At a glance
This page introduces the 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR). The U.S. SPR provides recommendations for health care providers that address a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods.
Introduction
U.S. Selected Practice Recommendations for Contraceptive Use, 2024 (U.S. SPR) provides recommendations for health care providers that address provision of contraceptive methods and management of side effects and issues related to contraceptive method use within the framework of removing unnecessary medical barriers to accessing and using contraception. U.S. SPR is a companion document to U.S. Medical Eligibility Criteria for Contraceptive Use, 2024 (U.S. MEC),[1] which provides recommendations for safe use of contraceptive methods for persons with various medical conditions and other characteristics. Both U.S. MEC and U.S. SPR were adapted from global guidance developed by the World Health Organization (WHO).[2],[3] 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] During 2012–2013, CDC went through a formal process 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;[4] a subsequent update was published in 2016.[5]
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.[6–8] 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.[9–13] 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.[9–13]
This report replaces the 2016 version of U.S. SPR[5] 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. Notable updates include 1) updated recommendations for provision of medications for intrauterine device (IUD) placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. CDC reviewed and affirmed the recommendations for bleeding irregularities with levonorgestrel (LNG) IUD (LNG-IUD) use and for use of regular contraception after ulipristal acetate (UPA) for emergency contraception on the basis of updated systematic reviews of the evidence. These 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; as needed, patients should seek advice from their health care providers about contraceptive use.