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 either are unavailable or too expensive. 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 to help nonmenstruating clients safely initiate their method of choice, Family Health International (FHI) developed a simple Pregnancy Checklist for use by family planning providers. The questions to rule out pregnancy are included in the IUD Checklist to ensure that pregnant women do not initiate use of an IUD. The questions for assessing pregnancy are also included in the COC, DMPA, and Implant Checklist. 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 that a client is not pregnant. For example, pharmacists may use this checklist when prescribing certain medications that should be avoided during pregnancy.

The Pregnancy Checklist is endorsed by the World Health Organization (WHO) and is based on criteria established by WHO for determining with reasonable certainty that a woman is not pregnant. Evaluation of the checklist in family planning clinics has 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, entitled How to Be Reasonable Sure a Client Is Not Pregnant, is available in: English (PDF, 120 KB), French (PDF, 100 KB), and Spanish (PDF, 82 KB). Previous versions of the Pregnancy Checklist 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 (PDF, 485 KB) 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.

How to Be Reasonably Sure a Client is Not Pregnant