COMMENTARY

Removing Barriers to Contraception

US Selected Practice Recommendations for Contraceptive Use, 2013

Tara P. Cleary, MD, MPH

Disclosures

September 23, 2013

Editorial Collaboration

Medscape &

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You want to provide up-to-date, evidence-based family planning care. You want to be an advocate for your patients and minimize the medical barriers that prevent them from getting the contraceptive method they want, when they want it. You need help in finding easy-to-access, evidence-based guidance to provide top-quality family planning care. We have tools and guidelines that can help.

Hello. I'm Dr. Tara Cleary, a Guest Researcher in the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC). I am pleased to join you today as part of the CDC Expert Commentary Series on Medscape.

In June 2013, CDC released the US Selected Practice Recommendations for Contraceptive Use (US SPR). These recommendations provide numerous evidence-based ways to reduce medical barriers to contraception. The US SPR is easy to access online, and you can start using the evidence-based recommendations today.

This new guidance-based document was adapted from global guidance by the World Health Organization and was developed with input from US experts and professional organizations.

More than 40 individual recommendations are included in the US SPR and they include most methods of contraception. As examples of how the US SPR can minimize barriers to care, I would like to mention a few of the key recommendations that you will find in the guidance.

  • Most women can start most methods of contraception anytime, as long as the provider is reasonably certain that the woman is not pregnant. Recommendations are provided for when women can start using contraception under different scenarios such as the postpartum period or when switching from another method. Recommendations are also provided for when and how long a back-up method is needed after starting a method.

  • Few, if any, examinations or tests are needed before starting a method. A summary grid is provided so that providers can easily see which, if any, tests or exams are essential before starting a specific contraceptive method. For example, pelvic exam is only essential before starting an intrauterine device (IUD), diaphragm, or cervical cap.

  • After a woman starts a new method, she should be advised to return at any time to discuss side effects or other concerns, to change the method being used, or to remove or replace the contraceptive method. Otherwise, routine follow-up is generally not required.

Other examples of recommendations that will be extremely useful to you include guidance for how to manage bleeding problems, algorithms to help providers and patients manage missed contraceptive pills appropriately, and guidance for when to consider emergency contraceptive (EC) use as well as how to start regular contraception after EC.

All of the recommendations can be found in the complete US SPR document from the CDC Website, which includes user-friendly charts and algorithms that you will find extremely useful in clinical practice. You can find links for other resources, including continuing education opportunities and how to sign up for updates.

Please visit our Website today and start exploring the US SPR.

Tara P. Cleary, MD, MPH, is originally from New Jersey where she graduated from medical school. She then moved to Atlanta where she completed residency training in ob/gyn at Emory. She stayed at Emory for 2 years for a family planning fellowship and to obtain her master's in public health in epidemiology. This fellowship also allowed some time for international work in both South Sudan and Thailand, where Tara trained midwives in both family planning and emergency obstetric care. Tara has worked on contraceptive research since her residency, including projects in postplacental IUD placement and a mixed-method study in bariatric patients and providers. She currently is employed at University of North Carolina but spends time as a guest researcher at the CDC, working on family planning guidance for the United Stated. She remains clinically active by volunteering at Grady Memorial Hospital in Atlanta.

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