Appendix A

Breastfeeding

The US Department of Health and Human Services recommends that infants be exclusively breastfed during the first 4--6 months of life, preferably for a full 6 months. Ideally, breastfeeding should continue through the first year of life (1). {Not included in WHO MEC}

3§ {4}

2§ {3}

2§ {3}

2§ {3}

2§ {3}

2 {1 if not breastfeeding and 3 if breastfeeding}

2 {3}

2{3}

ii. Lower risk for recurrent DVT/PE (no risk factors)

3 {4}

2 {3}

2 {3}

2 {3}

2 {3}

2 {1}

2 {1}

3§ {4}

2 {1}

Women on anticoagulant therapy are at risk for gynecologic complications of therapy such as hemorrhagic ovarian cysts and severe menorrhagia. Hormonal contraceptive methods can be of benefit in preventing or treating these complications. When a contraceptive method is used as a therapy, rather than solely to prevent pregnancy, the risk/benefit ratio may be different and should be considered on a case-by-case basis. {Not included in WHO MEC}

1 {2}

1 {2}

History of bariatric surgery†

a. Restrictive procedures: decrease storage capacity of the stomach (vertical banded gastroplasty, laparoscopic adjustable gastric band, laparoscopic sleeve gastrectomy)

1

1

1

1

1

1

b. Malabsorptive procedures: decrease absorption of nutrients and calories by shortening the functional length of the small intestine (Roux-en-Y gastric bypass, biliopancreatic diversion)

COCs: 3 P/R: 1

3

1

1

1

1

a. Normal or mildly impaired cardiac function (New York Heart Association Functional Class I or II: patients with no limitation of activities or patients with slight, mild limitation of activity) (2)

i <6 mos

4

1

1

1

2

2

ii ≥6 mos

3

1

1

1

2

2

b. Moderately or severely impaired cardiac function (New York Heart Association Functional Class III or IV: patients with marked limitation of activity or patients who should be at complete rest) (2)

4

2

2

2

2

2

a. On immunosuppressive therapy

2

1

2/3§

1

2

1

2

1

DMPA use among women on long-term corticosteroid therapy with a history of, or risk factors for, nontraumatic fractures is classified as Category 3. Otherwise, DMPA use for women with rheumatoid arthritis is classified as Category 2.

b. Not on immunosuppressive therapy

2

1

2

1

1

1

Emergency contraceptive pills

History of bariatric surgery, rheumatoid arthritis, inflammatory bowel disease, and solid organ transplantation were added to Appendix D and given a Category 1.

Barrier methods

For 6 conditions---history of bariatric surgery, peripartum cardiomyopathy, rheumatoid arthritis, endometrial hyperplasia, inflammatory bowel disease, and solid organ transplantation---the barrier methods are classified as Category 1.

Sterilization

In general, no medical conditions would absolutely restrict a person's eligibility for sterilization. Recommendations from the World Health Organization (WHO) Medical Eligibility Criteria for Contraceptive Use about specific settings and surgical procedures for sterilization are not included here. The guidance has been replaced with general text on sterilization.

Other deleted items

Guidance for combined injectables, levonorgestrel implants, and norethisterone enanthate has been removed because these methods are not currently available in the United States.

Guidance for "blood pressure measurement unavailable" and "history of hypertension, where blood pressure CANNOT be evaluated (including hypertension in pregnancy)" has been removed.

Unintended pregnancy and increased health risk

The following conditions have been added to the WHO list of conditions that expose a woman to increased risk as a result of unintended pregnancy: history of bariatric surgery within the past 2 years, peripartum cardiomyopathy, and receiving a solid organ transplant within 2 years.