TY - JOUR T1 - Seeking Synchrony Between Family Planning and Immunization: A Week-10 DMPA Start Option for Breastfeeding Mothers JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 341 LP - 344 DO - 10.9745/GHSP-D-17-00063 VL - 5 IS - 3 AU - John Stanback Y1 - 2017/09/27 UR - http://www.ghspjournal.org/content/5/3/341.abstract N2 - Many mothers initiate DMPA injectables at 6 weeks postpartum, at the time of their baby's first immunization visit. Offering an optional delayed DMPA start at the next (10-week) immunization visit has potential advantages including a reduced follow-up schedule with DMPA visits synchronized with other immunization visits, and, possibly, improved contraceptive and immunization outcomes.The single most popular moment in Africa (and many other regions) to initiate family planning may well be the 6-week postpartum clinic visit, when mothers also bring infants to begin the crucial primary immunization series.1 A 6-week start does indeed work well for mothers accepting long-acting, reversible contraceptives (LARCs) such as implants and intrauterine devices (IUDs), because these methods have no negative impacts on breastfeeding and, once inserted, remain effective for years. However, although there are no medical restrictions on starting injectables at 6 weeks, the 6-week postpartum visit may not be the optimal timing for initiating injectables, the most popular method in sub-Saharan Africa, comprising nearly half of modern method use in the region.2The 6-week postpartum visit may not be the optimal timing for initiating injectable contraceptives.What is the potential downside of initiating depot-medroxyprogesterone acetate (DMPA) injectables at 6 weeks? Beyond the redundant use of contraceptives during lactational infertility3,4 is the problem of high discontinuation. In a review of Demographic and Health Survey (DHS) data from 19 countries, Ali et al.5 noted that more than 40% of new injectable clients discontinued within the first year of use. When such early discontinuation occurs among postpartum women—during the time infants are weaned and fertility is reestablished—the stakes are even higher, because these mothers need effective contraception for optimal birth spacing.Although high injectable discontinuation has proven a particularly challenging problem to solve,6 several partial solutions present themselves for better … ER -