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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
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