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Current Opinion In Obstetrics and Gynecology. 2015 Dec; 27(6):451-9.PURPOSE OF REVIEW: The purpose of this review is to revisit the inception of the WHO's medical eligibility criteria for contraceptive use (MEC), particularly its objectives and methodology, and to describe its impact over the last 20 years in the field of family planning. New recommendations are summarized from the newly released fifth edition of the guidance. RECENT FINDINGS: Fourteen topics, encompassing over 575 recommendations were reviewed for the MEC, fifth edition. New recommendations include: changes for combined hormonal contraceptive use among postpartum women; progestogen-only methods among breastfeeding women; and women at high risk for HIV infection, women living with HIV, and women living with HIV using antiretroviral therapy and hormonal contraception. New methods reviewed include subcutaneously administered depot medroxyprogesterone acetate, Sino-implant (II), ulipristal acetate, and progesterone-releasing vaginal ring. SUMMARY: Over the past 20 years, the MEC has become a remarkably influential document for practitioners and policy makers in family planning, as it provides up-to-date, evidence-based recommendations for contraceptive use for women with various medical conditions and medically relevant characteristics.
Geneva, Switzerland, World Health Organization, Maternal and Child Health and Family Planning, Division of Family Health, 1990. iv, 59 p. (WHO/MCH/90.11)In February, 1987, the Safe Motherhood Conference was held in Nairobi, Kenya. It was sponsored by WHO, the World Bank, the UN Fund for Population Activities (UNFPA) and joined by UNDP. The Safe Motherhood Initiative was then started. This is a worldwide attempt to reduce maternal morbidity and mortality. The goal is to reduce maternal deaths by at least 1/2 by the year 2000. Partners in the safe motherhood initiative are governments, agencies, nongovernmental organizations (NGOs) and other groups and individuals who want to take part in efforts which will reduce the number of women dying and suffering from childbearing and pregnancy. A combination of health and nonhealth schemes is being used to add to the quality and safety of women's lives. Focus is on the need for more and better maternal health services, the extension of family planning facilities, and instruments that will improve the nutritional, social, and health status of females. Activities of the Safe Motherhood Initiative are reflected in many of the World Health Assembly Resolutions. There has also been a series of WHO Regional Committee resolutions. The major approach to achieve the reduction of maternal mortality and morbidity is actions in 4 areas. The 1st area is addressing social inequities; the 2nd, ensuring family planning access; the 3rd, developing community-based maternity care; and the 4th, providing support and backup at the 1st referral level for women who need obstetric care. Epidemiologic studies have been done, as have operation research studies. Evaluations of the home-based maternal record were completed in 12 countries by the end of 1988. Information analysis and dissemination and advocacy activities are described, as are technical cooperation activities with countries. Also described are human resources development activities and other closely linked program activities. Coordination and cooperation are described in chapter 4. A description of program management and resources is given in chapter 5.
International Journal of Gynecology and Obstetrics. 1992; 38 Suppl:S67-73.A staff person from the Population, Health, and Nutrition Division of the World Bank presents leading successful methods in evaluating maternal health programs in developing countries and their limitations. 1st it is important to define the program in terms of provider, setting, activities, interventions, and expected outcomes. It may be either a program with a single intervention or a complex program. The program evaluation must include coverage, equity, technical quality, women's satisfaction, efficiency, and cost effectiveness. The evaluators must compare these criteria with some standard usually based on previous research, so they need to define this standard. These standards can be theoretical standards or empirical standards such as best possible standards derived from randomized clinical and community trials and best achievable standards. Best achievable standards should be used, however, when significant differences exist between the outcomes of the health program in question and the best achievable standard. Depending on the choices made based on the aforementioned components, evaluators can choose the method and indicators to use. The most exact method for evaluating the efficacy of health interventions is the randomized clinical trial, but it is best for single interventions. Randomized clinical trials are not always achievable, however, because it is difficult to find similar communities in sufficient quantities for an adequate sample size and are costly. The most often used method is quasi-experiments including before and after measurements of the indicators, control group experiments, and demonstration health projects. The case control method is the only acceptable observational method. Another possible method is confidential investigations into maternal deaths. The most common indicators include structure, process, and outcome.