New WHO Medical Eligibility Criteria for Contraceptive Use Expected to Change the Family Planning Landscape

Ruwaida Salem

CCP | Associate Managing Editor, Global Health: Science and Practice
© 2012 Karolina Lagiewka, Courtesy of Photoshare
A mother in Kenya practices exclusive breastfeeding. By relaxing restrictions on use of progestin-only hormonal methods by breastfeeding women, the latest edition of the WHO Medical Eligibility Criteria expands women’s contraceptive options during the critical postpartum period.© 2012 Karolina Lagiewka, Courtesy of Photoshare
 

The World Health Organization (WHO) released highlights of its fifth edition to the Medical Eligibility Criteria for Contraceptive Use (MEC) on June 1, 2015.

During a Facebook Q&A chat coinciding with the release, Dr. Marlene Temmerman, WHO Director of the Department of Reproductive Health and Research, explained that among the most substantial updates in the latest MEC edition are the addition of four new contraceptive methods and the relaxed recommendations on use of progestin-only pills and implants by breastfeeding women.

The four new methods added to the fifth MEC edition are:

  1. Subcutaneous DMPA (follows current MEC recommendations for intramuscular DMPA)
  2. Sino-implant (II) (follows current MEC recommendations for levonorgestrel implants)
  3. Ulipristal acetate (UPA) emergency contraceptive pills (follows current MEC recommendations for levonorgestrel and combined oral contraceptives used as emergency contraception, except for breastfeeding women the MEC category is 2 for UPA instead of 1; category 2 means that the advantages of using the method generally outweigh the risks while category 1 indicates there is no restriction on use of the method)
  4. Progesterone-releasing vaginal ring (the previous MEC edition included recommendations only for the combined contraceptive vaginal ring)

The change that is getting the most buzz in the global health field though is the increased contraceptive options for breastfeeding women under six weeks postpartum. In the previous edition of the MEC, generally the only reversible contraceptives that such women could use were barriers methods and the lactational amenorrhea method (LAM). Now, WHO recommends that breastfeeding women under 6 weeks postpartum can also generally use progestin-only pills and implants (MEC category 2; advantages of using the method generally outweigh the risks). The change brings the WHO recommendations more in line with those from other normative bodies, including the US Centers for Disease Control and Prevention and the UK’s Royal College of Obstetricians and Gynaecologists.

Opening up the option to use implants, in particular, helps expand breastfeeding women’s access to highly effective contraception during the critical postpartum period when many women do not want to get pregnant soon after a birth but are not using contraception. Many of these women with unmet family planning need have limited access to health services. If they do deliver in a health facility, they may not be able to come back for a check-up six weeks later to get their preferred contraceptive method. Expanding the contraceptive options from which they can choose immediately after birth—while they’re already at a health facility or with a skilled birth attendant—might make the difference between starting a contraceptive method that fits their lifestyle and needs and having an unintended pregnancy that is at higher risk for maternal and newborn death. 

The latest round of changes to the MEC were a results of two expert working group meetings convened by WHO in 2014, in which 68 individuals representing a wide range of stakeholders reviewed 14 topics, encompassing more than 575 recommendations. The Executive Summary of the 2015 fifth edition, along with the updated 2015 MEC Wheel (a tool to facilitate use of the MEC), are currently available on the WHO website. The full fifth edition is expected to be available by July 1, 2015.

Comments

Thanks for this great summary, Ruwaida! The MEC revisions will also affect Family Planning: A Global Handbook for Providers and the Family Planning Training Resource Package. We are adding the new MEC wheel to those websites as an interim reference, and will be updating all other affected content in the coming months.