Operations research and the expansion of DMPA use in Peru.

This study evaluated an operations research (OR) program to reduce the medical barriers to use of the injectable Depo-Provera (DMPA) and improve the quality and accessibility of family planning care in Peru. It was determined in January 1991 that DMPA was almost lacking among methods offered. This was attributed to medical barriers logistical problems and lack of professional providers. DMPA was approved for use in 1988. The UNFPA was donating supplies. The project operated during 1992-93 in two rural areas. It was begun in September 1991 but was side-tracked for 7 months due to differences over its safety. The project resumed fully in August 1992. The OR project trained nonprofessional providers and improved logistics in two rural areas of Puno and Piura. A control group was useful for comparing the effects of the intervention. Findings indicate that the number of new users of specific hormonal and barrier methods and the number of couple years of protection doubled over a 10-month period. Increases occurred for all contraceptive methods but especially for DMPA . During 1990-96 the national trends indicate a major increase after 1993 which coincides with the national dissemination of findings on DMPAs increased use in the two rural sites. Survey data indicate that the use of injectables was higher in rural areas. The increased use is attributed to a number of activities. The Health Ministry distributed injectables and initiated a project to augment the physical and personnel infrastructure at the primary health care level in 1993; the US approved DMPA in late 1992; and this project survived.