Use of the injectable contraceptive medroxyprogesterone acetate in France in 2010-2023: A national descriptive study

We aimed to assess the use of the injectable contraceptive depo medroxyprogesterone acetate 150mg/3mL (DMPA, Depo-Provera®) in France between 2010 and 2023.

We identified all women of all ages living in metropolitan France and overseas territories with a dispensing of DMPA using data from the French National Health Data System (SNDS). Baseline social and medical characteristics of women were extracted. The type of physician at first prescription was also investigated (specialty, hospital or private practice). We supplemented our data with the DMPA sales data for 2022 and 2023 in France. We assessed the one-year and two-year continuation rates among new users.

During the study period 2010-2023, 30,395 individuals used DMPA at least once, for 140,247 dispensations. The median age at initiation was 31 years old (standard deviation: 8.6). The majority of new users of this contraception lived in French Guiana (26.8%, n = 9,271), Seine-Saint-Denis (11.5%, n = 3,979), and Guadeloupe (8.8%, n=3,038). Half of women were affiliated to the CMUc at initiation (51,2%, n=17,748), 17.7% (n=6,118) were classified in the category "recent arrival on the French territory", and 43.1% (n=14,937) lived in the Overseas territories. In 2023, general practitioners accounted for half of the first prescriptions of DMPA, with gynecologists and midwives accounting for the other half. One year after initiation, only 16.7% of women still used DMPA injections, and 15.5% after two years.

This nationwide study confirms that DMPA is rarely used in France, by disadvantaged populations living in areas of high immigration. Most users in France do not appear to use this contraception over the long-term, but the determinants of persistence with this contraception for those who continue need to be explored.