Friday, January 19, 2007

Depo Provera and breastfeeding

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.


Lauren said...

The idea that women are being given birth control (permanent or temporary) is reprehensible. I believe strongly in child spacing and family planning, but forcing a contraceptive on an unknowing woman (especially in the fog that can occur after giving birth) has no moral justification. The potential side effects, particularly those that affect the baby, make the doctors' choice in these situations even more egregious. In this situation, I feel that community and individual education and ongoing support from lactation consultants and EDUCATED physicians could help establish more nursing relationships between low-income mothers and their babies, leading to a reduction in fertility rates.

As an aside, I have never experienced Depo Provera's negative side effects on nursing, but I do believe it was responsible for several months of terrible, migraine-style headaches in my case.

Angela said...

When I sought support for infertility in on-line infertility communities, I read story after story of women having trouble conceiving long after taking Depo Provera--long after it should have stopped functioning as birth control for those women. I don't know anything about its effects on milk supply (very interesting what you have to say on this) but I would never use it based on the horror stories I've heard about subsequent infertility.

Liz said...

You know big pharma isn't making any money if women use ecological breastfeeding as contraception... *rolls eyes*


Matia Bryson said...

Very newsworthy article. Appalling that women could be given this drug without being fully informed to its affects on lactation. I will be including a link to this blog post in my RSS feed, Breastfeeding Daily Tip and News for the next two weeks.

kimdurdinjames said...

Thank you for writing about this Depo issue on your wonderful blog. My only wish is that the young (and not so young)mommas that I work with everyday had internet access and could read your work. I guess I will just have to print it out for them! Thanks for being an inspiration!

kimdurdinjames said...

Thank you for writing about this Depo issue on your wonderful blog. My only wish is that all of the young (and not so young)mommas that I work with everyday had access to the internet to read your work and words. Thanks for being an inspiration!
Kim Durdin-James