Use of the World Health Organization's Medical Eligibility Criteria for Contraceptive Use Guidance in sub-Saharan African Countries: A Cross-Sectional Study.
Given recent updates to the postpartum contraception recommendations in the fifth edition of the Medical Eligibility Criteria for Contraceptive Use (MEC), published by the World Health Organization (WHO), the purpose of this qualitative study was to assess the extent to which national family planning policies in sub-Saharan African countries are in agreement with the WHO MEC, particularly with regard to postpartum contraceptive use. WHO headquarters sent questionnaires to country-level focal points to complete with their Ministry of Health counterparts. Between February and May 2016, 23 of 32 (72%) surveys were completed. All respondents reported that their countries had used the MEC document in the past, with most reporting that they had used the guidance as a reference (n = 20, 87%), for training purposes (n = 19, 83%), to change clinical practices (n = 17, 74%), and to develop national policies (n = 16, 70%). While many respondents (16, 70%) indicated their countries already include immediate postpartum intrauterine device insertion among breastfeeding women in their family planning policies, few reported currently allowing use of progestogen-only pills (n = 8, 35%) or implants (n = 8, 35%) during the immediate postpartum period (i.e., less than 48 hours after delivery) for breastfeeding women. A higher percentage of respondents indicated their countries allowed breastfeeding women the option of progestogen-only pills (n = 16, 70%) and implants (n = 13, 57%) between 48 hours and 6 weeks postpartum. Findings from this baseline assessment suggest that many countries may benefit from training and policy formulation support to adapt both new WHO MEC updates as well as existing recommendations from previous MEC revisions into national family planning guidelines.
University of California, Davis Department of Obstetrics and Gynecology, Sacramento, CA, USA mejchen@ucdavis.edu.
Melissa J
MJ
Chen
World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland.
Mary E
ME
Gaffield
World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland.
James
J
Kiarie
D017954:Africa South of the Sahara; D001942:Breast Feeding; D003267:Contraception / Q000379:methods*; D003268:Contraception Behavior; D003276:Contraceptives, Oral; D003430:Cross-Sectional Studies; D005193:Family Planning Services; D005260:Female; D019983:Guideline Adherence; D006291:Health Policy; D006801:Humans; D007434:Intrauterine Devices; D018579:Patient Selection; D049590:Postpartum Period; D011372:Progestins; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014944:World Health Organization
D003276:Contraceptives, Oral; D011372:Progestins
MMWR Recomm Rep. 2010 Jun 18;59(RR-4):1-86
20559203
Curr Opin Obstet Gynecol. 2015 Dec;27(6):451-9
26390246
Contraception. 1989 May;39(5):477-96
2656086
Stud Fam Plann. 2015 Dec;46(4):355-67
26643487