The Loss of Foundational Contraceptive Expertise for the United States

Angeline Ti, MD, MPH, and Dalia Brahmi, MD, MPH
Posted on August 25, 2025

Drs. Ti and Brahmi are guest authors for the AFP Community Blog. Dr. Angeline Ti is a family physician and family planning specialist who serves as faculty at the Wellstar Douglas Family Medicine Residency Program. From 2017-2019, she was a full-time guest researcher with the Fertility and Epidemiology Studies team at the Centers for Disease Control and Prevention. Dr. Dalia Brahmi is a family physician and family planning specialist who provides clinical care and trains Family Medicine residents at Planned Parenthood South Atlantic; she also mentors clinicians in the Southeast with the Reproductive Health Access Project. From 2009-2011, Dr. Brahmi was a medical officer at the World Health Organization on the Family Planning team that collaborated with the Centers for Disease Control and Prevention on the US Family Planning Guidelines.

Highlighted in an article in the August 2025 issue of American Family Physician, the Centers for Disease Control and Prevention (CDC) updated the national Contraceptive Guidance for Health Care Providers in August 2024. The CDC’s contraceptive guidance comprises the US Medical Eligibility Criteria (US MEC) for contraceptive use and the US Selected Practice Recommendations (US SPR) for contraceptive use and was among the most viewed and downloaded publications from the CDC. In April 2025, the entire team responsible for the guidance was terminated, along with much of the Division of Reproductive Health.

In 2010, the CDC first published the US MEC for contraceptive use as an adaptation of similarly named guidelines from the World Health Organization, tailored for clinicians in the United States. The first edition of the US SPR for contraceptive use followed in 2013. These guidelines were created to help clinicians remove unnecessary medical barriers to contraceptive care. The US MEC for contraceptive use provides recommendations on the safe use of contraception for patients with medical conditions, and the US SPR for contraceptive use provides recommendations on common contraceptive management issues.

To produce these guidelines, the eight-person team at CDC was responsible for monitoring the literature on contraception, conducting rigorous systematic reviews, and convening national experts to synthesize recommendations. To help clinicians use the guidelines in day-to-day practice, the CDC contraception team also distilled their detailed but unwieldy publications into easy to use clinical tools, such as a color-coded chart summarizing the US MEC for contraception use or a simple algorithm (Management of Bleeding Irregularities While Using Contraception) from the US SPR for contraception use. This information was placed into a helpful app for increased portability and searchability.

The clinical tools and app have become essential teaching tools for students and residents. The guidance and the associated tools allow a clinician to quickly see that certain contraceptive methods have increased risks (eg, risk of stroke and myocardial infarction for people with hypertension) or that all methods are safe for healthy teens.

The loss of the expertise of the CDC contraception team and their essential work is devastating to patient care and clinician education. They represent a trusted source of evidence-based guidance that is respected by the reproductive health (eg, ACOG, SMFM, NAPSAG, and SFP) and primary care (eg, AAFP and AAP) communities alike. As the 2024 publications of the US MEC for contraceptive use and US SPR for contraceptive use gradually become outdated, family physicians will be forced to rely on outdated or incomplete information as they help their patients find the contraceptive method that best meets their needs. This may lead to clinicians creating unnecessary barriers to contraception, such as additional visits or referrals, due to uncertainty. It could also lead to clinicians continuing or refilling methods that now may be less safe. It will ultimately lead to many patients not receiving evidence-based contraceptive care when they need it. This is especially concerning for patients with medical conditions that might have increased health risks for certain contraceptive methods but may also have increased pregnancy risks.

The CDC contraception team did not represent “fraud, waste and abuse” in the federal government but, instead, were a dedicated group of public health professionals who provided crucial clinical guidance. The loss of this guidance and the expertise of the team that created it will have real consequences for family physicians, medical education, and the patients we serve.