Family Planning Training Resource Package

1. Family Planning Training Resource Package Summary of Updates in the WHO Medical eligibility criteria for contraceptive use,Fifth edition, 2015

2. Medical Eligibility Criteriafor Contraceptive Use • Offers evidence-based recommendations on contraceptive eligibility in the presence of medical conditions and client characteristics • Covers 20 contraceptive methods • Fifth edition included review of fourteen topics (encompassing over 575 recommendations) • In many instances, either no new evidence was identified, or emerging evidence confirmed previous findings. • Therefore, relevant recommendations in 4th edition were reviewed and upheld.

3. MEC 2015 Executive Summary • Presents the summaries of key recommendations about the updates. • May be downloaded at: http://www.who.int/reproductivehealth/publications/family_planning/Ex-Summ-MEC-5/en/

4. MEC wheel 2015 update Based on the MEC, provides quick information on who can use methods Includes COCs, POPs, DMPA, NET-EN (IM&SQ), implants, and copper IUDs, LNG-IUD, combined injectable contraceptives, patch, vaginal ring Available in print version, may also be downloaded: http://www.who.int/reproductivehealth/publications/family_planning/mec-wheel-5th/en/

5. Other WHO FP Cornerstones • Selected Practices Recommendations for contraceptive use • Range of issues including initiation, continuation, incorrect use, treatment of side effects, and some programmatic issues • Being updated, will be available in late 2015 • Family Planning: A Global Handbook for Providers • Essentials needed by clinical providers to provide quality care • Present guidance for delivering contraceptive methods appropriately and effectively • Update underway

6. MEC Categories • Where warranted, recommendations will differ if a woman is starting a method (I = initiation) or continuing a method (C = continuation)

7. MEC 5th Edition New methods added • Subcutaneously-administered depot medroxyprogesterone acetate (DMPA-SC) • Generally follow recommendations for DMPA-IM • Sino-Implant (II) ƒƒ • Generally will follow recommendations for LNG implants • Progesterone-releasing vaginal ring • For use by women who are actively breastfeeding and are ≥ 4 weeks postpartum without restrictions (MEC Category 1) • ƒƒUlipristal acetate (UPA) as emergency contraception • With specific recommendations for breastfeeding women (MEC Category 2)

8. MEC 5th Edition Specific Topics Reviewed • Combined hormonal contraceptive use (CHC) by age group, breastfeeding women, postpartum women, women with superficial venous disorders and with known dyslipidaemias. • Progestogen-only contraceptive (POC) and levonorgestrel-releasing intrauterine device (LNG-IUD) use among breastfeeding women. • IUD use for women with increased risk of sexually transmitted infections (STIs) • Use of CYP3A4 inducers and obesity as new conditions for ECP use • ƒƒƒƒHormonal contraception for women at high risk of HIV infection, women living with HIV, and women living with HIV using antiretroviral therapy (ART)

9. MEC 5th Edition Recommendations on specific topics Combined hormonal contraceptive use (CHC) • Age group • Without restriction from menarche to 40 years (MEC 1) • 40 years and older can generally use (MEC 2) • Breastfeeding women and post partum women • Should not use CHCs if less than 6 weeks post partum (MEC 4) • ≥ 6 weeks to < 6 months postpartum generally should not use CHCs (MEC 3). • ≥ 6 months postpartum can generally use CHCs (MEC 2).

10. MEC 5th Edition Recommendations on specific topics Combined hormonal contraceptive use (CHC) • Women with superficial venous disorders • New terminology used (formerly superficial thrombophlebitis) • Women with known dyslipidaemias • New terminology used (formerly known hyperlipidaemia), and to include only women without other known cardiovascular risk factors • Can generally use CHCs (note with clarifications in main document) .

11. MEC 5th Edition Recommendations on specific topics • Progestogen-only contraceptive (POC) and levonorgestrel-releasing intrauterine device (LNG-IUD) use among breastfeeding women. • Implants (LNG, ETG) and progestogen-only pills (POPs) can now be offered in the immediate postpartum period. • LNG-IUD can be immediately inserted in first 48 hours.

12. MEC 5th Edition Recommendations on specific topics • Copper-bearing IUD (Cu-IUD) or LNG-IUD use for women with increased risk of sexually transmitted infections (STIs) • Initiation - Many women with increased risk of STIs can generally undergo IUD initiation (MEC Category 2); unless with a very high individual likelihood of STIs in which they generally should not have an IUD inserted until appropriate testing and treatment occur (MEC Category 3). • Continuation - Women at increased risk of STIs can generally continue use of either Cu-IUD or LNG-IUD (MEC Category 2).

13. MEC 5th Edition Recommendations on specific topics • Use of CYP3A4 inducers and obesity as new conditions for ECP use • For these conditions, ECP using COC, LNG or UPA are in Category 1. • CYP3A4 inducers include rifampicin, phenytoin, phenobarbital, carbamazepine, efavirenz, fosphenytoin, nevirapine, oxcarbazepine, primidone, rifabutin, St John’s wort/ Hypericum perforatum

14. Filename ƒƒƒƒHormonal contraception for women at high risk of HIV infection, and women living with HIV • For women at high risk of HIV or living with HIV, WHO recommends no restrictions for: • Combined hormonal contraceptives or progestogen-only contraceptives • Women and couples at high risk of HIV infection & using POIs should be informed about (and have access to) HIV preventative measures, including male and female condoms. • LNG –IUDs can generally be used; however, initiation should be generally avoided if advanced/severe disease

15. Filename ƒƒƒƒHormonal contraception for women living with HIV using antiretroviral therapy (ART) • For women taking ART, WHO recommends they are generally eligible to use hormonal contraception: • Special consideration for efavirenz or neviripine & some protease inhibitors may be warranted. • Consistent and correct use of condoms, male or female, is critical to protect against STIs/HIV and for prevention of HIV transmission

16. MEC 5th Edition Recommendations • Details of the recommendations on the methods are available in the full MEC 5th edition document. • http://www.who.int/reproductivehealth/publications/family_planning/MEC-5/en/