48706 Federal Register / Vol. 86, No. 166 / Tuesday, August 31, 2021 / Notices 

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; 

correction. 

SUMMARY: On August 19, 2021 the 

Centers for Disease Control and 

Prevention (CDC) in the Department of 

Health and Human Services (HHS) 

published a notice 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. The 

notice did not include the mailing 

address to submit public comment. This 

notice provides the mailing address for 

the public. 

DATES: The document published on 

August 19, 2021 (FR 86 46703). 

Comments must be received by October 

18, 2021. 

ADDRESSES: You may submit comments, 

identified by Docket No. CDC–2021– 

0088 by any of the following methods: 

• Federal eRulemaking Portal: http:// 

www.regulations.gov. Follow the 

instructions for submitting comments. 

• Mail: 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. 

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: usmecspr@cdc.gov. 

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 

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. 

Supplementary Information: 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, 


khammond on DSKJM1Z7X2PROD with NOTICES
Federal Register / Vol. 86, No. 166 / Tuesday, August 31, 2021 / Notices 48707 

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. 

Sandra Cashman, 

Executive Secretary, Centers for Disease 

Control and Prevention. 

[FR Doc. 2021–18769 Filed 8–30–21; 8:45 am] 

BILLING CODE 4163–18–P 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Administration for Children and 

Families 

Submission for OMB Review; 

Monitoring and Compliance for ORR 

Care Provider Facilities (0970–0564) 

AGENCY: Office of Refugee Resettlement, 

Administration for Children and 

Families, Department of Health and 

Human Services. 

ACTION: Request for public comment. 

SUMMARY: The Office of Refugee 

Resettlement (ORR), Administration for 

Children and Families (ACF), U.S. 

Department of Health and Human 

Services (HHS), is proposing to continue 

to collect information that will allow the 

Unaccompanied Children (UC) Program 

to monitor its care provider facilities for 

compliance with federal and state laws 

and regulations, licensing and 

accreditation standards, ORR policies 

and procedures, and child welfare 

standards. These information 

collections were originally approved 

under emergency approval for 6 months. 

This request is to continue data 

collection. 

DATES: Comments due within 30 days of 

publication. OMB is required to make a 

decision concerning the collection of 

information between 30 and 60 days 

after publication of this document in the 

Federal Register. Therefore, a comment 

is best assured of having its full effect 

if OMB receives it within 30 days of 

publication. 

ADDRESSES: Written comments and 

recommendations for the proposed 

information collection should be sent 

within 30 days of publication of this 

notice to www.reginfo.gov/public/do/ 

PRAMain. Find this particular 

information collection by selecting 

‘‘Currently under 30-day Review—Open 

for Public Comments’’ or by using the 

search function. 

SUPPLEMENTARY INFORMATION: 

Description: ORR received several 

comments on this information 

collection in response to the Federal 

Register Notice published on 

January 21, 2021, (86 FR 6340) and has 

provided responses to those comments 

in its final submission to OMB. UC Path 

is critical to program operations and it 

is important that rollout of the new 

system not be delayed. Therefore, the 

below description details what will be 

included in the initial launch of the UC 

Path case management system and 

revisions based on public comments 

will be made after initial launch. ORR 

plans to conduct a deliberative review 

of commenters’ suggestions and 

concerns and submit a request for 

revisions to this information collection 

request in January 2022. The upcoming 

information collection request will also 

include revisions based on feedback 

from UC Path system users (i.e., ORR 

grantee, contractor, and federal staff). 

The components of this information 

request include: 

1. Corrective Action Report (Form M– 

1): This instrument is used by ORR 

Monitoring Team staff (includes federal 

and contractor staff), ORR Federal Field 

Specialists, and ORR Project Officers to 

document care provider noncompliance with minimum standards 

for the care and timely release of UC; 

federal and state laws and regulations; 

licensing standards; ORR policies and 

procedures; and child welfare 

standards. Care providers respond to 

each corrective action cited by ORR staff 

by entering a detail corrective action 

plan into the instrument and attaching 

any relevant supporting documents. 

Then, ORR staff document when each 

corrective action plan is completed to 

ORR’s satisfaction and enter a final 

determination. 

2. FFS Compliance and Safety Site 

Visit Report (Form M–3A): This 

instrument is used by ORR Federal 

Field Specialists to document site visit 

observations and interview responses. 

3. Out-of-Network Site Visit Report 

(Form M–3B): This instrument is used 

by ORR Federal Field Specialists to 

document site visit observations and 

interview responses for out-of-network 

providers. 

Checklists for a Child-Friendly 

Environment 

These instruments are used by care 

providers on a voluntary basis to help 

ensure compliance with ORR policies 

and procedures related to maintaining a 

safe, child-friendly environment. ORR 

may also ask care providers to complete 

the checklist prior to a site visit. 

4. Checklist for a Child-Friendly 

Environment—Care Provider 

Facility (Form M–4A) 

5. Checklist for a Child-Friendly 

Environment—Individual Foster 

Home (Form M–4B) 

Incident Reviews 

These instruments are used by ORR 

care provider staff to provide 

information to ORR on allegations of 

sexual abuse or sexual harassment that 

occurred in ORR care that were 

investigated by local child protective 

services, state licensing, local law 

enforcement, the HHS Office of the 

Inspector General, and/or the Federal 

Bureau of Investigation. Care providers 

submit the instrument to ORR’s 

Prevention of Sexual Abuse Team for 

review. Incident reviews help ensure 

that care providers have appropriate 

protective measures in place to prevent 

a similar incident from occurring again. 

6. UC Incident Review (Form M–5A): 

This instrument is completed for 

allegations of sexual abuse or sexual 

harassment that occurred in ORR care 

between two children. Changed the full 

name of the form from ‘‘Sexual Abuse 

and Sexual Harassment UAC Incident 

Review’’ to ‘‘PSA UC Incident Review.’’ 

7. Adult Incident Review (Form M– 

5B): This instrument is completed for 

allegations of sexual abuse, sexual 

harassment, or inappropriate sexual 


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