Improving patient care and reducing unintended pregnancy: translating new guidelines into effective practice.

Sound the trumpets. Family Planning guidance has finally and formally arrived as an initiative of national importance at the Centers for Disease Control and Prevention (CDC). In an historic move, CDC has issued national recommendations on the best contraceptive practices in the United States [1]. Since the mid 1990s, CDC has been working with the World Health Organization (WHO) to support WHO's famed Medical Eligibility Criteria for Contraceptive Use (MEC) with scientific evidence, critical appraisal, and the synthesis of the scientific evidence upon which the guidance is based. As Curtis et al. present in their article in this issue of Contraception, CDC has embraced and adapted the WHO's guidance and tailored its recommendations in the United States Medical Eligibility Criteria for Contraceptive Use (US MEC) [2]. The next task is to integrate these critical recommendations into the busy practices of health care providers throughout the United States. In the May, 2010 Contraception editorial, Taylor et al. [3] documented the lack of national recommendations for the prevention and management of unintended pregnancies. Taylor et al. discussed the need to establish culturally appropriate evidenceand competency-based clinical guidelines to reduce unintended pregnancy. She noted the severe budget cuts to federal agencies that have historically provided leadership for sexual and reproductive health care service standards as well as the political demonization of reproductive health, especially contraception and abortion care. Guidelines for pregnancy prevention must be built on a comprehensive public health framework. Such guidelines, specifying the essential competencies required of all members of the health care team, can then be integrated into health care provider training programs, primary care settings and the broader health system. In the absence of US Preventive Services Task Force recommendations for preventing unintended pregnancy, CDC's commitment to this critical aspect of health care marks an important step in the direction of creating a comprehensive plan to prevent and manage unintended pregnancy in the United States. While the issuance of guidelines from a federal agency is critical, guidance alone is insufficient to improve patient care.