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Contraceptive Practice Recommendations Tailored for Use in the U.S.

Guideline Watch |
June 14, 2013

Contraceptive Practice Recommendations Tailored for Use in the U.S.

  1. Eleanor Bimla Schwarz, MD, MSAU1978

The CDC has adapted the WHO's Selected Practice Recommendations for Contraceptive Use.

  1. Eleanor Bimla Schwarz, MD, MSAU1978

Despite recent advances in contraceptive technology, high unintended pregnancy rates remain problematic in the U.S. To help promote effective use of contraception, the CDC has adapted the WHO's Selected Practice Recommendations for Contraceptive Use for U.S. clinical settings. These revised guidelines arise from 30 systematic reviews (Contraception 2013; 87:701) as well as collective input from reproductive health experts about how best to translate this evidence into clinical recommendations.

The CDC's Selected Practice Recommendations offer evidence-based clinical guidance on a range of contraceptive management issues including initiation of contraception, necessary follow-up, and problems such as unscheduled bleeding and missed pills. Highlights of the guidelines include:

  • No laboratory testing is needed prior to initiating contraception.

  • No physical examination beyond a blood pressure check is needed prior to initiation of combined hormonal contraception.

  • Screening for cervical cancer is not necessary before placement of an intrauterine device (IUD).

  • Removing a woman's IUD is not necessary if she develops pelvic inflammatory disease; treatment with antibiotics is sufficient.

The CDC also identified significant research gaps and has committed to regularly updating the Selected Practice Recommendations to ensure that guidance remains current.

Comment

The Selected Practice Recommendations, like the CDC's Medical Eligibility Criteria for contraceptive use, verge on being encyclopedic. Several tools designed to make this information easily accessible in clinical settings have been developed, including a pocket-sized reference and an iPhone app. These resources, combined with the Affordable Care Act's mission to remove cost as a barrier to contraceptive choice, offer new hope for increased use of highly effective reversible contraceptives (i.e., intrauterine and subdermal methods) and meaningful reductions in rates of undesired pregnancy and induced abortion.

  • Disclosures for Eleanor Bimla Schwarz, MD, MS at time of publication Grant / research support AHRQ; American Diabetes Association; Department of Health and Human Services–Office of Population Affairs; FDA; Kellogg Foundation; NICHD; Society of Family Planning; VA; Women Veterans Health Editorial boards Contraception

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