CDC Article-US Medical Eligibility Criteria for Contraceptive Use, 2010

Vol. 59 / RR-4 Recommendations and Reports 1
U S. Medical Eligibility Criteria for Contraceptive Use, 2010
Adapted from the World Health Organization Medical Eligibility Criteria
for Contraceptive Use, 4th edition
Prepared by
Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion
Summary
CDC created U.S. Medical Eligibility Criteria for Contraceptive Use, 2010, from guidance developed by the World Health
Organization (WHO) and finalized the recommendations after consultation with a group of health professionals who met in
Atlanta, Georgia, during February 2009. This guidance comprises recommendations for the use of specific contraceptive methods by
women and men who have certain characteristics or medical conditions. The majority of the U.S. guidance does not differ from the
WHO guidance and covers >60 characteristics or medical conditions. However, some WHO recommendations were modified for
use in the United States, including recommendations about contraceptive use for women with venous thromboembolism, valvular
heart disease, ovarian cancer, and uterine fibroids and for postpartum and breastfeeding women. Recommendations were added
to the U.S. guidance for women with rheumatoid arthritis, history of bariatric surgery, peripartum cardiomyopathy, endometrial
hyperplasia, inflammatory bowel disease, and solid organ transplantation. The recommendations in this document are intended
to assist health-care providers when they counsel women, men, and couples about contraceptive method choice. Although these
recommendations are meant to serve as a source of clinical guidance, health-care providers should always consider the individual
clinical circumstances of each person seeking family planning services.
Introduction
In 1996, the World Health Organization (WHO) published
the first edition of the Medical Eligibility Criteria for
Contraceptive Use (MEC), which gave evidence-based guidance
on the safety of contraceptive method use for women and
men worldwide who had specific characteristics and medical
conditions. Since that time, WHO has regularly updated its
guidance on the basis of new evidence, and the WHO MEC
is now in its fourth edition (1).
CDC, through close collaboration with WHO, has contributed
substantially during the last 15 years to creation of
WHO’s global family planning guidance, which includes four
documents: the medical eligibility criteria for contraceptive
use, the selected practice recommendations for contraceptive
use, a decision-making tool for clients and providers, and a
global family planning handbook. This WHO guidance has
been based on the best available scientific evidence, and CDC
has served as the lead for establishing that evidence base and
presenting the evidence to WHO for use during its expert
working group meetings to create and update the guidance.
WHO has always intended for its global guidance to be used
by local or regional policy makers, managers of family planning
Corresponding preparer: Kathryn M. Curtis, PhD, Division of
Reproductive Health, CDC, MS K-34, 4770 Buford Highway NE,
Atlanta, GA 30341; Telephone 770-488-6397; Fax: 770-488-6391;
E-mail kmc6@cdc.gov
programs, and the scientific community as a reference when
they develop family planning guidance at the country or program
level. The United Kingdom is one example of a country
that has adapted the WHO MEC for its own use (2).
CDC undertook a formal process to adapt the WHO MEC
at this time because the fourth edition of the WHO guidance is
unlikely to undergo major revisions in the near future. Although
the WHO guidance is already available in the United States
through inclusion in textbooks, use by professional organizations,
and incorporation into training programs, the adaptation of the
guidance ensures its appropriateness for use in the United States
and allows for further dissemination and implementation among
U.S. health-care providers. Most of the U.S. guidance does not
differ from the WHO guidance and covers approximately 60 characteristics
or medical conditions. However, several changes have
been made, including adaptations of selected WHO recommendations,
addition of recommendations for new medical conditions,
and removal of recommendations for contraceptive methods not
currently available in the United States (Appendix A).
This document contains recommendations for health-care
providers for the safe use of contraceptive methods by women
and men with various characteristics and medical conditions. It is
intended to assist health-care providers when they counsel women,
men, and couples about contraceptive method choice. These
recommendations are meant to be a source of clinical guidance;
health-care providers should always consider the individual
clinical circumstances of each person seeking family planning
services.