Recommendations for Contraceptive Use
		Foreword

The Family Planning and Population Unit, Division of Reproductive Health of the World Health Organization (WHO) and the Office of Population of the U.S. Agency for International Development (USAID) are pleased to have collaborated with the Technical Guidance/Competence Working Group in the process which led to the production of this document. The recommendations contained in this document are intended to help national (and other) reproductive health teams to revise their family planning service delivery guidelines, on the basis of the latest clinical, epidemiological and programmatic experience.

This document acknowledges that despite many significant advances made over the past thirty years in the development of new contraceptive methods and in improving effectiveness and safety of older techniques, there is still a huge gap between this knowledge and its application for improving family planning care. In many regions of the world, current policies and delivery practices continue to be based on the older contraceptive products that are no longer in wide use, and/or on long standing theoretical concerns that have never been scientifically substantiated. The full range of modern family planning methods remains inaccessible to millions of couples and individuals who wish to space or prevent pregnancies.

A first step in redressing the situation was taken by the World Health Organization with the issuance of its document "Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for Contraceptive Use" in 1996. The Organization undertook, in 1994 and 1995, an in-depth review and analysis of all the clinical, epidemiological and acceptability research that had been carried out over the past ten years on all the contraceptive methods that are widely available around the world. A new approach and classification system was then devised by the participants of two scientific expert group meetings convened by WHO for defining the medical conditions or life situations that are relevant for consideration with the use of each contraceptive methods. New medical eligibility criteria were proposed based on this approach which ensures that each contraceptive method is "prescribed" with an adequate margin of safety for the user and that no one is unnecessarily denied the method of his or her choice.

The present document takes the process of improving access to family planning care one step further by defining the service delivery implications complementary to the new medical eligibility criteria developed by WHO. It proposes recommendations for appropriate screening procedures, provision of methods and follow-up care/procedures that are essential for high quality services. For each recommendation, a scientific basis has been formulated along with relevant references. The question/answer format utilized is particularly useful and reader-friendly.

This document is a valuable reference and guidance tool for professionals interested in updating their service delivery guidelines for improved quality of family planning care. It answers many of the difficult questions being raised about enhancing access to family planning without sacrificing safety and effectiveness, in a scientifically justifies manner. The World Health Organization and USAID encourage this document's widespread use as a major step forward in bridging the gap between current knowledge and its actual application for the benefit of all men and women around the world.

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Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.