National Partnership for Women & Families

Monthly Women's Health Research Review

Commentary outlines updates to CDC guidance on contraceptive use

Summary of "Removing medical barriers to contraception -- evidence-based recommendations from the Centers for Disease Control and Prevention, 2016," Kathryn M. Curtis et al., Contraception, August 30, 2016.

"[O]verall contraceptive use in the United States has remained fairly steady at about 60 percent among all females ages 15-44 years, but recently, use of the most effective, long-acting, reversible methods (LARCs) -- intrauterine devices (IUDs) and implants -- has been increasing," Kathryn M. Curtis of the Center for Disease Control and Prevention's (CDC) Division of Reproductive Health and colleagues wrote, citing recent declines in the unintended pregnancy rate among U.S. women overall and teenagers in particular.

The researchers noted that not only have studies on contraception and LARC initiatives in Colorado and Idaho "demonstrated success in increasing the use of contraception overall, including the most effective methods, and most importantly, decreasing unintended pregnancy," but the Affordable Care Act (ACA) also "requires most health plans to cover certain preventive services for women, including contraceptive methods and counseling."

The researchers continued, "It is within this context that the [CDC] has updated its evidence-based recommendations for health care providers on contraceptive use -- U.S. Medical Eligibility Criteria for Contraceptive Use, 2016 (US MEC) and U.S. Selected Practice Recommendations for Contraceptive Use, 2016 (US SPR)." These updated recommendations will not only aid providers in helping patients select "the most appropriate contraceptive method for individual circumstances and us[e] that method correctly, consistently and continuously to maximize effectiveness," but the recommendations "can also support removal of unnecessary medical barriers to access and successful use of contraceptive methods." According to the researchers, such barriers "can include unnecessary restrictions based on age, parity or presence of a medical condition"; "unnecessary screening examinations and tests before starting a method"; "inability to receive contraception on the same day as the visit"; and "difficulty obtaining continued contraceptive supplies."

The researchers explained the US MEC and UC SPR -- originally published in 2010 and 2013, respectively -- "have been included in the clinical recommendations for the Title X Family Planning Program, endorsed by the American College of Obstetricians and Gynecologists and disseminated widely to women's health, adolescent and primary care providers." The researchers outlined CDC's revision process for the recommendations and highlighted some of the primary updates.

For instance, in the UC MEC, CDC included new recommendations on safe contraceptive use "for women with multiple sclerosis and cystic fibrosis and for those using certain psychotropic drugs or St. John's wort" and added ulipristal acetate to emergency contraception recommendations. CDC also updated advice on contraceptive use for postpartum women, breastfeeding women, women with known conditions such as migraines or sexually transmitted infections, as well as for women undergoing antiretroviral therapy. In the US SPR, CDC provided additional advice on medicine to ease IUD insertion and updated guidance on beginning regular contraception after using emergency contraception. According to the researchers, during the revision and update process, CDC "identified gaps in the evidence, with the goal of encouraging investigation that can lead to further refinement of the recommendations." CDC also "developed and updated provider tools that can assist with implementation of the recommendations in practice."

The researchers noted that despite an ongoing effort to update and refine the recommendations based on new evidence, "the main messages in the guidance remain the same": "Most women -- including adolescents, those who are postpartum and those with certain medical conditions or other specific characteristics -- can safely use most methods of contraception," most "can start contraceptive methods on the day they request them, and few, if any, tests or examinations are needed before initiating any method." The researchers added that "[r]outine follow-up for most women after starting a contraceptive method includes assessment of her satisfaction with the method, concerns about the method and changes in medical eligibility for continued use."

The researchers praised the "exciting progress ... made in reducing unintended pregnancy in the United States," but they noted that "unnecessary barriers to contraception access and use remain." They conclude, "The US MEC and US SPR can help providers continue to remove medical barriers, as they work with patients to choose and use contraception successfully, enabling continued declines in unintended and teen pregnancy."