Medical Eligibility Criteria for Contraceptive Use

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    © 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.