By Emma Reeves
BMJ Sexual & Reproductive Health spoke with Dr Nancy Kidula, senior obstetrician & gynaecologist and Medical Officer at the World Health Organization’s Department of Sexual and Reproductive Health and Research, about the newly updated Medical Eligibility Criteria for Contraceptive Use (MEC) and Selected Practice Recommendations (SPR).
The supplement published in BMJ SRH brings together the systematic reviews that underpin this global guidance, which informs contraceptive policy and practice worldwide.
1. What makes the 6th edition of the WHO MEC, supported by the systematic reviews published in the BMJ SRH, a significant update?
Dr Nancy Kidula: This update comes ten years after the previous edition and addresses several key questions that countries and partners have raised over the past decade. We reviewed evidence on issues such as the safety of progesterone-only injectables during breastfeeding, interactions between antiretroviral therapies and hormonal contraceptives, and the use of emergency contraception more than once in a menstrual cycle. We also examined approaches to ease intrauterine device (IUD) insertion pain, which is a topic of great concern for users and providers alike. Not every review leads to a new recommendation, but all the evidence is transparently documented in the web annexe accompanying the guidelines, which gives the evidence to decision framework and the strength of recommendation.
2. How does the BMJ SRH supplement contribute to the WHO guidance?
Dr Nancy Kidula: The BMJ SRH supplement provides the full systematic reviews behind the new recommendations; it is the detailed evidence base that supports the decisions WHO makes. While the guideline summarises our conclusions, the supplement allows readers to see the data, methodology, evidence, risk of bias and quality assessments in full. This transparency is essential: it helps clinicians, researchers, and policymakers understand how recommendations are formed, critique them, and identify research gaps. WHO’s policy is to make this evidence openly accessible to improve safety and strengthen confidence in contraceptive guidance.
3. What are some of the most important changes or insights for clinicians and programme managers?
Dr Nancy Kidula: Several areas stand out. The updated guidance provides reassurance on the safety of certain progesterone-only injectables for breastfeeding women. This is especially relevant in low- and middle-income settings where these are widely used and therefore increases choices for post-partum contraception.
We also include new recommendations on interactions between hormonal contraception and HIV medications, including pre-exposure prophylaxis (PrEP), as well as guidance on the repeat use of emergency contraception in a single menstrual cycle.
Another focus is improving women’s experience of IUD placement by reviewing options to reduce pain or discomfort, which can make a real difference in acceptability and uptake.
4. The MEC and SPR are global tools; how can countries adapt them to their own realities?
Dr Nancy Kidula: Our goal is to ensure that the guidance is globally relevant, adaptable, and applicable. Most countries base their national family planning guidelines on the WHO MEC, and when we release an update, they can revise their local recommendations accordingly.WHO offers guidelines and technical support to facilitate adaptation and implementation of these guidelines. Context matters, as countries differ in what contraceptive methods they can procure, what is feasible or affordable, and which populations they prioritise, such as adolescents or people in humanitarian settings. WHO supports national teams to contextualise the global recommendations so they are equitable, practical, and responsive to local health realities.
5. What evidence gaps remain and where should future research focus?
Dr Nancy Kidula: There are always new questions to answer. We need more research on newer and more user-friendly contraceptive methods, for both women and men, and on areas like breastfeeding safety in preterm infants, optimal use of emergency contraception, and non-pharmacological ways to ease IUD insertion. Understanding return to fertility after stopping the use of different contraceptive methods remains important, too. Publishing the evidence base helps highlight these gaps so that researchers can build on what’s missing.
We’re also increasingly aware of the role of social media in shaping perceptions about contraception. Accurate, accessible communication of evidence, in language that resonates with users, is becoming just as important as the science itself.
The WHO MEC and SPR remain vital resources for evidence-based contraceptive care. By publishing the supporting systematic reviews in BMJ SRH, WHO reinforces its commitment to science, transparency, collaboration, and global accessibility in sexual and reproductive health.