"No Problem" Buying Depo-Provera in Mexico

While in Mexico city several months ago, my colleague Krystyna von Henneberg and I decided to see how easily we could buy Depo-Provera in pharmacies, without prescription.

In the farmacie on Calle Revillagigedo, we were greeted by a smiling young woman behind a long drug-filled glass counter. We asked if she carried Depo-Provera. She first brought out Perlutal, a monthly injectable contraceptive manufactured by the Mexican pharmaceutical company Syntex. We again requested Depo-Provera, and after a few moments she found it. When we asked about any precautions we should take, she pulled out the Diccionario de Especialidads Farmaceuticas, the Mexican equivalent of the U.S. Physicians Desk Reference. DepoProvera wasn't listed, but the woman assured us we would have "no problem" using it. We asked if it could be taken while breastfeeding, and she assured us it could. (In fact, the effect on infants of hormones like Depo-Provera is an area of concern.) Then we asked about any contraindications. She went to the phone and called a doctor. He wasn't in, but she reassured us nonetheless. "You don't need a prescription," she said. "If you know how to inject it, it's safe."

A second farmacie was just a few stores down the block. We asked for Depo-Provera, and the young pharmacist was back in a minute, drug in hand. Again we asked about using it while breastfeeding. "Absolutely no problem," she said. She double checked with a male pharmacist, who agreed. We asked if the drug is safe for patients with diabetes or cancer (the Physicians Desk Reference specifically advises against the use of the drug for these patients). "No problem," she said.

"Are there any adverse side effects?" "No."

The other pharmacies we visited gave us the same "no problem" responses. The only hesitation was shown by the pharmacist in the last store. We had asked to see all the different types of injectable contraceptives he had in stock. He brought out Mexican brands Patector and Perlutal, Noristerat by Schering, and the cheapest, DepoProvera. After he vigorously assured us of their safety, we said we'd take them all. Startled, he said we should not use them all at once, since one injection would last at least a month. We told him we just wanted to find the one we liked best, so we would try a different one each month. He went to the cash register and rang up the sale-about five dollars.

On a tour of Mexican family planning clinics, our guide explained that many pharmacists in the country have no more than a third-grade education, and that their job is simply to sell what is on the shelves. Because of the controversy over Depo-Provera in the U.S. and because of health effects that clinic doctors have observed in their patients, official Mexican policy is currently to use up Depo-Provera supplies already purchased for government-run clinics, but not to acquire any more.

Nonetheless the drug is clearly still available in the pharmacies, in grey and white boxes with the drug's name and dosage. But there is no patient insert with instructions or warnings about use.