Reproductive Health

U.S. Selected Practice Recommendations (US SPR) for Contraceptive Use, 2013

The U.S. Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR) provides recommendations for health care providers. The guidance addresses a select group of common, yet sometimes complex, management issues around the initiation and use of specific contraceptive methods. The US SPR is a companion document to CDC’s previously published contraceptive guidance document, U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (US MEC). While the US MEC provides guidance on who can use various methods of contraception, the US SPR provides guidance on how contraceptive methods can be used and how to remove unnecessary barriers for patients in accessing and successfully using contraceptive methods. Several medical barriers to initiating and continuing contraceptive methods may exist, such as—

Unnecessary screening exams and tests before starting the method.
Inability to receive the method on the same day as the visit.
Difficulty obtaining continued contraceptive supplies.

These recommendations have been adapted from global family planning guidance provided by the World Health Organization (WHO). Although many of the recommendations are the same as those provided by WHO, they have been adapted to be more specific to U.S. practices or have been modified because of new evidence. In addition, new topics of interest to U.S. health care providers have been added to the guidance.

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.

The American Congress of Obstetricians and Gynecologists (ACOG) endorses the U.S. SPR and encourages its use by Fellows. The committee opinion is explained in Understanding and Using the U.S. Selected Practice Recommendations for Contraceptive Use, 2013. Source: Obstet Gynecol. 2013;122:1132–1133.

US SPR Resources and Provider Tools

U.S. Selected Practice Recommendations for Contraceptive Use, 2013 (US SPR)
This guidance addresses a select group of common, yet sometimes complex, management issues around the initiation and use of specific contraceptive methods.
Source: MMWR. 2013;62(No. RR-5):1-60.

CDC has a new eBook which provides guidance for healthcare providers on common, yet sometimes complex, management issues around the initiation and use of specific contraceptive methods. This eBook includes the full content of the U.S. Selected Practice Recommendations for Contraceptive Use, 2013.

When to Start Contraceptive Methods and Routine Follow-Up [PDF - 644KB]
This provider tool contains information from the US SPR into a one page document. It includes How to Be Reasonably Certain That a Women Is Not Pregnant (Box 1), When to Start Using a Specific Contraceptive Methods (Appendix B), and Routine Follow-Up After Contraceptive Initiation (Appendix D).

What To Do If Late, Missed, or Delayed Combined Hormonal Contraception Method [PDF - 639KB]
This provider tool from the US SPR contains Recommended Actions After Late or Missed Combined Oral Contraceptive (Figure 2), Recommended Actions After Delayed Application or Detachment with Combined Hormonal Patch (Figure 3), and Recommended Actions After Delayed Insertion or Reinsertion with Combined Hormonal Ring (Figure 4).

Management of IUD when Pelvic Inflammatory Disease (PID) s Found and Management of Women with Bleeding Irregularities [PDF - 814KB]
This provider tool contains two diagrams presented in the US SPR. It includes the Management of Women with Bleeding Irregularities While Using Contraception (Appendix E) and the Management of the IUD When a CU-IUD or an LNG-IUD User Is Found to Have Pelvic Inflammatory Disease (Appendix F).