About 12 million women in developing countries use injectable contraceptives, 1.5% of married women of reproductive age and about 3% of married contraceptive users. By comparison, 36% of married contraceptive users rely on voluntary female sterilization, 25% on IUDs, 12% on oral contraceptives, 9% on vasectomy, and 6% on condoms. In most countries levels of use of injectables are too low to detect any trends over time (83, 195).

Regulatory delay in the US and the controversy surrounding injectables have limited availability and thus use around the world. Many clinics do not offer injectables, or they often run short of supplies (4, 19, 134, 144, 262, 281, 297, 366). In Bangladesh, for example, even though injectables are widely available, 58% of providers and program managers surveyed in 1992 said that lack of supply had forced them to turn away would-be users; 11% of women said that they had stopped using injectables or had switched to another method because they could not get an injection (4). In 1994, 5% of married women of reproductive age in Bangladesh were using injectables (218).

Knowledge of injectables is not as widespread as knowledgeof some other methods. For example, in 31 of 53 countries covered by Demographic and Health Surveys or similar surveys, one-quarter or more of married women of reproductive age did not know about injectables (268) (see Table 2). (By comparison, in 16 countries one-quarter or more did not know about OCs.) Women who know of injectables often do not know where to obtain them.

A few countries offer a contrast to the world pattern. In the countries with the greatest use of injectables—Indonesia, at 15% of married women of reproductive age and Thailand, at 12%—injectables have been widely available for more than 15 years. Thailand registered DMPA in 1970 and began to offer it in the national family planning program in 1975, becoming one of the first countries to do so (20, 34). Between 1987 and 1991 use in Thailand increased from 9% to 12% of married women of reproductive age. Indonesia registered DMPA in 1976, and it is manufactured locally (187). Between 1987 and 1994 use increased from 10% to 15% of married women of reproductive age. Injectables are well liked in these countries, where women value the convenience of injectables and are not discouraged by irregular menstrual bleeding or amenorrhea (see Chapter 4, Side Effects and Complications).

Among developed countries the highest prevalence of injectables use is in South Africa (see Table 2) and New Zealand. In 1993-94, 4% of visits to the Family Planning Association of New Zealand were for initial or repeat injections of DMPA (206). Surveys in other developed countries do not mention injectables or else include them among "other" methods (228, 289, 319). In the US the latest national survey was done before DMPA was approved (247). The Planned Parenthood Federation of America supplied DMPA to about 141,000 women in 1994, about 7% of their family planning clients (363).