Importance of Selected Procedures for Providing Family Planning Methods

The table on the next page shows how important various examinations and tests are when providing specific family planning methods.

Most methods do not require any of these exams or tests (Class C). However, these exams and tests may be useful as part of a general health check-up or for the diagnosis or monitoring of other health conditions.

Key to the chart:

Class A: Essential and mandatory in all circumstances for safe and effective use of the contraceptive method. A pelvic or genital examination is essential for IUD insertion, most diaphragms, female sterilization, and vasectomy. STI risk assessment also is essential before IUD insertion. Blood pressure screening is essential before female sterilization.

Class B: Contributes substantially to safe and effective use. If the test or examination cannot be done, however, the risk of not performing it should be weighed against the benefits of making the contraceptive method available. Laboratory screening for STIs and a hemoglobin test would contribute to the safety of IUD insertion. A hemoglobin test also would contribute to the safety of female sterilization.

Class C: Does not contribute substantially to safe and effective use of the contraceptive method. These tests and exams are not required or helpful for hormonal contraceptive methods, male or female condoms, or spermicides.

These classifications apply to people who are presumed to be healthy. For a person with a known medical condition or other special condition, refer to the Appendix D – Medical Eligibility Criteria for Contraceptive Use.

See this job aid for information on ruling out pregnancy. Ruling out pregnancy is essential for IUD insertion and helpful for deciding when to start hormonal methods.

Breast examination by provider	C	C	C	C	C	C	C	C	C	C	NA
Pelvic/genital examination	C	C	C	C	C	A	C	A	C	A	A
Cervical cancer screening	C	C	C	C	C	C	C	C	C	C	NA
Routine laboratory tests	C	C	C	C	C	C	C	C	C	C	C
Hemoglobin test	C	C	C	C	C	B	C	C	C	B	C
STI risk assessment: medical history and physical examination	C	C	C	C	C	A**	C	C†	C†	C	C
STI/HIV screening: laboratory tests	C	C	C	C	C	B**	C	C†	C†	C	C
Blood pressure screening	‡	‡	‡	‡	‡	C	C	C	C	A	C§

Note: No tests or examinations are needed before using fertility awareness-based methods, lactational amenorrhea method, or emergency contraceptive pills.

NA=Not applicable

* Includes patch and combined vaginal ring.

** If a woman has a very high individual likelihood of exposure to STIs, she generally should not have an IUD inserted unless other methods are not available or not acceptable. If she has current purulent cervicitis, gonorrhea, or chlamydia, she should not have an IUD inserted until these conditions are resolved and she is otherwise medically eligible.

† Women at high risk of HIV infection should not use spermicides. Using spermicides alone or diaphragms or cervical caps with spermicides is not usually recommended for women with HIV infection unless other, more appropriate methods are not available or acceptable.

‡ Desirable, but in settings where the risks of pregnancy are high, and hormonal methods are among the few methods widely available, women should not be denied use of hormonal methods solely because their blood pressure cannot be measured.

§ For procedures performed using only local anesthesia.