Keeping Guidance Up to Date

At a glance

This page describes the approach ÐÇ¿ÕÓéÀÖ¹ÙÍø uses for keeping the 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) up to date. The U.S. MEC comprises recommendations for health care providers for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions.

Overview

As with any evidence-based guidance document, a key challenge is keeping the recommendations up to date as new scientific evidence becomes available. Working with WHO, ÐÇ¿ÕÓéÀÖ¹ÙÍø uses the CIRE system to ensure that WHO and ÐÇ¿ÕÓéÀÖ¹ÙÍø guidance is based on the best available evidence and that a mechanism is in place to update guidance when new evidence becomes available.[16] ÐÇ¿ÕÓéÀÖ¹ÙÍø will continue to work with WHO to identify and assess all new relevant evidence and determine whether changes in the recommendations are warranted. ÐÇ¿ÕÓéÀÖ¹ÙÍø will completely review U.S. MEC periodically. Updates to the guidance will published in ÐÇ¿ÕÓéÀÖ¹ÙÍø's Morbidity and Mortality Weekly Report (MMWR) and posted on the ÐÇ¿ÕÓéÀÖ¹ÙÍø website (/contraception/hcp/contraceptive-guidance).

As part of the process to update these recommendations, ÐÇ¿ÕÓéÀÖ¹ÙÍø identifies gaps in the evidence for the recommendations considered. Evidence is often limited on the safety of contraceptive methods among persons with certain characteristics or medical conditions. Generalizability of the published evidence to all persons seeking contraceptive services presents a challenge because of biases about who might be included in studies on contraceptive safety. New, high-quality research on contraception that addresses priority research gaps inclusive of diverse populations can further strengthen these recommendations and improve clinical practice.

References

  1. Curtis KM, Nguyen AT, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2024. MMWR Recomm Rep 2024;73(No. RR-3):1–77.
  2. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-4):1–66.
  3. World Health Organization. Medical eligibility criteria for contraceptive use. Geneva, Switzerland: World Health Organization; 2015.
  4. World Health Organization. Selected practice recommendations for contraceptive use. Geneva, Switzerland: World Health Organization; 2016.
  5. ÐÇ¿ÕÓéÀÖ¹ÙÍø. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR Recomm Rep 2010;59(No. RR-4):1–86.
  6. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-3):1–103.
  7. Gavin L, Moskosky S, Carter M, et al.; ÐÇ¿ÕÓéÀÖ¹ÙÍø. Providing quality family planning services: recommendations of ÐÇ¿ÕÓéÀÖ¹ÙÍø and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-4):1–54.
  8. Gavin L, Pazol K. Update: providing quality family planning services—recommendations from ÐÇ¿ÕÓéÀÖ¹ÙÍø and the U.S. Office of Population Affairs, 2015. MMWR Morb Mortal Wkly Rep 2016;65:231–4.
  9. Gavin L, Pazol K, Ahrens K. Update: providing quality family planning services—recommendations from ÐÇ¿ÕÓéÀÖ¹ÙÍø and the U.S. Office of Population Affairs. MMWR Morb Mortal Wkly Rep 2017;66:1383–5.
  10. American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women, Contraceptive Equity Expert Work Group, and Committee on Ethics. Patient-centered contraceptive counseling: ACOG committee statement number 1. Obstet Gynecol 2022;139:350–3.

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  11. American Public Health Association. Opposing coercion in contraceptive access and care to promote reproductive health equity. Washington, DC: American Public Health Association; 2021.
  12. Holt K, Reed R, Crear-Perry J, Scott C, Wulf S, Dehlendorf C. Beyond same-day long-acting reversible contraceptive access: a person-centered framework for advancing high-quality, equitable contraceptive care. Am J Obstet Gynecol 2020;222(4S):S878.e1–e6.
  13. United Nations Population Fund. Programme of Action of the International Conference on Population and Development. Cairo, Egypt: United Nations; 1995.
  14. World Health Organization. Framework for ensuring human rights in the provision of contraceptive information and services. Geneva, Switzerland: World Health Organization; 2014.
  15. Tepper NK, Curtis KM, Cox S, Whiteman MK. Update to U.S. medical eligibility criteria for contraceptive use, 2016: updated recommendations for the use of contraception among women at high risk for HIV infection. MMWR Morb Mortal Wkly Rep 2020;69:405–10.
  16. Mohllajee AP, Curtis KM, Flanagan RG, Rinehart W, Gaffield ML, Peterson HB. Keeping up with evidence a new system for WHO’s evidence-based family planning guidance. Am J Prev Med 2005;28:483–90.
  17. ÐÇ¿ÕÓéÀÖ¹ÙÍø. Updating ÐÇ¿ÕÓéÀÖ¹ÙÍø’s contraception guidance documents: U.S. medical eligibility criteria for contraceptive use and U.S. selected practice recommendations for contraceptive use. Atlanta, GA: US Department of Health and Human Services, ÐÇ¿ÕÓéÀÖ¹ÙÍø; 2021.
  18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.
  19. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64:383–94.
  20. Guyatt GH, Oxman AD, Vist GE, et al.; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6.

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  21. Armstrong MJ, Rueda JD, Gronseth GS, Mullins CD. Framework for enhancing clinical practice guidelines through continuous patient engagement. Health Expect 2017;20:3–10.
  22. Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical practice guidelines we can trust. In: Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, eds. Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.
  23. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.
  24. Bradley SEK, Polis CB, Micks EA, Steiner MJ. Effectiveness, safety, and comparative side effects. In: Cason P, Cwiak C, Edelman A, Kowal D, Marrazzo JM, Nelson AL, et al., editors. Contracept Technol. 22nd ed. Burlington, MA: Jones-Bartlett Learning; 2023.
  25. Potter JE, Stevenson AJ, Coleman-Minahan K, et al. Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception 2019;100:1–4.
  26. Reproductive Health National Training Center. Contraceptive counseling and education eLearning. Washington, DC: US Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of Population Affairs, Office on Women’s Health; 2022.
  27. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1–187.
  28. ÐÇ¿ÕÓéÀÖ¹ÙÍø. US Public Health Service preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Atlanta, GA: US Department of Health and Human Services, ÐÇ¿ÕÓéÀÖ¹ÙÍø; 2021. /hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
  29. Blackwell S, Louis JM, Norton ME, et al. Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. Am J Obstet Gynecol 2020;222:B2–18.

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Division of Reproductive Health