The World Health Organization (WHO) developed the Medical Eligibility Criteria (MEC) chart to guide healthcare providers worldwide. This tool provides evidence-based recommendations on the safety and effectiveness of various contraceptive methods for individuals with different health conditions or characteristics.
The MEC has been influential in family planning for over 20 years, helping to improve access to contraceptives by removing unnecessary restrictions. It has also affected national drug formularies and patient information. The latest edition, the fifth, includes nearly 2000 recommendations across 26 family planning methods, reflecting ongoing scientific review and updates.
Understanding the WHO MEC Categories
The WHO MEC chart employs a four-category system to classify the suitability of contraceptive methods for individuals with specific health conditions. This system helps healthcare providers interpret the risks and benefits associated with each method.
Category 1 signifies “no restriction” on the use of a particular contraceptive method for an individual with a given condition. Category 2 indicates that the advantages of using the method outweigh its risks, meaning it can generally be used, though closer follow-up may be advisable.
For Category 3, the risks of using the method generally outweigh the advantages. It is usually not recommended unless other options are unavailable or unacceptable, and careful follow-up is necessary. Category 4 represents an “unacceptable health risk,” meaning the method should not be used due to health concerns.
How the WHO MEC Guides Method Selection
The WHO MEC chart applies its categorical system to various types of contraceptive methods, offering guidance on their suitability based on an individual’s health profile. For combined hormonal contraceptives, which include pills, patches, and rings, conditions like high blood pressure or migraines with aura are considered. For instance, breastfeeding women less than six weeks postpartum should not use combined hormonal contraceptives, classified as Category 4.
Progestin-only methods, such as implants or injectables, are suitable for a wide range of individuals, including breastfeeding women. For example, breastfeeding women who are at least six months postpartum can use progestin-only pills, injectables, and implants without restriction, falling into Category 1. The chart also provides specific guidance for intrauterine devices (IUDs), considering factors like recent childbirth or a history of pelvic infections.
Barrier methods, like condoms, have few medical contraindications listed in the MEC due to their non-systemic action. The chart also addresses emergency contraception, noting that breastfeeding women can use combined oral contraceptives or levonorgestrel for emergency contraception without restriction.
Addressing Common Health Conditions with the WHO MEC
The WHO MEC chart systematically addresses how various common medical conditions influence contraceptive choices. For individuals with hypertension, the chart indicates which methods are safe. For example, some combined hormonal contraceptives are less suitable for individuals with uncontrolled high blood pressure, while progestin-only methods or IUDs remain viable options.
For individuals with diabetes, the chart provides guidance on methods that do not adversely affect blood sugar control or pose increased risks of complications. Liver disease can affect how hormonal contraceptives are metabolized, so the MEC provides specific recommendations, favoring non-hormonal or progestin-only methods depending on the severity of the condition.
A history of deep vein thrombosis (DVT) is considered, as certain hormonal methods can increase the risk of blood clots. In such cases, the MEC recommends non-estrogen methods like progestin-only pills, implants, or IUDs, classifying combined hormonal contraceptives as a higher risk category.
The WHO MEC as a Guide, Not a Rulebook
While the WHO MEC chart is a guide, it is not a rigid set of rules. It provides evidence-based recommendations, but these should always be considered in the context of personalized medical consultation. A healthcare provider conducts a health assessment, reviewing an individual’s medical history, lifestyle, and personal preferences.
Individual circumstances, such as specific non-contraceptive benefits desired (e.g., managing heavy periods or acne reduction), also play a role in method selection. The chart’s recommendations are general guidelines, and ongoing health changes require regular medical advice. Discussion with a provider also includes potential side effects and how they might impact an individual’s daily life and adherence to a chosen method.