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The World Health Organization (WHO) has issued new family planning guidance, including the following:
- Most women with HIV infection generally can use IUDs.
- Women generally can take hormonal contraceptives while on antiretroviral (ARV) therapy for HIV infection, although there are interactions between contraceptive hormones and certain ARV drugs.
- Women with clinical depression usually can take hormonal contraceptives.
More than 35 experts met at WHO headquarters in Geneva, Switzerland, in October 2003 and developed this and other new guidance. The new guidance updates the Medical Eligibility Criteria (MEC) for Contraceptive Use. This was the third expert meeting to consider medical eligibility criteria. WHO first issued the MEC in 1996; they were first updated in 2000 (51).
MEC help define who can use which contraceptive methods
The MEC offer guidance on whether a person with a specific health condition can safely start to use a specific contraceptive method or, if she or he develops a health condition, can continue to use the method safely. For each health condition and contraceptive method addressed, the Expert Working Group by consensus classified a condition on a scale of 1 to 4. Table 1 describes these four categories, which were set out at the first MEC meetings in 1994-95. Where limited clinical judgement is available, categories 1 and 2 mean that people with the specific condition can safely use the method; categories 3 and 4 mean that they should not use it.
In the 2003 meeting the Expert Working Group addressed contraceptive use in situations involving or related to HIV/AIDS, considered whether certain drugs interact with hormonal contraceptives, assessed several new contraceptive methods, looked at several new conditions, and reviewed new evidence relevant to several other issues. This issue of INFO Reports focuses on changes and new criteria likely to have the greatest impact on service delivery.
| Table 1. WHO Medical Eligibility Criteria Classifications |
| Category |
Description |
Interpretation When Clinical Judgement Is Available |
Interpretation When Clinical Judgement Is Limited |
| 1 |
No restriction for the use of the contraceptive method. |
Use the method in any circumstances. |
Use the method. |
| 2 |
The advantages of using the method generally outweigh the theoretical or proven risks. |
Generally use the method. |
| 3 |
The theoretical or proven risks usually outweigh the advantages of using the method. Safe use requires careful clinical judgement and access to clnical services. |
Use the method not usually recommended unless other more appropriate methods are not available or not acceptable. |
Do not use the method. |
| 4 |
A condition which represents an unacceptable health risk if the contraceptive method is used. |
Method not to be used. |
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Source: World Health Organization, 2000 (51)
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