This is a pilot study of early postpartum initiation of the injectable progestin contraception, depo medroxyprogesterone acetate (DMPA), among 40 postpartum people. The study aims to assess the feasibility to conduct a larger trial evaluating the effects of early postpartum initiation DMPA on lactation and infant growth outcomes in Nepal.

The primary objective of this study is to pilot the procedures necessary to demonstrate feasibility for a larger randomized trial evaluating the effects of early postpartum initiation of DMPA on time to lactogenesis (transition to mature milk), lactation continuation, and infant growth and development.

The investigators will conduct a pilot study among 40 birthing people who deliver a singleton, healthy, term infant; intend to feed their infant human milk (breastfeed) exclusively for at least 6 months; and plan to use DMPA for postpartum contraception. Participants will be administered DMPA within 48 hours after birth and will be followed for 12 weeks postpartum. Time to lactogenesis, the proportion of participants exclusive feed their infant human milk at 12 weeks, any lactation and infant growth through 12 weeks will be measured. We will analyze time to onset of lactogenesis the proportion of participants exclusively feeding human milk at 12 weeks.

Inclusion Criteria:

• Currently live in Nepal
• Had a vaginal or cesarean delivery of a singleton full-term infant within the past 48 hours
• Not yet undergone lactogenesis
• Desire to use DMPA as a method of postpartum contraception

Exclusion Criteria:

• Desire a repeat pregnancy in less than 6 months
• Do not intend to exclusively feed infant own human milk for 6 months
• Do not have access to a telephone
• Any medical contraindication to DMPA
• Any contraindication to human milk feeding for their infant
• History of breast surgery (augmentation or reduction)
• Infant with a major congenital anomaly (will be excluded due to unique challenges with feeding in these populations)