Describe the WHO medical eligibility criteria for contraceptive use for women with medical conditions.

Understanding the WHO Medical Eligibility Criteria (MEC)

The WHO MEC is a comprehensive set of recommendations that categorize the safety of contraceptive methods for individuals with various medical conditions. Its primary objective is to help healthcare providers determine which contraceptive methods can be safely and effectively used by women with specific health issues, thereby ensuring reproductive autonomy while prioritizing patient safety. The MEC promotes informed choice and tailored family planning services.

The Four Categories of Medical Eligibility

For each medical condition and contraceptive method, the WHO MEC assigns a category from 1 to 4, indicating the level of safety and acceptability. These categories guide healthcare providers in counseling and prescribing contraception:

• Category 1: No Restriction for Use
  • A condition for which there is no restriction for the use of the contraceptive method. The method can be used in any circumstance.
  • Example: Most women without underlying health conditions can use combined hormonal contraceptives (CHCs) without restriction. Women with varicose veins can also use CHCs without restriction.
• Category 2: Generally Use
  • A condition where the advantages of using the method generally outweigh the theoretical or proven risks. The method can generally be used, but some follow-up may be needed.
  • Example: Women over 40 years of age can generally use combined hormonal contraceptives. Women living with asymptomatic or mild HIV (WHO stage 1 or 2) can generally use LNG-IUDs. Breastfeeding women who are less than 6 weeks postpartum can generally use Progestogen-Only Pills (POPs).
• Category 3: Usually Not Recommended
  • A condition where the theoretical or proven risks usually outweigh the advantages of using the method. Use of the method is not usually recommended unless other more appropriate methods are not available or not acceptable. Clinical judgment and continuing access to clinical services are required for use.
  • Example: Breastfeeding women at least 6 weeks to less than 6 months postpartum should generally not use combined hormonal contraceptives. Women with severe or advanced HIV (WHO stage 3 or 4) and using newer NNRTIs generally should not initiate use of the LNG-IUD.
• Category 4: Method Should Not Be Used
  • A condition that represents an unacceptable health risk if the contraceptive method is used. The method should not be used.
  • Example: Breastfeeding women less than 6 weeks postpartum should not use combined hormonal contraceptives. Women with current breast cancer should not use combined hormonal contraceptives, progestogen-only pills, or implants.

Key Considerations and Updates in MEC

The MEC is a dynamic document, with regular updates incorporating new scientific evidence and evolving clinical understanding. The 6th edition, published in 2025, includes several important changes:

• Postpartum Women: Changes in recommendations for combined hormonal contraceptive use among postpartum women, with a stronger emphasis on waiting periods for certain methods due to thrombosis risk and potential impact on lactation. For instance, estrogen-containing contraceptives are contraindicated (Category 4) until 6 weeks postpartum for all women due to the risk of blood clots.
• Breastfeeding Women: Updated guidance for progestogen-only methods among breastfeeding women. Progesterone-only contraceptives (pills, IUD, implants) are generally considered Category 1 after 6 weeks postpartum, indicating no risk to milk production.
• HIV and Antiretroviral Therapy (ART): Revised recommendations for women at high risk for HIV infection, women living with HIV, and those using antiretroviral therapy and hormonal contraception.
• New Contraceptive Methods: Review and inclusion of newer methods such as subcutaneously administered depot medroxyprogesterone acetate, Sino-implant (II), ulipristal acetate, and progesterone-releasing vaginal ring.
• Thromboembolic Risk: Increased caution for depot medroxyprogesterone acetate (DMPA) in patients with increased thromboembolic risk, aligning with evolving understanding of coagulation risks.
• Chronic Kidney Disease (CKD): The US MEC, which adapts WHO guidelines, has added recommendations for women with chronic kidney disease, stratifying risk based on nephrotic syndrome and dialysis status.

Importance of the MEC

The MEC guidelines are crucial for:

• Patient Safety: Minimizing the risks of adverse health outcomes for women with pre-existing medical conditions who wish to use contraception.
• Informed Choice: Empowering women to make informed decisions about their reproductive health by providing clear, evidence-based information.
• Standardized Care: Ensuring consistent and high-quality family planning services globally, reducing disparities in care.
• Healthcare Provider Support: Offering a practical tool for clinicians, especially in resource-limited settings, to make appropriate contraceptive recommendations.

The WHO MEC works in conjunction with the "Selected Practice Recommendations for Contraceptive Use (SPR)," which provides guidance on how to use contraceptive methods safely and effectively once eligibility has been established.