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It has been known for many years that migrant farmworkers rely on each other for treatment of common illnesses and have access in their home countries to medications that are only available by prescription in the US. Injections of various types have been a mainstay of this self-treatment. The most common types of medications injected have been antibiotics and vitamins. There has always been a concern among migrant health providers that this practice poses risks of injection site infections, hepatitis, and HIV.
This past year, I learned from a migrant health provider in Oklahoma of the recent practice of Mexican migrant women attending Depo parties, not unlike Tupperware parties. At these gatherings, a group of women come together socially, and during the evening someone (often the recognized health expert in the group) offers Depo-Provera injections for women who want or need contraceptive services. According to this source, these parties were occurring about once a month and this health care provider was quite concerned that these women were getting their injections more frequently than the indicated every three-month cycle. There was also concern about dosage, discussion of side effects, identification of contraindications, etc.
I have recently heard the same story in Pennsylvania from two individuals who are immigrants from Mexico. They both told me that they are receiving the Depo-Provera injections every three months. Their overall understanding of the effects, side effects, and contraindications to the medication was minimal.
Migrant clinicians need to be aware of this practice and specifically ask their female migrant patients if they are or anyone they know is participating in Depo parties. The obvious clinical concerns related to this practice include but are not limited to: injection site infections, exposure to Hepatitis B, C and HIV, inappropriate dosage or frequency of injection, inadequate education of effects and side effects, and inappropriate selection of individuals to receive the medication. MCN would be very interested in hearing from front line providers regarding the current self-administration of Depo-Provera and other injectables in the migrant farmworker population. If you have questions or experience with this issue please contact Ed Zuroweste MD , Medical Director, MCN.