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Research Triangle Park, North Carolina, FHI, 2008.  p.In order to help nonmenstruating clients safely initiate their method of choice, Family Health International (FHI) developed a simple checklist for use by family planning providers. Although originally the Pregnancy Checklist was developed for use by family planning providers, it can also be used by other health care providers who need to determine whether a client is not pregnant. For example, pharmacists may use this checklist when prescribing certain medications that should be avoided during pregnancy (e.g., certain antibiotics or anti-seizure drugs). The checklist is endorsed by the World Health Organization (WHO) and is based on criteria established by WHO for determining with reasonable certainty that a woman is not pregnant. Evaluation of the checklist in family planning clinics has demonstrated that the tool is very effective in correctly identifying women who are not pregnant. Furthermore, recent studies in Guatemala, Mali, and Senegal have shown that use of the checklist by family planning providers significantly reduced the proportion of clients being turned away due to menstrual status and improved women's access to contraceptive services.
Studies in Family Planning. 2005 Dec; 36(4):311-315.Women in many countries are often denied vital family planning services if they are not menstruating when they present at clinics, for fear that they might be pregnant. A simple checklist based on criteria approved by the World Health Organization has been developed to help providers rule out pregnancy among such clients, but its use is not yet widespread. Researchers in Guatemala, Mali, and Senegal conducted operations research to determine whether a simple, replicable introduction of this checklist improved access to contraceptive services by reducing the proportion of clients denied services. From 2001 to 2003, sociodemographic and service data were collected from 4,823 women from 16 clinics in three countries. In each clinic, data were collected prior to introduction of the checklist and again three to six weeks after the intervention. Among new family planning clients, denial of the desired method due to menstrual status decreased significantly from 16 percent to 2 percent in Guatemala and from 11 percent to 6 percent in Senegal. Multivariate analyses and bivariate analyses of changes within subgroups of nonmenstruating clients confirmed and reinforced these statistically significant findings. In Mali, denial rates were essentially unchanged, but they were low from the start. Where denial of services to nonmenstruating family planning clients was a problem, introduction of the pregnancy checklist significantly reduced denial rates. This simple, inexpensive job aid improves women's access to essential family planning services. (author's)
Progress in Reproductive Health Research. 2005; (68):8.Service providers need to be able to assess whether a woman who is seeking contraceptive services might already be pregnant. This can be difficult at a very early stage. Biochemical tests are often useful, but are not available in all areas. Pelvic examination, where feasible, is reliable from approximately 8–10 weeks after the first day of the last menstrual period. You can be reasonably certain that the woman is not pregnant if she has no symptoms or signs of pregnancy, and meets any of the following criteria: she has not had intercourse since her last normal menstrual period; she has been correctly and consistently using a reliable method of contraception; she started a normal menstrual period less than seven days ago; she had an abortion or a miscarriage less than 7 days ago; she gave birth less than 4 weeks ago (for non-breastfeeding women); she gave birth less than 6 months ago, is fully or nearly fully breastfeeding, and her menstrual periods have not returned. (excerpt)