Female sterilization 0.5 0.5
Male sterilization 0.1 0.1n5
Second Tier: Very Effective
DMPA 0.2 6
Third Tier: Effective
Diaphragm with spermicides 6 12 Fertility-awareness 24
Sym ptotherma I 0.4
Fourth Tier: Least Effective
For those seeking contraception, efective contraceptive No contraception methods are available and variably selected (Table 38-1). With aMethods organized according to tiers of efficacy.
these methods, estimated failure rates of perfect and typical use during the irst year difer widely. To reflect these failure
WHO = World Health Organization.
rates, the World Health Organization (WHO) has grouped
Data from Trussell, 201n1 a.
methods into eicacy tiers (see Table 38-1). Implants and intrauterine devices are found in the top tier. They efectively lower unintended pregnancy rates and are considered long-act ing reversible contraception (ARC). he American College tiers, recommends counseling on al options, and encourages highly efective LARC for appropriate candidates.
No contraceptive method is completely without side efects, but contraception usually poses less risk than pregnancy.
However, some disorders or medications can raise the risks from certain contraceptives. The World Health Organization (2015) has provided and updated evidence-based guidelines, termed Medical Eigibiliy Criteria, for the use of all highly efective reversible contraceptive methods by women with vari ous health conditions. Individual countries have subsequently modiied these guidelines. The United States Medical Eligibiliy
Criteria (US MEC) was updated in 2016 by the Centers for
Disease Control and Prevention (Curtis, 2016b). These docu ments are available at: http://ww.cdc.govlreproductivehealth/
U nin tendedPregnancy/ Contraception_ Guidance.h tm.
In the United States MEC, reversible contraceptive methods are organized into six groups by their similarity: combination hormonal contraceptives (CHCs), progestin-only pills (POPs), depot medroxyprogesterone acetate (DMPA), implants, levonorgestrel-releasing intrauterine system (LNGIUS), and copper intrauterine devices (Cu-IUDs). For a given health condition, each method is categorized 1 through 4 (Table 38-2). he score describes the safety proile for a typical woman with that condition: (1) no restriction of method use, (2) method advantages outweigh risks, (3) method risks outweigh advantages, and (4) method poses an unacceptably high health risk.
lternatively, depending on the underlying disorder or patient desire, male or female sterilization may be a preferred or recommended permanent contraceptive method (American College of Obstetricians and Gynecologists, 20 17b). hese options are fully discussed in Chapter 39.