[Federal Register Volume 86, Number 158 (Thursday, August 19, 2021)]
[Notices]
[Pages 46703-46704]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2021-17818]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Docket No. CDC-2021-0088]


Updating CDC's Contraception Guidance Documents: U.S. Medical 
Eligibility Criteria for Contraceptive Use and U.S. Selected Practice 
Recommendations for Contraceptive Use

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Notice with comment period.

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SUMMARY: The Centers for Disease Control and Prevention (CDC) in the 
Department of Health and Human Services (HHS) announces the opening of 
a docket to obtain comment on CDC's contraception recommendations. Two 
guidance documents, U.S. Medical Eligibility Criteria for Contraceptive 
Use (US MEC) and U.S. Selected Practice Recommendations for 
Contraceptive Use (US SPR), provide evidence-based recommendations to 
assist health care providers when counseling patients on contraceptive 
choice and use. Updates to these guidance documents typically occur 
every 5 years. As part of the planning process for the next update, CDC 
is requesting public comment on content to consider for revision or 
addition to the recommendations and how to improve the implementation 
of the guidance documents. This action is necessary to consider 
multiple and diverse perspectives and ensure that the documents meet 
the needs of U.S. health care providers and the persons they serve.

DATES: Written comments must be received on or before October 18, 2021.

ADDRESSES: You may submit comments, identified by Docket No. CDC-2021-
0088 by any of the following methods:
    <bullet> Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
    <bullet> Mail: [insert complete mailing address, including 
mailstop]
    Instructions: All submissions received must include the agency name 
and Docket Number. All relevant comments received will be posted 
without change to http://regulations.gov, including any personal 
information provided. For access to the docket to read background 
documents or comments received, go to http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Kathryn M. Curtis, Ph.D., Division of 
Reproductive Health, Centers for Disease Control and Prevention, 4770 
Buford Highway NE, MS S107-2, Atlanta, GA 30341. Telephone: 770-488-
5200. Email: <a href="/cdn-cgi/l/email-protection#b7c2c4dad2d4c4c7c5f7d4d3d499d0d8c1"><span class="__cf_email__" data-cfemail="4633352b23253536340625222568212930">[email protected]</span></a>.

SUPPLEMENTARY INFORMATION:

Public Participation

    Interested persons or organizations are invited to participate by 
submitting written views, recommendations, and data. CDC invites 
comments specifically on the following questions:
    1. Are there existing US MEC or US SPR recommendations that CDC 
should consider reviewing for possible revision, based on new evidence 
or other justification? Please provide references to new evidence and 
justification to support review of existing recommendations.
    2. Are there new recommendations that CDC should consider adding to 
the US MEC? This could include eligibility criteria for contraceptive 
use among people with medical conditions or characteristics not 
currently included in the US MEC. Please provide references to 
supporting evidence, justification, and impact of new recommendations.
    3. Are there new recommendations that CDC should consider adding to 
the US SPR? This could include clinical practice recommendations to 
address issues regarding initiation and use of specific contraceptive 
methods not currently included in the US SPR. Please provide references 
to supporting evidence, justification, and impact of new 
recommendations.
    4. Are there other issues that should be considered or suggestions 
to improve implementation of the US MEC and US SPR recommendations to 
help ensure equitable access to contraceptive services (such as better 
ways of presenting the recommendations, additional job aids or tools 
for providers, broader dissemination and implementation strategies, 
inclusion of additional partners, etc.)? Please provide references to 
supporting evidence or justification.
    Please note that comments received, including attachments and other 
supporting materials, are part of the public record and are subject to 
public disclosure. Comments will be posted on https://www.regulations.gov. Therefore, do not include any information in your 
comment or supporting materials that you consider confidential or 
inappropriate for public disclosure. If you include your name, contact 
information, or other information that identifies you in the body of 
your comments, that information will be on public display. CDC will 
review all submissions and may choose to redact, or withhold, 
submissions containing

[[Page 46704]]

private or proprietary information such as Social Security numbers, 
medical information, inappropriate language, or duplicate/near 
duplicate examples of a mass-mail campaign. CDC will carefully consider 
all comments submitted in preparation of the final document.
    In 2017-2019 in the United States, 65% of women aged 15-49 years 
used contraception; the most common contraceptive methods used were 
female sterilization, oral contraceptive pills, implants and 
intrauterine devices, and male condoms [1]. The majority (61%) of U.S. 
women aged 18-49 years have ongoing or potential need for contraceptive 
services [2]. Similarly, in 2010-2016, about 60% of men aged 15-44 
years in the United States needed family planning [3]. Equitable access 
to evidence-based, high quality care is critical to meeting the needs 
of persons seeking contraceptive services, improving reproductive 
autonomy, and reducing unintended pregnancy in the United States [2].
    Since 2010, CDC has published evidence-based recommendations on 
contraception provision. These recommendations are intended to assist 
health care providers when they counsel patients about choice and use 
of contraceptive methods, with the goal of reducing medical barriers to 
contraception access. U.S. Medical Eligibility Criteria for 
Contraceptive Use, 2016 (US MEC) comprises recommendations for the use 
of specific contraceptive methods by persons with certain 
characteristics or medical conditions, such as diabetes, hypertension, 
and being postpartum or breastfeeding [4]. U.S. Selected Practice 
Recommendations for Contraceptive Use, 2016 (US SPR) addresses common, 
yet sometimes complex, issues regarding initiation and use of specific 
contraceptive methods, such as examinations or tests needed before 
starting a method and management of side effects [5]. Both guidance 
documents are adapted from global guidance developed by the World 
Health Organization (WHO) and are based on review of the scientific 
evidence and consultation with national experts. CDC partners with 
other federal agencies and professional organizations in the 
development, dissemination, and implementation of the guidance 
documents to improve access to contraception and quality of family 
planning services.
    CDC is committed to ensuring that the US MEC and US SPR 
recommendations are reviewed and updated as new scientific evidence 
becomes available. Working with WHO, CDC continuously monitors peer-
reviewed literature and updates recommendations as needed, with 
comprehensive reviews approximately every 5 years. CDC is currently 
planning for the next update of the US MEC and US SPR and will consider 
public comments when determining the scope of the guidance update. CDC 
is seeking feedback from health care providers, professional 
organizations, community-based organizations, organizations that seek 
to improve reproductive health, patient advocacy groups, and the 
public.
    The current US MEC may be found at the Supplementary Materials tab 
of the docket and at https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html. The current US SPR may be found at 
the Supplementary Materials tab of the docket and at https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/summary.html.

References

1. Daniels K, Abma JC. Current contraceptive status among women aged 
15-49: United States, 2017-2019. NCHS Data Brief 2020:388;1-8.
2. Zapata LB, Pazol K, Curtis KM et al. Need for contraceptive 
services among women of reproductive age--45 jurisdictions, United 
States, 2017-2019. MMWR Morb Mortal Wkly Rep 2021;70:910-15.
3. Marcell AV, Gibbs SE, Choiriyyah I et al. National needs of 
family planning among US men aged 15 to 44 years. Am J Public Health 
2016:106;733-9.
4. Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. medical 
eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 
2016;65(RR-3):1-103.
5. Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. selected practice 
recommendations for contraceptive use, 2016. MMWR Recomm Rep 
2016;65(RR-4):1-66.

    Dated: August 16, 2021.
Sandra Cashman,
Executive Secretary, Centers for Disease Control and Prevention.
[FR Doc. 2021-17818 Filed 8-18-21; 8:45 am]
BILLING CODE 4163-18-P


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