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Commentary| Volume 95, ISSUE 4, P326-330, April 2017

Proposed clinical guidance for excluding pregnancy prior to contraceptive initiation

      Current clinical guidance is unanimous in its recommendation that pregnancy should be ruled out prior to initiation of hormonal contraception and intrauterine devices (IUDs) [
      • World Health Organization
      Selected practice recommendations for contraceptive use.
      ,
      • Centers for Disease Control and Prevention
      U.S. selected practice recommendations for contraceptive use, 2013.
      ,
      • World Health Organization/Department of Reproductive Health and Research (WHO/RHR)
      • Johns Hopkins Bloomberg School of Public Health (JHSPH)
      • Center for Communication Programs (CCP)
      Family planning: a global handbook for providers.
      ]. As a result, screening for possible pregnancy constitutes a substantial part of the workload of family planning providers. The rationale for excluding pregnancy is simple: to avoid providing unnecessary contraception and, in the case of the IUD (including hormonal IUDs), to avoid possible harm to the pregnant woman or her fetus.
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      References

        • World Health Organization
        Selected practice recommendations for contraceptive use.
        2nd ed. World Health Organization, Geneva (Switzerland)2008 ([http://www.who.int/reproductivehealth/publications/family_planning/9241562846index/en/])
        • Centers for Disease Control and Prevention
        U.S. selected practice recommendations for contraceptive use, 2013.
        Morb Mortal Wkly Rep. 2013; 62 ([http://www.cdc.gov/mmwr/pdf/rr/rr62e0614.pdf]): 1-60
        • World Health Organization/Department of Reproductive Health and Research (WHO/RHR)
        • Johns Hopkins Bloomberg School of Public Health (JHSPH)
        • Center for Communication Programs (CCP)
        Family planning: a global handbook for providers.
        CCP, Baltimore (MD)2007 ([Co-published by WHO. Available from: https://www.fphandbook.org/])
        • Charlton B.M.
        • et al.
        Maternal use of oral contraceptives and risk of birth defects in Denmark: prospective, nationwide cohort study.
        BMJ. 2016; 352: h6712
        • Pardthaisong T.
        • Yenchit C.
        • Gray R.
        The long-term growth and development of children exposed to Depo-Provera during pregnancy or lactation.
        Contraception. 1992; 45: 313-324
        • Bracken M.B.
        Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies.
        Obstet Gynecol. 1990; 76: 552-557
        • Cervinski M.A.
        • Gronowski A.M.
        Reproductive-endocrine point-of-care testing: current status and limitations.
        Clin Chem Lab Med. 2010; 48: 935-942
      1. IDA Foundation electronic price indicator.
        IDA Foundation, Amsterdam2016
        • Technical Guidance Working Group
        Recommendations for updating selected practices in contraceptive use: results of a technical meeting.
        vol 1. United States Agency for International Development, Washington, DC1994
        • Stanback J.
        • Qureshi Z.
        • Sekadde-Kigondu C.
        • Gonzalez B.
        • Nutley T.
        Checklist for ruling out pregnancy among family planning clients in primary care.
        Lancet. 1999; 354: 566
        • Stanback J.
        • Nakintu N.
        • Qureshi Z.
        • Nasution M.
        Does assessment of signs and symptoms add to the predictive value of an algorithm to rule out pregnancy?.
        J Fam Plann Reprod Health Care. 2006; 32: 27-29
        • Stanback J.
        • Nanda K.
        • Ramirez Y.
        • Rountree W.
        • Cameron S.B.
        Validation of a job aid to rule out pregnancy among family planning clients in Nicaragua.
        Rev Panam Salud Publica. 2008; 23: 116-118
        • Torpey K.
        • Mwenda L.
        • Kabaso M.
        • Malebe T.
        • Makelele P.
        • Mwema F.
        • et al.
        Excluding pregnancy among women initiating antiretroviral therapy: efficacy of a family planning job aid.
        BMC Public Health. 2010; 10: 249
        • Tepper N.
        • Marchbanks P.
        • Curtis K.
        Use of a checklist to rule out pregnancy: a systematic review.
        Contraception. 2013; 87: 661-665
        • Min J.
        • Buckel C.
        • Secura G.
        • Peipert J.
        • Madden T.
        Performance of a checklist to exclude pregnancy at the time of contraception initiation among women with a negative urine pregnancy test.
        Contraception. 2015; 91: 80-84
        • Stanback J.
        • Diabate F.
        • Dieng T.
        • Duarte de Morales T.
        • Cummings S.
        • Traoré M.
        Ruling out pregnancy among family planning clients: the impact of a checklist in three countries.
        Stud Fam Plann. 2005; 36: 311-315
        • Stanback J.
        • Brechin J.
        • Lynam P.
        • Ruto C.
        • Cummings S.
        Improving adherence to family planning guidelines in Kenya: an experiment.
        Int J Qual Health Care. 2007; 19: 68-73
        • Bergin A.
        • Tristan S.
        • Terplan M.
        • Gilliam M.L.
        • Whitaker A.K.
        A missed opportunity for care: two-visit IUD insertion protocols inhibit placement.
        Contraception. 2012; : 694-697
        • Langston A.M.
        • Joslin-Roher S.L.
        • Westhoff C.L.
        Immediate postabortion access to IUDs, implants and DMPA reduces repeat pregnancy within 1 year in a New York City practice.
        Contraception. 2014; 89: 103-108
        • Hatcher R.A.
        • Zieman M.
        • Cwiak C.
        • Darney P.D.
        • Creinin M.D.
        • Stosur H.R.
        A pocket guide to managing contraception.
        Bridging the Gap Foundation, Tiger, Ga2005: 135
        • Reproductive Health Supplies Coalition
        Database of family planning and maternal health Commodities in National Essential Medicines Lists.
        • Comfort A.B.
        • Chankova S.
        • Juras R.
        • His C.N.
        • Peterson L.A.
        • Hathi P.
        Providing free pregnancy test kits to community health workers increases distribution of contraceptives: results from an impact evaluation in Madagascar.
        . 2016; 98: 44-51
      2. Glob Health Sci Pract. 2013; 1: 294
        • Rossier C.
        • Hellen J.
        Traditional birthspacing practices and uptake of family planning during the postpartum period in Ouagadougou: qualitative results.
        Int Perspect Sex Reprod Health. 2014; 40: 87-94
        • Brunie A.
        • Tolley E.E.
        • Ngabo F.
        • Wesson J.
        • Chen M.
        • et al.
        Getting to 70%: barriers to modern contraceptive use for women in Rwanda.
        Int J Gynaecol Obstet. 2013; 123: e11-e15
        • Stanback J.
        • Vance G.
        • Asare G.
        • Kasonde P.
        • Kafulubiti B.
        • Chen M.
        • et al.
        Does free pregnancy testing reduce service denial?.
        Glob Health Sci Pract. 2013; 1: 382-388
        • Westhoff C.
        • Morroni C.
        • Kerns J.
        • Murphy P.A.
        Bleeding patterns after immediate vs. conventional oral contraceptive initiation: a randomized, controlled trial.
        Fertil Steril. 2003; 79: 322-329
        • Lesnewski L.
        • Prine R.
        Initiating hormonal contraception.
        Am Fam Physician. 2006; 74: 105-112
        • Westhoff C.
        • Heartwell S.
        • Edwards S.
        • Zieman M.
        • Cushman L.
        • Robilotto C.
        • et al.
        Initiation of oral contraceptives using a quick start compared with a conventional start.
        Obstet Gynecol. 2007; 109: 1270-1276
      3. Culwell K. Immediate start of hormonal contraceptives for contraception: RHL commentary. 2009. The WHO reproductive health library; Geneva: World Health Organization.