an injection of Depo Provera. Even worse, how many mothers now think this is one more way that their body doesn't work; they could not produce milk for their baby. Yet, it didn't have to be that way.
Do doctors know they are sabotaging their patients? Do they care? What information is out there?
I decided to do some of my own research. Information online varies from site to site. The actual Depro Provera site says that women can use the medication after the birth of a baby. It does not specifically mention any affect on milk production.
Various sites say it is compatible with breastfeeding or safe for the breastfeeding mother and baby.
Other sites offer more specific guidelines. The general consensus is to administer at 3 to 5 days if NOT breastfeeding and after 6-8 weeks (or after breastfeeding is well established) if breastfeeding. However, it is not listed as a "con" or reason not to choose Depo Provera.
Depo Provera has a dark side, excluding its affect on lactation. Sara Littlecrow-Russell shares her experience with this form of birth control, doctor coercion and finding out about the potential side effects here. According to her article, Depro appears to be the contraceptive of choice for many government clinics and agencies and is growing in popularity in those settings. Interestingly, black teens are more than twice as likely as white teens to use it (19% compared to 8%). I have heard time and time again of it being given with and without consent to black mothers (some young, some low income, some not) in the hospital. Apparently some doctors are so concerned that these potentially "non-compliant" patients will either skip the 6 weeks appointment or come back pregnant that they are willing to trample on their right to make an informed decision (especially one they may not agree with). Why not teach these women how very important it is that they exclusively breastfeed to prevent the return of fertility until the 6 weeks postpartum check-up where they can discuss other options?
Even if given "with consent", there are some valid concerns. Twelve years ago, four consumer groups including the National Black Women's Health Project banned together to ask for a moratorium on Depo Provera. The FDA promised to "monitor any adverse health effects" and the groups asked for healthcare professionals to use a standard informed-consent form. Twelve years later, and as they say, "ain't nothin' changed". Women are still reporting negative side effects and have their stories online including a general Petition against Depo provera and and a Men's Petition. The Philadelphia Black Woman's Health Project states on it's web site:
"While Depo is viewed as a drug of convenience, we maintain that it exacerbates pre-existing disease conditions. Depo has been linked with long-term irreversible effects such as breast cancer and cervical cancer, both of which disproportionately affect Black women. Depo is also associated with a thinning of the bones. This places young women who use Depo at a higher risk for developing osteoporosis. Other risks include increased depression, excessive weight gain, excessive bleeding, and loss of sex drive."
Again, no mention of negative affect on milk supply, but honestly that may be the least of your problems with this contraceptive. What is scary, is that it not only takes away your ability to produce milk, but also takes away your ability to reap the protective nature breastfeeding offers against breast and cervical cancer. It is a "double whammy". But it prevents more "ghetto babies" right? Apparently that is the most important objective.
Depo Provera may be a solution for some mothers in some situations. It is important that we give mothers the information, counseling and opportunity to make the best choice. For breastfeeding mothers, especially mothers who already have social barriers against breastfeeding, we should do everything we can to eliminate barriers where we can. For more information on breastfeeding and fertility click here and for more information on breastfeeding and hormonal contraceptives and options click here.