We recommend that family planning providers rule out pregnancy before they start any woman on a hormonal contraceptive or an intrauterine device (IUD).
Hormonal contraceptives include combined oral contraceptives, progestin-only pills, emergency contraceptive pills, monthly injectables, combined patch, combined vaginal ring, progesterone-releasing vaginal ring, and implants. Two types of IUDs exist – copper-bearing and levonorgestrel IUDs.
There are three ways that family planning providers can utilise to ascertain the possibility of pregnancy. They are – medical history, pregnancy tests, and delaying the start of the method until the woman’s next monthly bleeding.
Unless the woman has missed her monthly bleeding, we start with a pregnancy checklist to rule out pregnancy. When used correctly, the pregnancy checklist provides reasonable certainty that a woman is not pregnant. See the table below.
|Did your last monthly bleeding start within the past 7 days (12 days for a copper-bearing IUD)?|
|Have you abstained from sexual intercourse since your last monthly bleeding, delivery, abortion, or miscarriage?|
|Have you been using a reliable contraceptive method consistently and correctly since your last monthly bleeding, delivery, abortion, or miscarriage?|
|Have you had a baby in the last 4 weeks?|
|Did you have a baby less than 6 months ago, are you fully or nearly-fully breastfeeding, and have you had no monthly bleeding since then?|
|Have you had a miscarriage or abortion in the past 7 days (12 days for a copper-bearing IUD)?|
We do not recommend ruling out pregnancy using pregnancy tests before the first day of missed monthly bleeding has passed. It is because such tests are less likely to work. Before such a time, it is not only pointless but also wasteful to use the tests.
It is paramount to note that the only contraceptive method known to pose a health risk if started during pregnancy is the IUD. We recommend that a family planning provider uses a pregnancy test to rule out pregnancy if the pregnancy checklist cannot do so. Apart from, the levonorgestrel IUD, family planning providers can administer all the other hormonal methods without delay. In a few cases, follow-up will be paramount.
We advise against delaying the start of any family planning method as a tool for assessing the presence of a pregnancy. The woman in question may become pregnant before her next monthly bleeding, for which she will probably be unprepared to carry.
In a nutshell, both the pregnancy checklist and pregnancy tests are highly accurate for ruling out pregnancy when appropriately used. There’s no reason to prefer the test if we can use the pregnancy checklist.
Learn more about family planning from here.