The table below summarizes World Health Organization (WHO) medical eligibility criteria for starting contraceptive methods. The table is based on the recommendations made by two meeting of a scientific working group, held in March 1994 and May 1995, and reassessed and updated at a subsequent scientific working group meeting in March 2000. The revised criteria are being published in the World Health Organization's second edition of Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for Contraceptive Use. The fulltext of the new edition is available on-line.
The scientific meetings classified known medical conditions that might affect eligibility for the use of a contraceptive method into one of the four following categories::
| WHO 1 | Can use the method. No restriction on use. |
|---|---|
| WHO 2 | Can use the method. Advantages generally outweigh theoretical or proven risks. Category 2 conditions could be considered in choosing a method. If the client chooses the method, more than usual follow-up may be needed. |
| WHO 3 | Should not use the method unless a doctor or nurse makes a clinical judgement that the client can safely use it. Theoretical or proven risks usually outweigh the advantages of the method. Method of last choice, for which regular monitoring will be needed. |
| WHO 4 | Should not use the method. Condition represents an unacceptable health risk if method is used. |
The table below shows the number of the WHO category, as recommended by the working group meetings, for each condition and each major family planning method.
The scientific group meetings classified each condition both as it affects initiating a method and, if a condition develops during use of a method, as it affects continuation. In most but not all instances, conditions were classified the same for initiation and for continuation. The table below reports initiation criteria only.
Where a doctor or nurse is not available to make clinical judgements, the WHO 4-category classification system can be simplified into a 2-category system as shown in this table:
| WHO Category | With Clinical Judgement |
With Limited Clinical Judgement |
|---|---|---|
| 1 | Use the method in any circumstances | Use the method |
| 2 | Generally use the method | Use the method |
| 3 | Use of the method not usually recommended unless other, more appropriate methods are not available or acceptable | Do not use the method |
| 4 | Method not to be used | Do not use the method |
No medical conditions rule out female sterilization or vasectomy. Some conditions call for the procedure to be delayed or performed with caution or under certain conditions. The WHO scientific group meetings classified medical conditions affecting the performance or female sterilization and vasectomy procedures into the following four categories:
| Accept | No medical reason prevents performing the procedure in a routine setting. |
|---|---|
| Caution | The procedure can be performed in a routine setting but with extra preparation and precautions. |
| Delay | Delay the procedure. Condition must be treated and resolved before the procedure can be performed. Provide temporary methods. |
| Refer | Refer client to a center where an experienced surgeon and staff can perform the procedure. Setting should be equipped for general anesthesia and other medical support. Provide temporary methods. (WHO calls this category "Special.") |
| Combined OCs | COCs | Norplant Implants | NP | Condoms | Con | Diaphragm, Cervical Cap | Dia/CC |
| Progestin-Only OCs | POCs | Female Sterilization | FS | Spermicides | Sperm | Fertility Awareness-Based Methods | FABM |
| DMPA/NET EN | DMPA | Vasectomy | Vas | TCu-380A IUD | IUD | Lactational Amenorrhea Method | LAM |
| CONDITION | COCs | POCs | DMPA | NP | FS | Vas | Con | IUD | Sperm | Dia/CC | FAMB | LAM |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pregnant | N/A | N/A | N/A | N/A | Delay | — | 1 | 4 | 1 | 1 | — | — |
| Age | ||||||||||||
| Less than 18 (< 20 for IUD) | 1 | 1 | 2 | 1 | Caution3 | —a | 1 | 2 | 1 | 1 | 1b , c | 1 |
| 18 to 39 | 1 | 1 | 1 | 1 | Accepta | —a | 1 | 1 | 1 | 1 | 1 | 1 |
| 40 to 45 | 2 | 1 | 1 | 1 | Accepta | —a | 1 | 1 | 1 | 1 | 1b , c | 1 |
| over 45 | 2 | 1 | 2 | 1 | Accepta | —a | 1 | 1 | 1 | 1 | 1b , c | 1 |
| Smoking | ||||||||||||
| Less than age 35 | 2 | 1 | 1 | 1 | Accepta | —a | 1 | 1 | 1 | 1 | 1 | 1 |
| Age 35 and over | ||||||||||||
| & Light smoker (fewer than 15 cigarettes per day) | 3 | 1 | 1 | 1 | Accepta | —a | 1 | 1 | 1 | 1 | 1 | 1 |
| & Heavy smoker (15 or more cigarettes per day) | 4 | 1 | 1 | 1 | Accepta | —a | 1 | 1 | 1 | 1 | 1 | 1 |
| High blood pressure (hypertension) | ||||||||||||
| Systolic 140-159 or diastolic 90-99 | 3 | 1 | 2 | 1 | Caution | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Systolic 160 and over or diastolic 100 and over | 4 | 2 | 3 | 2 | Refer | — | 1f | 1 | 1f | 1f | 1f | 1 |
| Adequately conntrolled hypertension where blood pressure can be monitored | 3 | 1 | 2 | 1 | Caution | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Past hypertension where blood pressure cannot be evaluated | 3 | 2 | 2 | 2 | Caution | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Diabetes | ||||||||||||
| Past elevated blood sugar levels during pregnancy | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Diabetes without vascular disease | ||||||||||||
| Not treated with insulin | 2 | 2 | 2 | 2 | Caution | Caution | 1 | 1 | 1 | 1 | 1 | 1 |
| Treated with insulin | 2 | 2 | 2 | 2 | Caution | Caution | 1d | 1 | 1d | 1d | 1d | 1 |
| Diabetes with vascular disease or diabetes for more than 20 years | 3/4g | 2 | 3 | 2 | Refer | Caution | 1d | 1 | 1d | 1d | 1d | 1f |
| Multiple cardiovascular risksh | 3/4 | 2 | 3 | 2 | Refer | — | 1 | 1 | 1 | 1 | — | — |
| Thromboembolic disorder i | ||||||||||||
| Current thromboembolic disorder | 4 | 3 | 3 | 3 | Delay | — | 1 | 1 | 1 | 1 | 1 | 1f , j |
| Past thromboembolic disorder | 4 | 3 | 3 | 3 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Ischemic heart disease k | ||||||||||||
| Current ischemic heart disease | 4 | 2 | 3 | 2 | Delay | — | 1d | 1 | 1d | 1d | 1d | 1f , j |
| Past ischemic heart disease | 4 | 2 | 3 | 2 | Caution | — | 1d | 1 | 1d | 1d | 1d | 1 |
| Valvular heart disease | ||||||||||||
| Without complications | 2 | 1 | 1 | 1 | Caution | — | 1 | 1 | 1 | 1 | 1 | 1 |
| With complicationsl | 4 | 1 | 1 | 1 | Refer | — | 1d | 2 | 1d | 1d | 1d | 1f , j |
| Varicose veins | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Superficial thrombophlebitism | 2 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Major surgery | ||||||||||||
| With prolonged immobilization or surgery on the legs | 4 | 1 | 1 | 1 | Delay | — | 1 | 1 | 1 | 1 | 1 | 1f , j |
| Without prolonged immobilization | 2 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Stroke (past cerebrovascular accident) | 4 | 2 | 3 | 2 | Caution | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Headaches | ||||||||||||
| Non migrain headaches, mild or severe | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Migraine without focal neurological symptomsn | 2 | 1 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Less than age 35 | 2 | 1 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Age 35 and older | 3 | 1 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Migraine with focal neurological symptomsn , o | 4 | 2 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Vaginal bleeding patterns | ||||||||||||
| Irregular without heavy bleeding | 1 | 2 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1p | — |
| Irregular with heavy or prolonged bleeding | 1 | 2 | 2 | 2 | Accept | — | 1 | 2q | 1 | 1 | 1p | — |
| Unexplained abnormal vaginal bleeding | 2 | 3 | 3 | 4 | Accept | — | 1 | 4 | 1 | 1 | 1p | — |
| Breast cancer | ||||||||||||
| Current | 4 | 4 | 4 | 4 | Caution | — | 1d | 1 | 1d | 1d | 1d | 1f , j |
| Past, with no evidence of disease in last 5 years | 3 | 3 | 3 | 3 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Breast lump (undiagnosed) | 2 | 2 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Benign breast disease | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Family history of breast cancer | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Cervical cancer (awaiting treatment) | 2 | 1 | 2 | 2 | Delay | — | 1d | 4 | 2d | 1d , r | 1b , d | 1f |
| Noncancerous cervical lesions (cervical intraepithelial neoplasia) | 2 | 1 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1r | 1b | 1 |
| Endometrial cancer | 1 | 1 | 1 | 1 | Delay | — | 1d | 4 | 1d | 1d | 1d | 1f |
| Ovarian cancer | 1 | 1 | 1 | 1 | Delay | — | 1 | 3 | 1 | 1 | 1 | 1 |
| Benign ovarian tumors (including cysts) | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Pelvic inflammatory disease (PID) | ||||||||||||
| Past PID (no known current risk of STDs) | ||||||||||||
| Became pregnant since PID | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Has not become pregnant since PID | 1 | 1 | 1 | 1 | Caution | — | 1 | 2 | 1 | 1 | 1 | 1 |
| Current PID or in last 3 monthss | 1 | 1 | 1 | 1 | Delay | — | 1 | 4 | 1 | 1 | 1b , t | 1 |
| Sexually transmitted disease (STDs)u | ||||||||||||
| Current STD (including purulent cervicitis)v | 1 | 1 | 1 | 1 | Delay | Delay | 1 | 4 | 1 | 1 | 1b | 1 |
| STD in last 3 months (no symptoms persisting after treatment) | 1 | 1 | 1 | 1 | Accept | — | 1 | 4 | 1 | 1 | 1b , t | 1 |
| Vaginitis without purulent cervicitisv , w | 1 | 1 | 1 | 1 | Accept | — | 1 | 2w | 1 | 1 | 1 | 1 |
| Increased risk of STDsx | 1 | 1 | 1 | 1 | Accept | — | 1 | 3 | 1 | 1 | 1 | 1 |
| Urinary tract infection | — | — | — | — | — | — | — | — | 1y | 1y | 1 | — |
| HIV infection/AIDSu | ||||||||||||
| HIV infected | 1 | 1 | 1 | 1 | Accept | Accept | 1d | 3z | 1d | 1d | 1d | 1aa |
| High risk of HIV infectionx | 1 | 1 | 1 | 1 | Accept | Accept | 1 | 3 | 2ab | 1 | 1 | 1aa |
| AIDS | 1 | 1 | 1 | 1 | Refer | Refer | 1d | 3z | 1d | 1d | 1d | 1aa |
| Gallbladder disease | ||||||||||||
| Current disease | 3 | 2 | 2 | 2 | Delay | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Treated with medication | 3 | 2 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Without symptoms or surgically treated | 2 | 2 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Past cholestasis (jaundice) | ||||||||||||
| Related to pregnancy | 2 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Related to past combined oral contraceptive use | 3 | 2 | 2 | 2 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Viral hepatitis | ||||||||||||
| Active disease | 4 | 3 | 3 | 3 | Delay | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Carrier | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Cirrhosis of the liver | ||||||||||||
| Mild (compensated) | 3 | 2 | 2 | 2 | Caution | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Severe (decompensated) | 4 | 3 | 3 | 3 | Refer | — | 1d | 1 | 1d | 1d | 1b , d , t | 1f , j |
| Liver tumors | ||||||||||||
| Benign | 4 | 3 | 3 | 3 | Caution | — | 1 | 1 | 1 | 1 | 1b , t | 1 |
| Malignant | 4 | 3 | 3 | 3 | Caution | — | 1d | 1 | 1d | 1d | 1b , d , t | 1f , j |
| Uterine fibroids | 1 | 1 | 1 | 1 | Caution | — | 1 | 2ac | 1 | 1 | 1 | 1 |
| Past ectopic pregnancy | 1 | 2 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Obesity (body mass index >30) | 2 | 1 | 2 | 2 | Caution | — | 1 | 1 | 1 | 1ad | 1 | 1 |
| Thyroid | ||||||||||||
| Simple goiter | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Hyperthyroid | 1 | 1 | 1 | 1 | Refer | — | 1 | 1 | 1 | 1 | 1b , t | 1 |
| Hypothyroid | 1 | 1 | 1 | 1 | Caution | — | 1 | 1 | 1 | 1 | 1b , t | 1f |
| Thalassemia (inherited anemia) | 1 | 1 | 1 | 1 | Caution | — | 1 | 2 | 1 | 1 | 1 | 1 |
| Trophoblast disease | ||||||||||||
| Benign | 1 | 1 | 1 | 1 | Accept | — | 1 | 3 | 1 | 1 | 1 | 1 |
| Malignant | 1 | 1 | 1 | 1 | Delay | — | 1d | 4 | 1d | 1d | 1d | 1f |
| Sickle cell disease | 2 | 1 | 1 | 1 | Caution | Accept | 1d | 2 | 1d | 1d | 1d | 1 |
| Coagulation (blood clotting) disorders | — | — | — | — | Refer | Refer | — | — | — | — | — | — |
| Iron deficiency anemia | ||||||||||||
| Hemoglobin 7 g/dl-10 g/dl | 1 | 1 | 1 | 1 | Caution | — | 1 | 2 | 1 | 1 | 1 | 1 |
| Hemoglobin less than 7 g/dl | 1 | 1 | 1 | 1 | Delay | — | 1 | 2 | 1 | 1 | 1 | 1 |
| Epilepsy | 1 | 1 | 1 | 1 | Caution | — | 1 | 1 | 1 | 1 | 1 | 1f |
| Schistosomiasis | ||||||||||||
| Without complications | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| With fibrosis of the liver | 1 | 1 | 1 | 1 | Caution | — | 1f | 1 | 1f | 1f | 1b , d , t | 1h |
| With severe fibrosis of the liver | 4 | 3 | 3 | 3 | Refer | — | 1f | 1 | 1f | 1f | 1b , d , t | 1h |
| Malaria | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | 1 |
| Drug interactions | ||||||||||||
| Taking the antibiotics rifampin (rifampicine) or griseofulvin | 3 | 3 | 2 | 3 | Caution | — | 1 | 1 | 1 | 1 | 1 | — |
| Taking other antibioticsae | 1 | 1 | 1 | 1 | Accept | — | 1 | 1 | 1 | 1 | 1 | — |
| Taking anticonvulsants for epilepsy except valproic acidaf | 3 | 3 | 2 | 3 | Caution | — | 1 | 1 | 1 | 1 | 1 | — |
| Allergy to latex | — | — | — | — | — | — | 3ag | — | 1 | 3 | — | — |
| Other drug use | ||||||||||||
| Mood-altering drugs, lithium therapy, tricyclic antidepressants, or anti-anxiety therapies | — | — | — | — | — | — | — | — | — | — | 1b , t | 4ah |
| Parity | ||||||||||||
| Nulliparous (has no children) | 1 | 1 | 1 | 1 | Acceptai | Acceptai | 1 | 2 | 1 | 1 | 1 | — |
| parous (has children) | 1 | 1 | 1 | 1 | Accept | Accept | 1 | 1 | 1 | 2 | 1 | 1 |
| Severe dysmenorrhea (pain during menstruation) | 1 | 1 | 1 | 1 | Accept | — | 1 | 2 | 1 | 1 | 1 | —aj |
| Tuberculosis | ||||||||||||
| Nonpelvic | 1 | 1 | 1 | 1 | Accept | — | 1d | 1 | 1d | 1d | 1d | 1ak |
| Pelvic | 1 | 1 | 1 | 1 | Refer | — | 1d | 4 | 1d | 1d | 1d | 1ak |
| Endometriosis | 1 | 1 | 1 | Refer | — | 1 | 2 | 1 | 1 | 1 | 1 | |
| Anatomical abnormalities | ||||||||||||
| Distorted uterine cavity | — | — | — | — | — | — | — | 4al | — | —am | — | — |
| Other abnormalities not distorting the uterine cavity and not interfering with IUD insertionan | — | — | — | — | — | — | — | 2 | — | — | — | — |
| Past toxic shock syndrome | — | — | — | — | — | — | 1 | — | 1 | 3 | — | — |
| Breastfeeding | ||||||||||||
| Less than 6 weeks after childbirth | 4 | 3 | 3 | 3 | Accept | — | 1 | —ao | 1 | —ao | 1b | 1 |
| 6 weeks to 6 months after childbirth (fully or almost fully breastfeeding) | 3 | 1 | 1 | 1 | Accept | — | 1 | — | 1 | 1 | 1b | 1 |
| 6 months or more after childbirth | 2 | 1 | 1 | 1 | Accept | — | 1 | — | 1 | 1 | 1b | — |
| Postpartum (nonbreastfeeding women) | ||||||||||||
| Less than 21 days after childbirth | 3 | 1 | 1 | 1 | * | ** | 1 | + | 1 | — | 1b | — |
| 21 days or more after childbirth | 1 | 1 | 1 | 1 | * | ** | 1 | + | 1 | —ao | 1b | — |
| Postabortion | ||||||||||||
| First trimester | 1 | 1 | 1 | 1 | — | — | 1 | 1 | 1 | 1 | 1b | — |
| Second trimester | 1 | 1 | 1 | 1 | — | — | 1 | 2 | 1 | 1ap | 1b | — |
| After septic abortionaq | 1 | 1 | 1 | 1 | — | — | 1 | 4 | 1 | 1 | 1b | — |
| N/A | Not applicable to decision to use method. |
| — | Condition not listed by WHO for this method; does not affect eligibility for method use. |
| a | Sterilization is appropriate for women and men of any age, but only if they are sure they will not want children in the future. |
| b | This condition may affect ovarian function and/or change fertility signs and symptoms and/or make methods difficult to learn and use. |
| c | Shortly after menarche (age at first menstrual bleeding) and as menopause approaches, menstrual cycles may be irregular. |
| d | Higher typical failure rates of this method may expose the user to an unacceptable risk of dangerous unintended pregnancy. |
| e | With or without vascular disease. |
| f | Breastfeeding may not be recommended with drugs used to treat this condition. |
| g | Category 3 or 4, depending on the severity of the condition. |
| h | Risk factors for arterial disease, such as age, smoking, diabetes and high blood pressure |
| i | Circulatory disease due to blood clots. |
| j | LAM has no impact on this condition, but the condition may rule out breastfeeding. |
| k | Heart disease due to blocked arteries. |
| l | Pulmonary hypertension, risk of arterial fibrillation, history of subacute bacterial endocarditis, or taking anticoagulant drugs. |
| m | Inflammation of a vein just beneath the skin. |
| n | Focal neurological symptoms = blurred vision, temporary loss of vision, sees flashing lights or zigzag lines, or has brief trouble speaking or moving. |
| o | Regardless of age. |
| p | This condition may make the calendar method difficult or impossible to use effectively. |
| q | Category 3 if client is anemic. Also, unusually heavy bleeding may indicate a serious underlying condition. |
| r | Cervical cap not recommended. |
| s | Including endometritis (inflammation of the lining of the uterus) following childbirth or abortion. |
| t | Condition does not affect vaginal bleeding patterns; calendar method can be used. |
| u | Barrier methods, especially condoms, are always recommended for prevention of STDs, including HIV/AIDS. |
| v | Purulent cervicitis = a pus-like discharge from the opening of the cervix. |
| w | In areas where STD incidence is high, vaginitis may indicate an STD. |
| x | For example, currently has or will have more than one sex partner or a partner who has more than one partner. |
| y | There is a potential increased risk of urinary tract infection with diaphragms and spermicides. |
| z | For IUDs, HIV-infected or any other medical condition or medication that makes the body less able to fight infection. |
| aa | In areas where infectious disease is the main cause of infant death, HIV-infected women should be advised to breastfeed. In other areas, if affordable alternatives to breastmilk are available, HIV-infected women should not breastfeed. |
| ab | High dose of nonoxynol-9 spermicide may cause vaginal abrasions, which may increase risk of HIV infection. |
| ac | Uterine fibroids distorting the uterine cavity; otherwise category 1. |
| ad | Severe obesity may make diaphragm or cap placement difficult. |
| ae | Antibiotics other than rifampin and griseofulvin. |
| af | Barbiturates, phenytoin, carbamezapine, primidone. |
| ag | Allergy to latex is not a problem with plastic condoms, if available. |
| ah | In order to protect infant health, breastfeeding is not recommended. |
| ai | Counseling requires special care to ensure an informed choice is made. |
| aj | Menstruation indicates need for another contraceptive method. |
| ak | Decision to breastfeed should take into consideration the risks and benefits to the infant. |
| al | Any abnormality distorting the uterine cavity so that proper IUD insertion is not possible. |
| am | Diaphragm cannot be used in certain cases of prolapse; cap not acceptable for clients with severely distorted cervical anatomy. |
| an | Including uterine fibroids, cervical stenosis, or cervical lacerations. |
| ao | Can start diaphragm use 6 weeks after childbirth. |
| ap | Can start diaphragm use 6 weeks after second-trimester abortion. |
| aq | That is, immediately after abortion involving genital tract infection. |
Conditions that require delay: abdominal skin infection; acute bronchitis or pneumonia; emergency surgery; surgery for an infectious condition; systemic infection or severe gastroenteritis.
Conditions that require referral to a special center: chronic asthma, bronchitis, emphysema, or lung infection; fixed uterus due to previous surgery or infection; abdominal wall or umbilical hernia.
Conditions that require caution: diaphragmatic hernia; kidney disease; elective surgery; severe nutritional deficiencies.
Conditions that pose no special requirements: cesarian section.
Postpartum sterilization conditions that require delay: 7 days to 42 days after childbirth; severe preeclampsia/eclampsia; prolonged rupture of membranes (24 hours or more); severe hemorrhage; fever during or right after delivery; sepsis; severe trauma to the genital tract (cervical or vaginal tear at delivery).
Postpartum sterilization conditions that require referal to a special center: uterine rupture or perforation.
Postpartum sterilization conditions that pose no special requirements: less than 7 days after childbirth; more than 42 days after childbirth; mild preeclampsia.
Postpartum sterilization conditions that require delay: severe sepsis or fever; severe hemorrhage; severe trauma to the genital tract; acute hematometra (excess blood in the uterus).
Postabortion sterilization conditions that require referal to a special center: uterine perforation.
** Additional conditions related to vasectomy:
Conditions that require delay: scrotal skin infection; active STD; balanitis; epididymitis or orchitis; systemic infection or severe gastroenteritis; filariasis or elephantiasis; intrascrotal mass.
Conditions that require caution: previous scrotal surgery or injury; large varicocele, large hydrocele; cryptorchidism. (In some circumstances, cryptorchidism may require referral.)
+ Additional conditions related to TCu"-3"80A IUD, postpartum insertion (breastfeeding or nonbreastfeeding):
Condition that represents an unacceptable health risk (WHO 4): puerperal sepsis (genital tract infection during the first 42 days after childbirth).
Condition that requires a doctor or nurse to make a clinical judgement that the client can safely use an IUD (WHO 3): 48 hours to 4 weeks postpartum.
Condition for which advantages of IUD use generally outweigh theoretical or proven risks (WHO 2): less than 48 hours after childbirth.
Condition that requires no restriction: More than 4 weeks after childbirth.
++ Additional conditions related to LAM:
Conditions that represent an unacceptable health risk to the infant: use of reserpine, ergotamine, antimetabolites, cyclosporine, cortisone, bromocriptine, radioactive drugs, lithium, or anticoagulants.
Conditions for which LAM has no effect on the condition, but the condition may prevent breastfeeding: sore nipples; mastitis (breast inflammation); congenital deformity of infant's mouth, jaw or palate; infant small for age, premature birth, or neonatal intensive care; past breast surgery; certain infant metabolic disorders.
Condition that requires no restrictions (WHO 1): breast engorgement.