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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.
ADVANCES IN CONTRACEPTION. 1993 Jun; 9(2):129-39.Quality of care means that the needs of the clients should be the major determinant of the behavior of the providers and the goal of the programs. Quality of care can be considered a right of the clients, defining clients not only as those who approach the health care system for services but also as everyone in the community who is in need of services. Any member of the community who is of reproductive age should be considered a potential client for family planning (FP) services. The International Planned Parenthood Federation (IPPF) has outlined 10 rights of FP clients: rights to information, access, choice, safety, privacy, confidentiality, dignity, comfort, continuity, and opinion. Program managers and service providers should achieve fulfillment of the rights of the FP clients. This goal is directly related to the availability and quality of FP information and services. The responsibilities for quality of care are distributed throughout the whole FP program, but those who are actually seen as most responsible are the ones who are in direct contact with the clients; the service providers. The needs of the service providers can be enumerated as a need for training, information, infrastructure, supplies, guidance, back-up, respect, encouragement, feedback and self-expression. The interaction between clients and providers of contraceptive services could be an exchange of knowledge, needs, and experience that contributes to the personal growth of both. Quality of care involves physical, technical, and human aspects. When fulfilling the rights of the clients and needs of the service providers, both technical and human aspects should be taken into account.