关于避孕药具使用的实践建议

Unintended pregnancy rates remain high in the United States; approximately 50% of all pregnancies are unintended, with higher proportions among adolescent and young women, women who are racial/ethnic minorities, and women with lower levels of education and income (1). Unintended pregnancies increase the risk for poor maternal and infant outcomes (2) and in 2002, resulted in $5 billion in direct medical costs in the United States (3). Approximately half of unintended pregnancies are among women who were not using contraception at the time they became pregnant; the other half are among women who became pregnant despite reported use of contraception (4). Therefore, strategies to prevent unintended pregnancy include assisting women at risk for unintended pregnancy and their partners with choosing appropriate contraceptive methods and helping women use methods correctly and consistently to prevent pregnancy. In 2010, CDC first adapted global guidance from the World Health Organization (WHO) to help health-care providers counsel women, men, and couples about contraceptive method choice. The U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (U.S. MEC), focuses on who can safely use specific methods of contraception and provides recommendations for the safety of contraceptive methods for women with various medical conditions (e.g., hypertension and diabetes) and characteristics (e.g., age, parity, and smoking status) (Appendix A) (5). The recommendations in this new guide, U.S. Selected Practice Recommendations for Contraceptive Use, 2013 (U.S. SPR), focuses on how contraceptive methods can be used and provides recommendations on optimal use of contraceptive methods for persons of all ages, including adolescents.

During the past 15 years, CDC has contributed to the development and updating of the WHO global family planning guidance. CDC has supported WHO by coordinating the identification, critical appraisal, and synthesis of the scientific evidence on which the WHO guidance is based. In 2002, WHO published the first edition of the Selected Practice Recommendations for Contraceptive Use (WHO SPR), which presented evidence-based global guidance on how to use contraceptive methods safely and effectively once they are deemed to be medically appropriate. Since then, WHO has regularly updated its guidance on the basis of new evidence, and the document is now in its second edition (6), with an additional update in 2008 (7). The WHO global guidance is not intended for use directly by health-care providers; rather, WHO intends for the guidance to be used by local or national policy makers, family planning program managers, and the scientific community as a reference when they develop family planning guidance at the country or program level (6). For example, the United Kingdom adapted WHO SPR and in 2002 published the U.K. Selected Practice Recommendations for Contraceptive Use for use by U.K. health-care providers (8).

CDC initiated a formal adaptation process to create U.S. SPR, using both the second edition of WHO SPR (6) and the 2008 update (7) as the basis for the U.S. version. Although much of the guidance is the same as the WHO guidance, the recommendations are specific to U.S. family planning practice. In addition, guidance on contraceptive methods not available in the United States has been removed, and four new topics for guidance have been added (the effectiveness of female sterilization, extended use of combined hormonal methods and bleeding problems, starting regular contraception after use of emergency contraception, and determining when contraception is no longer needed). This document contains recommendations for health-care providers for the safe and effective use of contraceptive methods and addresses provision of contraceptive methods and management of side effects and other problems with contraceptive method use. Although the term woman is used throughout this report, these recommendations refer to all females of reproductive age, including adolescents. Adolescents are identified throughout this document as a special population that might benefit from more frequent follow-up. These recommendations are meant to serve as a source of clinical guidance for health-care providers; health-care providers should always consider the individual clinical circumstances of each person seeking family planning services. This report is not intended to be a substitute for professional medical advice for individual patients; persons should seek advice from their health-care providers when considering family planning options.

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