JHPIEGO TrainerNews™ |
Clinical Update
(October 2001)
Contraceptive Pearl: Is it a good idea for doctors to use a "hormonal pregnancy test" before providing contraception?
Question: I've noticed that some providers in my country use a "hormonal pregnancy test" to try to rule out pregnancy before providing contraception. They provide a few days of oral contraceptives, and then observe whether withdrawal bleeding occurs. Is this a good practice?
Answer: No. This practice was discredited in the 1970s for a number of reasons including its poor ability to detect or rule out pregnancy. Yet the practice persists in sub-Saharan Africa as documented in a recent study, especially for women with lactational amehorrhea. In a sense the practice is a version of the inappropriate "menstruation requirement" whereby providers only allow access to contraception for women who are actually menstruating when they are seen.
Rather than a pregnancy test, a specifically designed checklist is an effective way to screen nonmenstruating women for pregnancy.
Reference: Stanback J and E Raymond. 2001. Hormonal pregnancy tests in Sub-Saharan Africa. AJPH 91: 1614-1615.
This "Pearl" was prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID).