From Policy to Practice: Reviewing the Acceptance and Barriers of Antara-Injectable Contraceptive in India

Abstract

Background: Depot Medroxyprogesterone Acetate (DMPA), marketed as Antara in India, was introduced to widen the range of modern contraceptive choices for women. Evidence from tertiary hospitals, rural and tribal communities, and qualitative studies shows considerable variation in acceptability, continuation, and influencing factors, reflecting both programmatic challenges and user perceptions across diverse settings. Aim: This narrative review synthesizes available evidence on Antara (DMPA) focusing on uptake, determinants, side effects, and programmatic gaps, while outlining implications for practice and policy within India’s family-planning framework. Objectives 1. To identify socio-demographic, cultural, and health-system determinants influencing initiation and continuation of Antara. 2. To evaluate user-reported adverse effects contributing to dissatisfaction and discontinuation. 3. To assess provider- and system-related barriers, counselling quality, supply-chain issues, and follow-up mechanisms. Methods: Ten articles published between 1998 and 2025 were reviewed to identify consistent patterns in utilization, continuation, and side-effect profiles among Antara users. Results: Community-based studies consistently report low prevalence (4–6%) of Antara use, predominantly among parous women aged 20–30 years. Hospital-based findings show moderate continuation rates of 25–55% at 12 months, with nearly half discontinuing within six months due to side effects or inadequate follow-up. Menstrual disturbances—including irregular bleeding (50–80%) and amenorrhea (20–30%)—are the most frequent adverse effects and commonly lead to dissatisfaction when not anticipated through proper counselling. Conclusion: Antara demonstrates moderate uptake and good early continuation, especially among young parous women seeking spacing. Facilitators include education, awareness, and partner support, while barriers include myths, fear of bleeding changes, limited autonomy, inconsistent supply, and inadequate counselling.