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Recommendations to Promote Safe and Effective Use of Contraceptives: World Health Organization [letter]
CHRISMED Journal of Health and Research. 2017 Oct-Dec; 4(4):291.The authors discuss the need to support and strengthen national family planning programs through more investment and better awareness to address the 220 million women who have an unmet need for family planning.
Geneva, Switzerland, WHO, 2017. 12 p. (Summary Brief WHO/RHR/17.20)Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid- and lower-level cadres limit access to effective contraceptive methods in many settings. Expanding the provision of contraceptive methods to other health worker cadres can significantly improve access to contraception for all individuals and couples. Many countries have already enabled mid- and lower-level cadres of health workers to deliver a range of contraceptive methods, utilizing these cadres either alone or as part of teams within communities and/or health care facilities. The WHO recognizes task sharing as a promising strategy for addressing the critical lack of health care workers to provide reproductive, maternal and newborn care in low-income countries. Task sharing is envisioned to create a more rational distribution of tasks and responsibilities among cadres of health workers to improve access and cost-effectiveness.
Contraceptive method considerations for clients with HIV including those on ART: provider reference tool.
[Washington, D.C.], FHI 360, 2017 Nov. 2 p.This is an at-a-glance resource for clinical providers to determine whether clients with HIV, including those on antiretroviral therapy (ART), may initiate or continue using common contraceptive methods. This chart is based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use (2016). The tool provides foundational information for clinical providers on how the effectiveness of different types of hormonal contraceptive methods is affected by interaction with antiretroviral drugs. It also provides guidance on how to promote informed decision-making and help women with HIV who are taking antiretroviral drugs use their chosen hormonal contraceptive method successfully.
Contraceptives and condoms for family planning and STI & HIV prevention external procurement support report.
New York, New York, United Nations Population Fund [UNFPA], 2014 Dec. 86 p.Access to reproductive health, including family planning, is recognized as a human right. Support from donors is critical to improving and ensuring the security of essential contraceptives and other life-saving reproductive health commodities. Contraceptives procured through external support constitute a significant contribution to reproductive health, including family planning and, through the dual protection provided by condoms, the prevention of sexually transmitted infections (STIs) including HIV. This report, updated annually, is a rich source of data for development that can drive good planning for contraceptive supply, advocacy and resource mobilization. The report contains dozens of figures, tables, and graphs, along with information and analysis that can influence policy dialogue, advocacy and interagency work. It aims to enhance coordination among donors, improve partnerships between donors and national governments, and mobilize the resources needed to accelerate progress towards universal access to sexual and reproductive health, and in particular to reduce the unmet need for family planning. The report also analyses data received from individual donors and partner organizations about the support they have provided directly to developing countries for the procurement of contraceptives and condoms.
Washington, D.C., PAI, 2016 Oct. 2 p.When the Global Financing Facility (GFF) was announced in 2014, it promised a “pioneering” way to finance and improve the lives of women, adolescents, children and newborns through provision of reproductive, maternal newborn and child health programs and policies. Family planning advocates and implementers were interested in the possibility of additional funds particularly as a global contraceptives funding crisis is looming, and the Sustainable Development Goals (SDGs) are being operationalized. To date, the GFF has had three rounds of countries selected to receive funding. In the first round, Democratic Republic of the Congo, Ethiopia, Kenya and Tanzania were selected. In the second round, Bangladesh, Cameroon, Liberia, Mozambique, Nigeria, Senegal and Uganda were selected. In the third round, Guatemala, Guinea, Myanmar and Sierra Leone were selected. To better understand the role of the GFF in filling funding gaps for family planning and contraceptive procurement, we analyzed the four published investment cases for Kenya, Tanzania, Ethiopia and Uganda.
Quality of care in contraceptive information and services, based on human rights standards: a checklist for health care providers.
Geneva, Switzerland, WHO, 2017. 32 p.Unmet need for contraception remains high in many settings, and is highest among the most vulnerable in society: adolescents, the poor, those living in rural areas and urban slums, people living with HIV, and internally displaced people. The latest estimates are that 225 million women have an unmet need for modern contraception, and the need is greatest where the risks of maternal mortality are highest. There is increasing recognition that promotion and protection of human rights in contraceptive services and programs is critical to addressing this challenge. However, despite these efforts, human rights are often not explicitly integrated into the design, implementation and monitoring of services. A key challenge is how to best support health care providers and facility managers at the point of service delivery, often in low-resource real-world settings, to ensure their use of human rights aspects in provision of contraceptive services. The point of service delivery is the most direct point of contact where potential violations/omissions of rights come into play and requires special attention. This checklist covers five areas of competence needed by health care providers to provide quality of care in contraceptive information and services including: respecting users’ privacy and guaranteeing confidentiality, choice, accessible and acceptable services, involvement of users in improving services and fostering continuity of care and follow-up. International and regional human rights treaties, national constitutions and laws provide guarantees specifically relating to access to contraceptive information, commodities and services. In addition, over the past few decades, international, regional and national legislative and human rights bodies have increasingly applied human rights to contraceptive information and services. They recommend, among other actions, that states should ensure timely and affordable access to good quality sexual and reproductive health information and services, including contraception, which should be delivered in a way that ensures fully informed decision making, respects dignity, autonomy, privacy and confidentiality, and is sensitive to individuals’ needs and perspectives. This document presents a user friendly checklist specifically addressed to health care providers, at the primary health care level, who are involved in the direct provision of contraceptive information and services. It is complimentary to WHO guidelines on Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations, and the Implementation Guide published jointly with UNFPA in 2015. This checklist also builds on WHO vision document on Standards for Improving Quality of Care for Maternal and Newborn Care and its ongoing work under the Quality, Equity and Dignity initiative. The checklist should be read along with other guidance from WHO and also from partners.
Selected practice recommendations for contraceptive use. Third edition 2016. Web annex: Development of updated guidance for the third edition.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2016. 50 p.Over the past 40 years, there have been significant advances in the development of new contraceptive technologies, including changes in formulations and dosing, schedules for administration and novel delivery systems. However, current policies and health-care practices in some countries are based on scientific studies of contraceptive products that are no longer in wide use, on long-standing theoretical concerns that have never been substantiated or on the personal preference or bias of service providers. These outdated policies or practices often result in limitations to both the quality of and the access to family planning services for clients. The goal of this document is to improve access to and quality of family planning services by providing policy-makers and decision-makers with a set of recommendations on how to use family planning methods safely and effectively once they are deemed medically appropriate. Because country situations and programme environments vary so greatly, it is inappropriate to set firm international guidelines on criteria for contraceptive use. However, it is expected that national programmes will use these recommendations for updating or developing their own contraceptive guidelines according to national health policies, needs, priorities and resources, while reflecting upon local values and preferences. There are a total of four World Health Organization (WHO) guidance documents (cornerstones) pertaining to contraception: two focusing on evidenced-based recommendations (primarily targeted towards policy-makers and programme managers) and two focusing on application of the recommendations (primarily targeted towards health-care providers). All four cornerstones are best interpreted and used in a broader context of reproductive and sexual health care. These documents are updated periodically to reflect changes in medical and scientific knowledge. (excerpt)
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2016. 72 p.This document is part of the process for improving the quality of care in family planning. Specifically, it is one of two evidence-based cornerstones (guidance documents) of the World Health Organization’s (WHO’s) initiative to develop and implement family planning guidelines for national programmes. The first cornerstone, the Medical eligibility criteria for contraceptive use (MEC, now in its fifth edition), provides thorough information and guidance on the safety of various contraceptive methods for use in the context of specific health conditions and characteristics. This document, Selected practice recommendations for contraceptive use, third edition (SPR third edition), is the second cornerstone; it provides guidance for how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate. For recommendations issued in the SPR, safety considerations include common barriers to safe, correct and consistent use of contraception and the benefits of preventing unintended or unwanted pregnancy.
Hormonal contraceptive eligibility for women at high risk of HIV. Guidance statement. Recommendations concerning the use of hormonal contraceptive methods by women at high risk of HIV.
Geneva, Switzerland, WHO, 2017. 20 p. (WHO/RHR/17.04)The World Health Organization (WHO) convened a technical consultation during 1-2 December 2016 to review new evidence on the risk of HIV acquisition with the use of hormonal contraception. The issue was recognized as a critical one, particularly for sub-Saharan Africa, where women have a high lifetime risk of acquiring HIV, hormonal contraceptives constitute a significant component of the contraceptive method mix and unintended pregnancy is a common threat to the well-being and lives of women and girls. A wide range of stakeholders were present at this meeting, and serving on the Guideline Development Group (GDG) was global representation from experts in family planning and HIV, representatives from affected populations, clinicians, epidemiologists, researchers, programme managers, policy-makers and guideline methodologists. The GDG considered the following factors in making their determination for each contraceptive method: quality of the evidence (GRADE profile); values and preferences of contraceptive users and health care providers; balance of benefits and harms; priority of the problem; equity and human rights; acceptability; and feasibility. Through consensus, the GDG arrived at new recommendations for progestogen-only injectables. The recommendations for use of progestogen-only injectables among women at high risk of HIV changed from category 1 to category 2, with an accompanying clarification, in the Medical eligibility criteria for contraceptive use (MEC). Recommendations for all other methods of hormonal contraception remained unchanged. (Excerpts)
The Botswana Medical Eligibility Criteria Wheel: Adapting a tool to meet the needs of Botswana's family planning program.
African Journal of Reproductive Health. 2016 Jun; 20(2):9-12.In efforts to strive for family planning repositioning in Botswana, the Ministry of Health convened a meeting to undertake an adaptation of the Medical eligibility criteria for contraceptive use (MEC) wheel. The main objectives of this process were to present technical updates of the various contraceptive methods, to update the current medical conditions prevalent to Botswana and to adapt the MEC wheel to meet the needs of the Botswanian people. This commentary focuses on the adaptation process that occurred during the week-long stakeholder workshop. It concludes with the key elements learned from this process that can potentially inform countries who are interested in undergoing a similar exercise to strengthen their family planning needs.
[New recommendations from the World Health Organization (WHO) for the use of contraceptive methods] Nuevas recomendaciones de la Organizacion Mundial de la Salud (OMS) para el uso de los metodos anticonceptivos.
Gaceta Medica De Mexico. 2016 Sep - Oct; 152(5):601-603.The Medical Eligibility Criteria for Contraceptive Use of the World Health Organization have been updated recently. These criteria constitute a guideline for the selection of family planning methods appropriated for women and men with known medical conditions or personal characteristics of medical relevance. The guidelines last updating incorporates recommendations for the use of a new emergency contraceptive pill and three long-acting hormonal methods, and revises some previously established recommendations. This article provides information on the last edition of such document and aims to contribute to its dissemination.
Contraception. 2016 Sep; 94(3):193-194.Add to my documents.
Geneva, Switzerland, WHO, 2015.  p. (WHO/RHR/15.07)This executive summary contains all the new recommendations that will be incorporated into the fifth edition of the Medical eligibility criteria for contraceptive use. In addition to the recommendations themselves, the summary provides an introduction to the guideline, a description of the methods used to develop the recommendations for this fifth edition, and a summary of changes (from the fourth edition to the fifth edition of the MEC). It is anticipated that the Medical eligibility criteria for contraceptive use, fifth edition will be available online by 1 July 2015. In the interim, the fourth edition of the guideline, along with this summary of new recommendations provides the complete set of WHO recommendations on medical eligibility criteria for contraceptive use.
Hormonal contraceptive methods for women at high risk of HIV and living with HIV. 2014 guidance statement. Recommendations concerning the use of hormonal contraceptive methods by women at high risk of HIV and women living with HIV.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2014.  p. (WHO/RHR/14.24)During 9-12 March 2014, the World Health Organization (WHO) convened a meeting of the Guideline Development Group (GDG) comprising 52 individuals representing a wide range of stakeholders, for the purpose of reviewing, and where appropriate, revising its Medical eligibility criteria for contraceptive use, fourth edition (MEC) guidance. Recommendations concerning the use of hormonal contraceptive methods by women at high risk of HIV and women living with HIV, including women taking antiretroviral therapy (ART), were among the many topics reviewed at this meeting. Given the public health importance of this topic, and at the encouragement of the GDG, the World Health Organization is issuing its contraceptive eligibility guidance for women at high risk of HIV and women living with HIV in advance of the entire guideline revision. It is anticipated that the revised fifth edition of the MEC will be completed in 2015. Recommendations for hormonal contraceptive use are provided for: women at high risk of HIV infection; women living with asymptomatic or mild HIV clinical disease (WHO stage 1 or 2); women living with severe or advanced HIV clinical disease (WHO stage 3 or 4); women living with HIV using antiretroviral therapy (ART). In addition to the recommendations themselves, this publication provides a description of the background and methods used in their development. An executive summary and information on dissemination and evaluation are also included. (Excerpts)
Best Practice and Research. Clinical Obstetrics & Gynaecology. 2014 Aug; 28(6):917-30.Many women in the reproductive years have chronic medical conditions that are affected by pregnancy or in which the fetus is placed at increased risk. In most of these women, ongoing medical management of their conditions is greatly improved, even compared with a decade or two ago. However, their condition may still be seriously exacerbated by the physiological changes of pregnancy, and close monitoring of a carefully planned pregnancy is optimal. This requires effective and safe contraceptive use until pregnancy is desired and the medical condition is stabilised. Many contraceptives will also have adverse effects on some medical conditions, and there is now a considerable awareness of the complexities of some of these interactions. For this reason the World Health Organization has developed an excellent, simple and pragmatic programme of guidelines on a four point scale (the WHO "Medical Eligibility Criteria": WHO-MEC), summarising risk of specific contraceptive methods in women with specified chronic medical conditions. The general approach to contraceptive management of many of these conditions is addressed in this article. Copyright (c) 2014. Published by Elsevier Ltd.
Programmatic and research considerations for hormonal contraception for women at risk of HIV and women living with HIV.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2012 May.  p. (Policy Implications; WHO/RHR/12.09)Between 31 January and 2 February 2012, the World Health Organization (WHO) convened a meeting of experts to discuss recent research on use of hormonal contraception by women at high risk of HIV and those currently living with HIV and its implications. The purpose of the meeting was to review all available published evidence on the relationship between the use of hormonal contraceptives and the risk of HIV acquisition, HIV disease progression, and HIV transmission to uninfected partners, and to determine whether any change in the WHO recommendations on hormonal contraceptive use by women at high risk of, or living with, HIV-infection was needed. During the discussion on the balance of risks and benefits of hormonal contraceptive use among women at high risk of, or living with, HIV infection, multiple programmatic and research issues emerged, including priority knowledge gaps. This brief serves to highlight actions that programmes providing sexual and reproductive health and HIV-prevention services should undertake, in order to complement the Consultation’s recommendations. Directions for future research to address current gaps are noted. (Excerpts)
[Geneva, Switzerland], WHO, 2010 Mar.  p.Adapted from the WHO's Decision-Making Tool for Family Planning Clients and Poviders, this flip-chart is a tool to use during family planning counseling or in group sessions with clients. It can: help your clients choose and use the method of family planning that suits them best; give you the information you need for high-quality and effective family planning counselling and care; help you know who may need referral.
Journal of Midwifery and Women's Health. 2011 Nov; 56(6):598-607.In the late 1990s, the World Health Organization (WHO) created the Medical Eligibility Criteria for Contraceptive Use (MEC), which provide evidence-based recommendations for safe and effective contraception in women with medical problems. The WHO MEC incorporate the best available evidence, are periodically updated, and are designed to be modified for specific populations. The US Centers for Disease Control and Prevention published US MEC in 2010. Changes to WHO guidelines for use in the US population include the following areas: breastfeeding, intrauterine device use, valvular heart disease, ovarian cancer, uterine fibroids, and venous thromboembolism. Medical conditions not covered by WHO recommendations but added to the US MEC include contraceptive guidance for women with inflammatory bowel disease, history of bariatric surgery, rheumatoid arthritis, endometrial hyperplasia, history of peripartum cardiomyopathy, and history of solid organ transplant. This article reviews the changes and additions to WHO MEC found in the US MEC. (c) 2011 by the American College of Nurse-Midwives.
Journal of Women's Health. 2011 Jun; 20(6):825-8.Abstract Women with unintended pregnancies are more likely to experience poor pregnancy outcomes. For women with medical conditions, unintended pregnancy may worsen the condition and carry even greater risk of adverse pregnancy outcomes, including maternal and perinatal death. Although safe and highly effective contraceptive methods are available to prevent unintended pregnancy, there may be concerns about the safety of contraceptive methods among women with medical conditions. The Centers for Disease Control and Prevention (CDC) has recently developed the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, which provides evidence-based recommendations for the safety of contraceptive use among women with medical conditions. Most women, even those with medical conditions, can safely use most methods of contraception.
Update to CDC's U.S. Medical Eligibility Criteria for Contraceptive Use, 2010: revised recommendations for the use of contraceptive methods during the postpartum period.
MMWR. Morbidity and Mortality Weekly Report. 2011 Jul 8; 60(26):878-83.Initiation of contraception during the postpartum period is important to prevent unintended pregnancy and short birth intervals, which can lead to negative health outcomes for mother and infant. In 2010, CDC published U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC), providing evidence-based guidance for choosing a contraceptive method based on the relative safety of contraceptive methods for women with certain characteristics or medical conditions, including women who are postpartum. Recently, CDC assessed evidence regarding the safety of combined hormonal contraceptive use during the postpartum period. This report summarizes that assessment and the resulting updated guidance. These updated recommendations state that postpartum women should not use combined hormonal contraceptives during the first 21 days after delivery because of the high risk for venous thromboembolism (VTE) during this period. During 21-42 days postpartum, women without risk factors for VTE generally can initiate combined hormonal contraceptives, but women with risk factors for VTE (e.g., previous VTE or recent cesarean delivery) generally should not use these methods. After 42 days postpartum, no restrictions on the use of combined hormonal contraceptives based on postpartum status apply.
U S. Medical Eligibility Criteria for Contraceptive Use, 2010: adapted from the World Health Organization Medical Eligibility Criteria for Contraceptive Use, 4th edition.
MMWR. Recommendations and Reports. 2010 Jun 18; 59(RR-4):1-86.CDC created U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, from guidance developed by the World Health Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in Atlanta, Georgia, during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the WHO guidance and covers >60 characteristics or medical conditions. However, some WHO recommendations were modified for use in the United States, including recommendations about contraceptive use for women with venous thromboembolism, valvular heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added to the U.S. guidance for women with rheumatoid arthritis, history of bariatric surgery, peripartum cardiomyopathy, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation. The recommendations in this document are intended to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual clinical circumstances of each person seeking family planning services.
Adaptation of the World Health Organization's Medical Eligibility Criteria for Contraceptive Use for use in the United States.
Contraception. 2010 Jul; 82(1):3-9.BACKGROUND: The Centers for Disease Control and Prevention (CDC) recently adapted global guidance on contraceptive use from the World Health Organization (WHO) to create the United States Medical Eligibility Criteria for Contraceptive Use (MEC). This guidance includes recommendations for use of specific contraceptive methods by people with certain characteristics or medical conditions. STUDY DESIGN: CDC determined the need and scope for the adaptation, conducted 12 systematic reviews of the scientific evidence and convened a meeting of health professionals to discuss recommendations based on the evidence. RESULTS: The vast majority of the US guidance is the same as the WHO guidance and addresses over 160 characteristics or medical conditions. Modifications were made to WHO recommendations for six medical conditions, and recommendations were developed for six new medical conditions. CONCLUSION: The US MEC is intended to serve as a source of clinical guidance for providers as they counsel clients about contraceptive method choices. Published by Elsevier Inc.
Contraception. 2010 Jul; 82(1):113-8.This article aims to stimulate research to address gaps in the Medical Eligibility Criteria for Contraceptive Use so that more women have access to the most appropriate contraceptive methods, based on safety and effectiveness, for their particular condition and characteristics. It identifies the three conditions for which further research is needed; contraception for obese women, contraception for breastfeeding women, and contraception for women with HIV or AIDS. Copyright © 2010 Elsevier Inc. All rights reserved.
Postpartum Family Planning: Sharing Experiences, Lessons Learned and Tools for Programming -- Meeting report, 12 May 2009, Washington, D.C.
Baltimore, Maryland, Jhpiego, ACCESS, Family Planning Initiative [ACCESS-FP], 2009.  p.On May 12, 2009, more than 76 experts and leaders in reproductive health (RH) and maternal, neonatal and child health (MNCH) from more than 22 global health organizations and programs convened in Washington, D.C., for the “Postpartum Family Planning: Sharing Experiences, Lessons Learned and Tools for Programming” meeting. The meeting had three objectives: 1. Present and discuss experiences and lessons learned in implementing PPFP in a variety of settings; 2. Share tools and other resources to support PPFP programming; and 3. Discuss progress, continuing priorities for research and advancing MNCH / FP integration. (Excerpts)
[New York, New York], UNFPA, 2008. 30 p.Since 1990, the United Nations Population Fund (UNFPA) has been tracking donor support for contraceptives and condoms for STI / HIV prevention. The Fund publishes an annual report based on this donor database to enhance the coordination among partners at all levels to continue progress toward universal access to sexual and reproductive health, as set forth in the ICPD Programme of Action and, subsequently, the Millennium Development Goals. This report represents the 2008 installment of the series and has three main sections. The first section summarizes patterns and trends—by method, by donor and by region—in donor support from 2000-2008. The second section takes a closer look at donor support for male and female condoms over time and by region. The third and final section compares aggregate donor support to global contraceptive need for 2000-2008 and provides projections of contraceptive needs through 2015. (Excerpt)