The 2016 U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) comprises recommendations for the use of specific contraceptive methods by women and men who have certain characteristics or medical conditions. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2010 U.S. MEC (CDC. U.S. medical eligibility criteria for contraceptive use, 2010. MMWR 2010:59 [No. RR-4]). Notable updates include the addition of recommendations for women with cystic fibrosis, women with multiple sclerosis, and women receiving certain psychotropic drugs or St. John's wort; revisions to the recommendations for emergency contraception, including the addition of ulipristal acetate; and revisions to the recommendations for postpartum women; women who are breastfeeding; women with known dyslipidemias, migraine headaches, superficial venous disease, gestational trophoblastic disease, sexually transmitted diseases, and human immunodeficiency virus; and women who are receiving antiretroviral therapy. The recommendations in this report are intended to assist health care providers when they counsel women, men, and couples about contraceptive method choice. Although these recommendations are meant to serve as a source of clinical guidance, 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.

The 2016 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a select group of common, yet sometimes controversial or complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and consultation with national experts who met in Atlanta, Georgia, during August 26-28, 2015. The information in this report updates the 2013 U.S. SPR (CDC. U.S. selected practice recommendations for contraceptive use, 2013. MMWR 2013;62[No. RR-5]). Major updates include 1) revised recommendations for starting regular contraception after the use of emergency contraceptive pills and 2) new recommendations for the use of medications to ease insertion of intrauterine devices. The recommendations in this report are intended to serve as a source of clinical guidance for health care providers and provide evidence-based guidance to reduce medical barriers to contraception access and use. 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.

Despite numerous studies reporting an increased risk of cesarean delivery among overweight or obese compared with normal weight women, the magnitude of the association remains uncertain. Therefore, we conducted a meta-analysis of the current literature to provide a quantitative estimate of this association. We identified studies from three sources: (i) a PubMed search of relevant articles published between January 1980 and September 2005; (ii) reference lists of publications selected from the search; and (iii) reference lists of review articles published between 2000 and 2005. We included cohort designed studies that reported obesity measures reflecting pregnancy body mass, had a normal weight comparison group, and presented data allowing a quantitative measurement of risk. We used a Bayesian random effects model to perform the meta-analysis and meta-regression. Thirty-three studies were included. The unadjusted odd ratios of a cesarean delivery were 1.46 [95% confidence interval (CI): 1.34-1.60], 2.05 (95% CI: 1.86-2.27) and 2.89 (95% CI: 2.28-3.79) among overweight, obese and severely obese women, respectively, compared with normal weight pregnant women. The meta-regression found no evidence that these estimates were affected by selected study characteristics. Our findings provide a quantitative estimate of the risk of cesarean delivery associated with high maternal body mass.

The concept of unintended pregnancy has been essential to demographers in seeking to understand fertility, to public health practitioners in preventing unwanted childbearing and to both groups in promoting a woman's ability to determine whether and when to have children. Accurate measurement of pregnancy intentions is important in understanding fertility-related behaviors, forecasting fertility, estimating unmet need for contraception, understanding the impact of pregnancy intentions on maternal and child health, designing family planning programs and evaluating their effectiveness, and creating and evaluating community-based programs that prevent unintended pregnancy. 1 Pregnancy unintendedness is a complex concept, and has been the subject of recent conceptual and methodological critiques. 2 Pregnancy intentions are increasingly viewed as encompassing affective, cognitive, cultural and contextual dimensions. Developing a more complete understanding of pregnancy intentions should advance efforts to increase contraceptive use, to prevent unintended pregnancies and to improve the health of women and their children.To provide a scientific foundation for public health efforts to prevent unintended pregnancy, we conducted a review of unintended pregnancy between the fall of 1999 and the spring of 2001 as part of strategic planning activities within the Division of Reproductive Health at the Centers for Disease Control and Prevention (CDC). We reviewed the published and unpublished literature, consulted with experts in reproductive health and held several joint meetings with the Demographic and Behavioral Research Branch of the National Institute of Child Health and Human Development, and the Office of Population Affairs of the Department of Health and Human Services. We used standard scientific search engines, such as Medline, to find relevant articles published since 1975, and identified older references from bibliographies contained in recent articles; academic experts and federal officials helped to identify unpublished reports. This comment summarizes our findings and incorporates insights gained from the joint meetings and the strategic planning process. CURRENT DEFINITIONS AND MEASURESConventional measures of unintended pregnancy are designed to reflect a woman's intentions before she became pregnant. 3 Unintended pregnancies are pregnancies that are reported to have been either unwanted (i.e., they occurred when no children, or no more children, were desired) or mistimed (i.e., they occurred earlier than desired). In contrast, pregnancies are described as intended if they are reported to have happened at the "right time" 4 or later than desired (because of infertility or difficulties in conceiving). A concept related to unintended pregnancy is unplanned pregnancy-one that occurred when the woman used a contraceptive method or when she did not desire to become pregnant but did not use a method. Intentions are often measured or reported only for pregnancies ending in live births; pregnancies ending in abortion a...

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