Introduction of U.S. MEC, 2024

At a glance

This page introduces the 2024 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), which comprises recommendations for health care providers for the use of specific contraceptive methods by persons who have certain characteristics or medical conditions.

Introduction

U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 (U.S. MEC) provides recommendations for health care providers for safe use of contraceptive methods for persons who have certain characteristics or medical conditions within the framework of removing unnecessary medical barriers to accessing and using contraception. U.S. MEC is a companion document to U.S. Selected Practice Recommendations for Contraceptive Use, 2024 (U.S. SPR),[1] which provides recommendations for health care providers that address provision of contraceptive methods and management of side effects and issues related to contraceptive method use.[2] Both U.S. MEC and U.S. SPR were adapted from global guidance developed by the World Health Organization (WHO).[3],[4] WHO intended for the global guidance to be used by local or national policymakers, family planning program managers, and the scientific community as a reference when they develop family planning guidance at the country or program level.[3] CDC first published U.S. MEC in 2010, after a formal process during 2008–2010 to adapt the global guidance for use in the United States, which included rigorous identification and critical appraisal of the scientific evidence through systematic reviews and input from national experts on how to translate that evidence into recommendations for U.S. health care providers;[5] a subsequent update was published in 2016.[6]

U.S. MEC and U.S. SPR recommendations are components of quality contraceptive services and can be used in conjunction with other guidance documents such as Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs, which provides recommendations for the content and delivery of services related to preventing or for achieving pregnancy.[7–9] Evidence-based guidance can support health care providers when providing person-centered counseling and contraceptive services, including assisting persons in selecting and using contraceptive methods safely and effectively.

Equitable access to the full range of contraceptive methods for all those seeking care is an essential component of high-quality sexual and reproductive health care. Contraceptive services should be offered in a noncoercive manner that supports a person's values, goals, and reproductive autonomy through a shared decision-making process with health care providers.[10–14] Because of the history of and ongoing forced sterilization and reproductive coercion in the United States among persons of racial and ethnic minority groups, persons with disabilities, and other groups that have been marginalized, it is important that persons can select the method that best meets their needs to promote reproductive autonomy.[10–12]

This report replaces the 2016 version of U.S. MEC[6] with new and revised recommendations, on the basis of new evidence and input from experts. This updated document uses gender-inclusive language throughout. However, when summarizing published evidence that describes study populations by specific genders, the wording of the primary studies has been maintained for accuracy. A summary of new and revised recommendations from the 2016 U.S. MEC is provided (Appendix A). Notable updates include:

  • Addition of recommendations for persons with chronic kidney disease, specifically those with nephrotic syndrome, those receiving hemodialysis, and those receiving peritoneal dialysis.
  • Revisions to recommendations for persons with certain characteristics or medical conditions (i.e., breastfeeding, postpartum, postabortion, obesity, surgery, history of deep venous thrombosis or pulmonary embolism with or without anticoagulant therapy, thrombophilia, superficial venous thrombosis, valvular heart disease, peripartum cardiomyopathy, systemic lupus erythematosus, cirrhosis, liver tumor, sickle cell disease, and solid organ transplantation).
  • Revisions to recommendations for persons at high risk for HIV infection (this recommendation was developed and published in 2020).[15]
  • Revisions to recommendations for drug interactions with antiretrovirals to include prevention in addition to treatment for HIV infection (this recommendation was developed and published in 2020).[15]
  • Inclusion of additional contraceptive methods, including new doses or formulations of combined oral contraceptives (COCs), contraceptive patches, vaginal rings, progestin-only pills (POPs), levonorgestrel intrauterine devices (LNG-IUDs), and vaginal pH modulator.

U.S. MEC recommendations are meant to serve as a source of evidence-based clinical guidance for health care providers and can support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

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References

  1. Curtis KM, Nguyen AT, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2024. MMWR Recomm Rep 2024;73(No. RR-3):1–77.
  2. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-4):1–66. PMID:27467319 https://doi.org/10.15585/mmwr.rr6504a1
  3. World Health Organization. Medical eligibility criteria for contraceptive use. Geneva, Switzerland: World Health Organization; 2015. https://www.who.int/publications/i/item/9789241549158
  4. World Health Organization. Selected practice recommendations for contraceptive use. Geneva, Switzerland: World Health Organization; 2016. https://www.who.int/publications/i/item/9789241565400
  5. CDC. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR Recomm Rep 2010;59(No. RR-4):1–86. PMID:20559203
  6. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-3):1–103. PMID:27467196 https://doi.org/10.15585/mmwr.rr6503a1
  7. Gavin L, Moskosky S, Carter M, et al.; CDC. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep 2014;63(No. RR-4):1–54. PMID:24759690
  8. Gavin L, Pazol K. Update: providing quality family planning services—recommendations from CDC and the U.S. Office of Population Affairs, 2015. MMWR Morb Mortal Wkly Rep 2016;65:231–4. PMID:26963363 https://doi.org/10.15585/mmwr.mm6509a3
  9. Gavin L, Pazol K, Ahrens K. Update: providing quality family planning services—recommendations from CDC and the U.S. Office of Population Affairs. MMWR Morb Mortal Wkly Rep 2017;66:1383–5. PMID:29267259 https://doi.org/10.15585/mmwr.mm6650a4
  10. American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women, Contraceptive Equity Expert Work Group, and Committee on Ethics. Patient-centered contraceptive counseling: ACOG committee statement number 1. Obstet Gynecol 2022;139:350–3. PMID:35061341 https://doi.org/10.1097/AOG.0000000000004659

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  11. American Public Health Association. Opposing coercion in contraceptive access and care to promote reproductive health equity. Washington, DC: American Public Health Association; 2021. https://www.apha.org/Policies-and-Advocacy/Public-Health-Policy-Statements/Policy-Database/2022/01/07/Contraceptive-Access
  12. Holt K, Reed R, Crear-Perry J, Scott C, Wulf S, Dehlendorf C. Beyond same-day long-acting reversible contraceptive access: a person-centered framework for advancing high-quality, equitable contraceptive care. Am J Obstet Gynecol 2020;222(4S):S878.e1–e6. PMID:31809706 https://doi.org/10.1016/j.ajog.2019.11.1279
  13. United Nations Population Fund. Programme of Action of the International Conference on Population and Development. Cairo, Egypt: United Nations; 1995. https://unfpa.org/sites/default/files/pub-pdf/programme_of_action_Web%20ENGLISH.pdf
  14. World Health Organization. Framework for ensuring human rights in the provision of contraceptive information and services. Geneva, Switzerland: World Health Organization; 2014. https://www.who.int/publications/i/item/9789241507745
  15. Tepper NK, Curtis KM, Cox S, Whiteman MK. Update to U.S. medical eligibility criteria for contraceptive use, 2016: updated recommendations for the use of contraception among women at high risk for HIV infection. MMWR Morb Mortal Wkly Rep 2020;69:405–10. PMID:32271729 https://doi.org/10.15585/mmwr.mm6914a3
  16. Mohllajee AP, Curtis KM, Flanagan RG, Rinehart W, Gaffield ML, Peterson HB. Keeping up with evidence a new system for WHO’s evidence-based family planning guidance. Am J Prev Med 2005;28:483–90. PMID:15894153 https://doi.org/10.1016/j.amepre.2005.02.008
  17. CDC. Updating CDC’s contraception guidance documents: U.S. medical eligibility criteria for contraceptive use and U.S. selected practice recommendations for contraceptive use. Atlanta, GA: US Department of Health and Human Services, CDC; 2021. https://www.govinfo.gov/content/pkg/FR-2021-08-31/pdf/2021-18769.pdf
  18. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. PMID:33782057 https://doi.org/10.1136/bmj.n71
  19. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol 2011;64:383–94. PMID:21195583 https://doi.org/10.1016/j.jclinepi.2010.04.026
  20. Guyatt GH, Oxman AD, Vist GE, et al.; GRADE Working Group. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924–6. PMID:18436948 https://doi.org/10.1136/bmj.39489.470347.AD

    21. Back to Top

  21. Armstrong MJ, Rueda JD, Gronseth GS, Mullins CD. Framework for enhancing clinical practice guidelines through continuous patient engagement. Health Expect 2017;20:3–10. PMID:27115476 https://doi.org/10.1111/hex.12467
  22. Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical practice guidelines we can trust. In: Graham R, Mancher M, Miller Wolman D, Greenfield S, Steinberg E, eds. Clinical practice guidelines we can trust. Washington, DC: National Academies Press; 2011.
  23. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.
  24. Bradley SEK, Polis CB, Micks EA, Steiner MJ. Effectiveness, safety, and comparative side effects. In: Cason P, Cwiak C, Edelman A, Kowal D, Marrazzo JM, Nelson AL, et al., editors. Contracept Technol. 22nd ed. Burlington, MA: Jones-Bartlett Learning; 2023.
  25. Potter JE, Stevenson AJ, Coleman-Minahan K, et al. Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception 2019;100:1–4. PMID:30851238 https://doi.org/10.1016/j.contraception.2019.02.005
  26. Reproductive Health National Training Center. Contraceptive counseling and education eLearning. Washington, DC: US Department of Health and Human Services, Office of the Assistant Secretary for Health, Office of Population Affairs, Office on Women’s Health; 2022. https://rhntc.org/resources/contraceptive-counseling-and-education-elearning
  27. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1–187. PMID:34292926 https://doi.org/10.15585/mmwr.rr7004a1
  28. CDC. US Public Health Service preexposure prophylaxis for the prevention of HIV infection in the United States—2021 update: a clinical practice guideline. Atlanta, GA: US Department of Health and Human Services, CDC; 2021. https://www.cdc.gov/hiv/pdf/risk/prep/cdc-hiv-prep-guidelines-2021.pdf
  29. Blackwell S, Louis JM, Norton ME, et al. Reproductive services for women at high risk for maternal mortality: a report of the workshop of the Society for Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, the Fellowship in Family Planning, and the Society of Family Planning. Am J Obstet Gynecol 2020;222:B2–18. PMID:32252942 https://doi.org/10.1016/j.ajog.2019.12.008

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Division of Reproductive Health