News | CDC Cuts Could Leave US Contraceptive Guidelines Outdated for Years
Brianna Henderson of Texas did not choose contraception solely to prevent pregnancy.
After delivering her second child, the mother of two was diagnosed with peripartum cardiomyopathy (PPCM), a rare and potentially fatal heart condition. She needed to avoid the life-threatening risk of another pregnancy while ensuring that her contraceptive method would not worsen her condition.
For more than a decade, a small specialist team at the US Centers for Disease Control and Prevention (CDC) addressed cases like hers. It developed guidance on safe contraceptive use for clinicians nationwide, particularly for women with conditions including heart disease, systemic lupus erythematosus, sickle cell disease, and obesity. The team was recently affected by large-scale cuts at the Department of Health and Human Services (HHS).
According to three dismissed employees, the restructuring nearly dismantled the CDC's reproductive health division. Clinicians, patient advocates, and former staff warn that the decision threatens the health and safety of women and infants.
Contraception is not one-size-fits-all
Clinicians say prescribing contraception is relatively straightforward for the general population, but risk assessment and personalized guidance are essential for women with high-risk conditions.
"We were effectively the only team in the country monitoring contraceptive safety," said a former CDC employee who requested anonymity. The team maintained the US Medical Eligibility Criteria for Contraceptive Use (MEC), an important resource for assessing whether a method is appropriate for a particular patient.
Henderson developed a rapid heartbeat and shortness of breath six weeks after delivery and was diagnosed with PPCM. MEC guidance advises most patients with PPCM to avoid combined estrogen-progestin contraception, such as standard birth-control pills, because it may cause blood clots or worsen heart failure. Some injectable contraceptives, including Depo-Provera, also carry higher risk. Safer progestin-only options such as implants are recommended.
"I had no idea birth-control pills could cause blood clots or worsen heart failure," Henderson said. "I now use a progestin implant that is more than 99% effective and was personally approved by my cardiologist."
Layoffs end the only active contraceptive-safety system
Employees familiar with the cuts said the reproductive health division had about 165 staff and contractors, more than two-thirds of whom were dismissed. The cuts affected the core MEC team and also:
The team running the Pregnancy Risk Assessment Monitoring System (PRAMS), a major maternal-health survey operating since the 1980s;
Statisticians tracking IVF and assisted reproductive technology data;
Epidemiologists collecting pregnancy-care data to study major causes of maternal complications and deaths.
"They uprooted the entire system," said one dismissed employee.
Without updates, the guidance may quickly become outdated
Since 2010, the CDC has published MEC guidance based on World Health Organization recommendations, with full updates every five years and interim revisions when major evidence emerges. That continuous monitoring and updating process has now been suspended.
In 2020, for example, the CDC updated safety classifications for contraception among women at high risk of HIV. The 2024 edition added current recommendations for patients with chronic kidney disease, women who are breastfeeding, and patients with systemic lupus erythematosus or PPCM.
"Missing guidance can mislead doctors and may be life-threatening," said Michael Policar, professor of obstetrics and gynecology at the University of California, San Francisco, who has repeatedly used MEC guidance for complex cases.
"Without a resource like MEC, it is extremely difficult to advise a woman with type 2 diabetes, hypertension, systemic lupus erythematosus, or prior treatment for precancerous breast disease."
Community response: This is about life and death, not politics
Henderson spent two years recovering her heart function. She founded the nonprofit Let’s Talk PPCM to educate women about heart failure and its relationship to contraception.
"We do not want more blood clots or more heart failure caused by the wrong contraceptive method," she said. "So many women already distrust doctors, and now the government has removed the last trusted authority."
"This should not be a political issue. It is a matter of life and death."
News | CDC Cuts Could Leave US Contraceptive Guidelines Outdated for Years
News | CDC Cuts Could Leave US Contraceptive Guidelines Outdated for Years
Brianna Henderson of Texas did not choose contraception solely to prevent pregnancy.
After delivering her second child, the mother of two was diagnosed with peripartum cardiomyopathy (PPCM), a rare and potentially fatal heart condition. She needed to avoid the life-threatening risk of another pregnancy while ensuring that her contraceptive method would not worsen her condition.
For more than a decade, a small specialist team at the US Centers for Disease Control and Prevention (CDC) addressed cases like hers. It developed guidance on safe contraceptive use for clinicians nationwide, particularly for women with conditions including heart disease, systemic lupus erythematosus, sickle cell disease, and obesity. The team was recently affected by large-scale cuts at the Department of Health and Human Services (HHS).
According to three dismissed employees, the restructuring nearly dismantled the CDC's reproductive health division. Clinicians, patient advocates, and former staff warn that the decision threatens the health and safety of women and infants.
Contraception is not one-size-fits-all
Clinicians say prescribing contraception is relatively straightforward for the general population, but risk assessment and personalized guidance are essential for women with high-risk conditions.
"We were effectively the only team in the country monitoring contraceptive safety," said a former CDC employee who requested anonymity. The team maintained the US Medical Eligibility Criteria for Contraceptive Use (MEC), an important resource for assessing whether a method is appropriate for a particular patient.
Henderson developed a rapid heartbeat and shortness of breath six weeks after delivery and was diagnosed with PPCM. MEC guidance advises most patients with PPCM to avoid combined estrogen-progestin contraception, such as standard birth-control pills, because it may cause blood clots or worsen heart failure. Some injectable contraceptives, including Depo-Provera, also carry higher risk. Safer progestin-only options such as implants are recommended.
"I had no idea birth-control pills could cause blood clots or worsen heart failure," Henderson said. "I now use a progestin implant that is more than 99% effective and was personally approved by my cardiologist."
Layoffs end the only active contraceptive-safety system
Employees familiar with the cuts said the reproductive health division had about 165 staff and contractors, more than two-thirds of whom were dismissed. The cuts affected the core MEC team and also:
The team running the Pregnancy Risk Assessment Monitoring System (PRAMS), a major maternal-health survey operating since the 1980s;
Statisticians tracking IVF and assisted reproductive technology data;
Epidemiologists collecting pregnancy-care data to study major causes of maternal complications and deaths.
"They uprooted the entire system," said one dismissed employee.
Without updates, the guidance may quickly become outdated
Since 2010, the CDC has published MEC guidance based on World Health Organization recommendations, with full updates every five years and interim revisions when major evidence emerges. That continuous monitoring and updating process has now been suspended.
In 2020, for example, the CDC updated safety classifications for contraception among women at high risk of HIV. The 2024 edition added current recommendations for patients with chronic kidney disease, women who are breastfeeding, and patients with systemic lupus erythematosus or PPCM.
"Missing guidance can mislead doctors and may be life-threatening," said Michael Policar, professor of obstetrics and gynecology at the University of California, San Francisco, who has repeatedly used MEC guidance for complex cases.
"Without a resource like MEC, it is extremely difficult to advise a woman with type 2 diabetes, hypertension, systemic lupus erythematosus, or prior treatment for precancerous breast disease."
Community response: This is about life and death, not politics
Henderson spent two years recovering her heart function. She founded the nonprofit Let’s Talk PPCM to educate women about heart failure and its relationship to contraception.
"We do not want more blood clots or more heart failure caused by the wrong contraceptive method," she said. "So many women already distrust doctors, and now the government has removed the last trusted authority."
"This should not be a political issue. It is a matter of life and death."
Source:
Collected online