FHI - Pregnancy Checklist

Before initiating a medical regimen, health care providers often need to assess whether a woman is pregnant, because some medications may have side effects that are potentially harmful to the fetus. According to the World Health Organization (WHO), there is no known harm to the woman, the course of her pregnancy, or the fetus if COCs, DMPA (or NET-EN), combined injectable contraceptives, the contraceptive patch, or the contraceptive ring are accidentally used during pregnancy. However, it is recommended that family planning providers assess whether a woman seeking contraceptive services might already be pregnant, because women who are currently pregnant do not require contraception. In addition, the IUD should never be inserted in pregnant women because doing so might lead to septic miscarriage, a serious complication. Although pregnancy tests are reliable, in many areas such tests are unavailable or unaffordable. When providers lack recourse to pregnancy tests, they rely on the presence of menses as evidence that a woman is not pregnant. In these cases, clients who are not menstruating when they visit a health facility for contraception are turned away. These women are often required to wait for their menses to return before they can initiate use of a contraceptive method.

In order for nonmenstruating clients to be able to safely initiate their method of choice, Family Health International (FHI) developed a simple checklist entitled How to Be Reasonably Sure a Client Is Not Pregnant and known informally as the Pregnancy Checklist (PDF, 120 KB). The Pregnancy Checklist contains a series of questions to rule out pregnancy. These questions, based on criteria established by the World Health Organization (WHO) for determining with reasonable certainty that a woman is not pregnant, are also included in the COC, DMPA, IUD, and implant checklists.

Although originally developed for use by family planning providers, the Pregnancy Checklist can also be used by other health care providers who need to determine whether a client could be pregnant. For example, pharmacists may use this checklist when prescribing certain medications that should be avoided during pregnancy.

Evaluations of the Pregnancy Checklist have been conducted in family planning clinics and have demonstrated that the tool is effective in correctly identifying women who are not pregnant. Furthermore, studies in Guatemala, Mali, and Senegal have shown that use of the checklist by family planning providers significantly reduced the proportion of clients being turned away due to menstrual status and improved women's access to contraceptive services.

The Pregnancy Checklist is also available in French and Spanish, and older versions are available in Arabic, Creole, Hindi, Khmer, Nepali, and Romanian (PDF, 103 KB).

To access country-adapted Pregnancy Checklists, click on the following links:

Training and Reference Guide

Accompanying the Pregnancy Checklist is a training and reference guide intended for program managers, administrators, trainers, and service providers interested in learning how to use the checklist. Designed to serve as both a training and reference tool, the guide has two parts: a training module and a collection of essential, up-to-date reference materials on ruling out pregnancy.

Select printed copies of these materials are available. Click here to make an inquiry.