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What's New in This Handbook?
This new handbook on family planning methods and related topics is the first of its kind: Through an organized, collaborative process, experts from around the world have come to consensus on practical guidance that reflects the best available scientific evidence. The World Health Organization (WHO) convened this process. Many major technical assistance and professional organizations have endorsed and adopted this guidance.
This book serves as a quick-reference resource for all levels of health care workers. It is the successor to The Essentials of Contraceptive Technology, first published in 1997 by the Center for Communication Programs at Johns Hopkins Bloomberg School of Public Health. In format and organization it resembles the earlier handbook. At the same time, all of the content of Essentials has been re-examined, new evidence has been gathered, guidance has been revised where needed, and gaps have been filled. This handbook reflects the family planning guidance developed by WHO. Also, this book expands on the coverage of Essentials: It addresses briefly other needs of clients that come up in the course of providing family planning.
New WHO Guidance Since 2007
Since the handbook was first published in 2007, the Department of Reproductive Health and Research of WHO convened an expert Working Group in April 2008 and two technical consultations in October 2008 and January 2010 to address questions for the Medical Eligibility Criteria (MEC) and the Selected Practice Recommendations and a technical consultation in June 2009 on the provision of progestin-only injectables by community health workers. Also, the HIV Department of WHO convened an expert Working Group in October 2009 to update guidance on infant feeding and HIV. This 2011 printing of the Global Handbook reflects new guidance developed in these meetings. (See p. 354.) Updates include:
- A woman may have a repeat injection of depot-medroxyprogesterone acetate (DMPA) up to 4 weeks late. (Previous guidance said that she could have her DMPA reinjection up to 2 weeks late.) The guidance for reinjection of norethisterone enanthate (NET-EN) remains at up to 2 weeks late. (See p. 74.)
- During breastfeeding, antiretroviral (ARV) therapy for the mother, for the HIV-exposed infant, or for both can significantly reduce the chances of HIV transmission through breast milk. HIV-infected mothers should receive the appropriate ARV therapy and should exclusively breastfeed their infants for the first 6 months of life, then introduce appropriate complementary foods and continue breastfeeding for the first 12 months of life. (See p. 294.)
- Postpartum women who are not breastfeeding can generally start combined hormonal methods at 3 weeks (MEC category 2). However, some women who have additional risk factors for venous thromboembolism (VTE) generally should not start combined hormonal methods until 6 weeks after childbirth, depending on the number, severity, and combination of the risk factors (MEC category 2/3). These additional risk factors include previous VTE, thrombophilia, caesarean delivery, blood transfusion at delivery, postpartum hemorrhage, pre-eclampsia, obesity, smoking, and being bedridden. (See p. 325.)
- Women with deep vein thrombosis who are established on anticoagulant therapy generally can use progestin-only contraceptives (MEC category 2) but not combined hormonal methods (MEC category 4). (See p. 327.)
- Women with systemic lupus erythematosus generally can use any contraceptive except that: (a) A woman with positive (or unknown) antiphospholipid antibodies should not use combined hormonal methods (MEC category 4) and generally should not use progestin-only methods (MEC category 3). (b) A woman with severe thrombocytopenia generally should not start a progestin-only injectable or have a copper-bearing IUD inserted (MEC category 3). (See p. 328.)
- Women with AIDS who are treated with ritonavir-boosted protease inhibitors, a class of ARV drugs, generally should not use combined hormonal methods or progestin-only pills (MEC category 3). These ARV drugs may make these contraceptive methods less effective. These women can use progestin-only injectables, implants, and other methods. Women taking only other classes of ARVs can use any hormonal method. (See p. 330.)
- Women with chronic hepatitis or mild cirrhosis of the liver can use any contraceptive method (MEC category 1). (See p. 331.)
- Women taking medicines for seizures or rifampicin or rifabutin for tuberculosis or other conditions generally can use implants. (See p. 332.)
New Guidance for Community-Based Provision of Injectables
- Community-based provision of progestin-only injectable contraceptives by appropriately trained community health workers is safe, effective, and acceptable. Such services should be part of a family planning program offering a range of contraceptive methods. (See p. 63.)
Other Content Addressing Important Questions
- Combined Oral Contraceptives (COCs)
Facts about COCs and cancer .......................................................... 4
Extended and continuous use of COCs ............................................ 21
- Emergency Contraceptive Pills (ECPs)
New guidance on taking ECPs up to 5 days after unprotected sex ....... 49
New guidance on providing contraceptive methods after ECP use ........ 52
Updated list of oral contraceptives that can be used as ECPs ............ 56
- Progestin-Only Injectables
Includes NET-EN as well as DMPA .................................................. 59
New information on subcutaneous DMPA ......................................... 63
New guidance on managing late injections ....................................... 74
New research on bone density and DMPA ........................................ 80
- Implants
Includes Jadelle, Implanon, and Sino-Implant (II) ............................... 109
- Copper-Bearing Intrauterine Device
New checklist questions on AIDS, antiretroviral therapy, and
sexually transmitted infections (STIs)
............................................. 136
Screening questions for pelvic examination before IUD insertion ........ 137
New guidance on assessing STI risk for potential IUD users ............. 138
- Vasectomy
Most effective vasectomy techniques .............................................. 190
New guidance on when a man can rely on his vasectomy ................ 192
- Male Condoms
New criteria on severe allergic reaction to latex rubber ..................... 202
Revised guidance on what can be done if a condom breaks,
slips off the penis, or is not used
.................................................. 206
New guidance for managing clients with mild or severe allergic
reaction to condom
....................................................................... 207
- Fertility Awareness Methods
Includes Standard Days and TwoDay Methods ................................. 239
- Lactational Amenorrhea Method (LAM)
Revised guidance on using LAM for women with HIV ........................ 260
- Sexually Transmitted Infections, Including HIV
Contraception for clients with STIs, HIV, AIDS,
or on antiretroviral therapy
.............................................................. 282
New information on hormonal contraceptives and risk of HIV ............. 288
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