Keeping evidence-based recommendations up to date: the World Health Organization's global guidance for family planning.

Since the mid 1990s, the World Health Organization's (WHO) Department of Reproductive Health and Research, in collaboration with international partners, has been creating and updating global guidance for family planning, based on the best scientific evidence. In April 2008, WHO held its most recent expert meeting to update this guidance and create the fourth edition of the Medical Eligibility Criteria for Contraceptive Use [1] and the third edition of the Selected Practice Recommendations for Contraceptive Use [2]. The Medical Eligibility Criteria for Contraceptive Use gives recommendations regarding whether women with specific characteristics and medical conditions can use various methods of contraception. The Selected Practice Recommendations for Contraceptive Use addresses 33 contraceptive management issues, including contraceptive method initiation and continuation, management of side effects, and screening tests needed prior to contraceptive initiation. WHO has also created two companion documents that incorporate all of the guidance of the Medical Eligibility Criteria for Contraceptive Use and the Selected Practice Recommendations for Contraceptive Use into tools for family planning providers. The first is the Decision Making Tool for Family Planning Clients and Providers [3], which is a flip chart used to facilitate provider–client interaction in choosing a method of contraception. The second is Family Planning: A Global Handbook for Providers [4], created in collaboration with major family planning organizations around the world. These WHO Four Cornerstones for Evidence-based Guidance for Family Planning have had an impact on family planning practice globally. For example, the third edition of the Medical Eligibility Criteria for Contraceptive Use has been incorporated into guidelines in over 50 countries and is available in 13 languages. Keeping evidence-based guidance up to date is one of the most challenging aspects of guidelines development. Guidelines can become out of date quickly as new evidence becomes available, and many guidelines do not have formal