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WHO Medical Eligibility Criteria for contraceptive use and other FP Guidelines and ToolsMary Lyn Gaffield and Mario FestinHuman Reproduction Team Department of Reproductive Health and Research

September 2015

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Outline of the presentation

Medical eligibility criteria for contraceptive use 5th ed– Process to develop the 5th edition– Expanding access to contraception

• New contraceptive methods included• More options for women who breastfeed, women living with HIV,

women at high risk of HIV, and women taking ARVs MEC Wheel Family Planning Training Resource Package (TRP) Other cornerstones and tools

– Selected practices recommendations (SPR)– WHO counseling tools, Global handbook,

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Medical Eligibility Criteria

Selected Practice Recommendations

Decision-Making ToolDecision-Making Tool(to be updated)(to be updated)

Global HandbookTo be updated in 2016

Family planning guidelines and tools: Family planning guidelines and tools: constant updates, constant demandconstant updates, constant demand

The Medical Eligibility Criteria

(MEC) Wheel (new)

Reproductive Choices and Family Planning for People with HIV (to be updated)

Guide to family planning for community health care providers and their clients(to be updated)

5th edition

3rd edition in 2016

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Medical eligibility criteria for contraceptive use (MEC)

Purpose: Who can safely use contraceptive methods?

Offers ≈ 2000 recommendations for 25 methods

– pre-existing medical conditions– personal characteristics– certain health problem

Developed through consensus driven process during 3 consultations

– Systematic review of scientific evidence – Adhered to WHO procedures for

guideline development Previous editions 1996, 2000, 2004, 2009

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MEC Categories

Where warranted, recommendations will differ if a woman is starting a method (I = initiation) or

continuing a method (C = continuation)

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Highlights

Recommendations in the MEC 5th edition enable programmes to further expand contraceptive choice

Four new methods of contraception added to the 5th edition

Breastfeeding women have more contraceptive choices during the postpartum period

Women living with HIV, including women taking ART have more contraceptive options

Adolescents can use all methods of contraception, including IUDs and implants

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Methods of contraception Combined oral contraceptives Combined hormonal contraceptives (1

month injectables, patch, vaginal ring) Progestogen-only contraceptives

(pills, implants, 2-3 month injectables)– DMPA subcutaneous (NEW method)

– Sino-implant (II) (NEW method)

Emergency contraceptive pills– Ulipristal acetate (NEW method)

IUDs (copper bearing and levonorgestrel)

Emergency IUD Barrier methods (condoms,

spermicides & diaphragm)

Fertility awareness-based methods

Lactational amenorrhoea (LAM)

Progesterone-releasing vaginal ring (NEW method)

Coitus Interruptus Sterilization (male and female)

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DMPA-subcutaneous injectable (DMPA SC)

Depot medroxyprogesterone acetate is delivered subcutaneously (DMPA SC) at dose of 104 mg/0.65 mL

– Also feasible for self-administration

Guideline group determined all recommendations for DMPA SC should follow existing DMPA intramuscular injectable recommendations

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Sino-implant (II)

2-rod, 150 mg LNG implant manufactured in China

Guideline group determined that all Sino-implant (II) recommendations should follow existing LNG implant recommendations

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Ulipristal Acetate (UPA)

Delays ovulation

Single dose and effective up to 120 hours

All women can use UPA for emergency

contraception – For example, women with the following conditions and/or

characteristics can use UPA: migraine, breastfeeding, obesity,

past ectopic pregnancy, taking certain medications, history of

severe cardiovascular disease, rape, repeat EC use

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Progesterone-releasing vaginal ring (PVR)

• Specifically designed for women who actively breastfeed (at least 4 episodes/day)

• Delivers daily low dose of natural progesterone

• Currently registered in at least 9 Latin American countries

• Women can use the PVR without restriction from 4 weeks post delivery

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Breastfeeding and postpartumTime period Progestogen-only

pillDMPA/NET-EN injectable

Levorgestrel/Etonogestrel implants

< 6 weeks postpartum 2 3 2

≥ 6 weeks postpartum

1 1 1

Time period LNG-IUD

<48 hours including insertion immediately after cesearan section

not breastfeeding = 1breastfeeding = 2

≥ 48 hours to < 4 weeks 3

≥ 4 weeks 1

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Women living with HIV, taking ART and at high risk of HIV infection For women at high risk of HIV or living with HIV, WHO

recommends no restrictions for:

– Combined hormonal contraceptives or progestogen-only contraceptives

– LNG –IUDs can generally be used; however, initiation should be generally avoided if living with advanced/severe disease

For women taking ART, WHO recommends they are generally eligible to use hormonal contraception

Consistent and correct use of condoms, male or female, is critical to protect against STIs/HIV and for prevention of HIV transmission

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MEC Wheel

Contains the MEC for starting use of contraceptive methods

Filename

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MEC Wheel Selected methods

Medical or health conditions

MEC category Comments

Filename

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FP Training Resource Packagewww.fptraining.org

The PackageOn-line Tool for trainers to design, implement, evaluate FP/contraception training based on evidence-based guidelines Pre-service and in-service training applicable in both public and private sectors

New modules added (Emergency contraception – for providers and for pharmacists, and SDM)Translation into French completed for all 10 modules, with a request for Spanish and Portuguese translation

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Derivative products and tools

Counseling Tools (to be revised/updated as needed)– Decision-making tool– Guide to family

planning for CHWs– Reproductive

choices and family planning for people living with HIV

2020

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Selected practice recommendations for contraceptive use (SPR) – 3rd edition

Revision of the SPR is underway

Anticipated release of 3rd edition during Spring 2016

Will release new service delivery recommendations for the patch, vaginal ring and regular use of contraception after ECP use

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Global Handbook for Family Planning

Revision underway, anticipated completion Summer 2016

Recommendations issued within the MEC 5th edition and SPR 3rd edition will be incorporated

Guidance from other relevant WHO documents to be included, such as (but not limited to):– task shifting– human rights– cervical cancer– gender-based violence– postnatal care– HIV counseling

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Copies of the MEC 5th edition can be downloaded from: http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/

Visit our website who.int/reproductivehealth

Email us at: hrx-info@who.int