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. In addition, methods such as IUDs should never be initiated in pregnant women because doing so might lead to septic miscarriage, which is a serious complication. Although pregnancy can be reliably determined with pregnancy tests, in many areas, such tests are either not available or affordable for clients. In such cases, many clients who are not menstruating at the time of their visit are denied contraception as providers rely on the presence of menses as an indicator that a woman is not pregnant. These women are often required to wait for their menses to return before they initiate a contraceptive method.

In order to help nonmenstruating clients safely initiate their method of choice, Family Health International (FHI) developed a simple checklist for use by family planning providers. Although originally the Pregnancy Checklist was developed for use by family planning providers, it can also be used by other health care providers who need to determine whether a client is not pregnant. For example, pharmacists may use this checklist when prescribing certain medications that should be avoided during pregnancy (e.g., certain antibiotics or anti-seizure drugs). The 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 very effective in correctly identifying women who are not pregnant. Furthermore, recent 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.

Accompanying the Pregnancy Checklist is a Training and Reference Guide (English – PDF, 485 KB and French – PDF, 783 KB) intended for program managers, administrators, trainers, and service providers interested in learning to use the checklist. Designed to serve as both a training and reference tool, the guide is composed of two parts: a training module and a collection of essential, up-to-date reference materials on ruling out pregnancy. 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), Spanish (PDF, 82 KB), Arabic, Creole, Hindi, Khmer, Kiswahili (PDF, 87 KB), Nepali, and Romanian (PDF, 103 KB). To request hard copies of the checklist or guide, send an e-mail to publications@fhi.org.

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

How to Be Reasonably Sure a Client is Not Pregnant