Telemedicine utilization has increased significantly in recent years, with the potential to increase access to reproductive healthcare. These two Clinical Recommendations provide evidence-based guidance to optimize the management of and access to medication abortion and contraception care via telemedicine within the US.  

With several states imposing restrictions on abortion care and creating challenges to obtaining abortions earlier in pregnancy, the clinical need for abortions at or after 24 0/7 weeks of gestation is expected to increase. This Clinical Recommendation reviews relevant literature and summarizes the evidence for providing abortion care at or after 24 0/7 weeks of gestation in settings where it is legal to support the broadest, safest, and most patient-centered care.  

This Clinical Recommendation provides evidence-informed, equitable, anti-racist, and person-centered recommendations to optimize the management of and access to medication abortion up to 13 6/7 weeks of gestation within a reproductive justice framework. It addresses eligibility, counseling, testing, medication regimens, and approaches such as no-test and advanced provision. It updates the Society’s current clinical guidance on medication abortion up to 70 days of gestation. 

This Committee Statement discusses interpreting and applying the Centers for Disease Control and Prevention’s forthcoming US Medical Eligibility Criteria for Contraceptive Use (US MEC) and US Selected Practice Recommendations for Contraceptive Use (US SPR) in clinical practice. It focuses on offering patient-centered counseling and care when a contraceptive method is classified as category 3 or 4 based on specific medical conditions or characteristics.  

This Clinical Recommendation reviews clinical questions regarding complex management and special consideration in IUD care, from complexity assessment to placement through removal. This document will supplement already-existing guidance, such as the Centers for Disease Control and Prevention’s (CDC’s) forthcoming update to the US Medical Eligibility Criteria (US MEC) for Contraceptive Use and US Selected Practice Recommendations for Contraceptive Use (US SPR), and uplift patient-centered, trauma-informed, and complex care.  

This Committee Statement will review clinical questions related to complex management and special consideration for deeply placed and non-palpable contraceptive implants. It will focus on assessing the complexity of implant removal, localization, and removal of non-palpable contraceptive implants. Aligned with the Society’s vision, this document will be grounded in a patient-centered framework that prioritizes patient autonomy, builds trust and rapport, and individualizes contraception counseling and care. 

This Clinical Recommendation will consider evidence-informed guidance for cervical preparation before abortion across gestational durations. This document will acknowledge that there is a range of safe, effective, and acceptable approaches to cervical preparation before abortion, and the selected approach may depend on patient response, the clinician’s technical capability, available resources, legal context, and institutional policies. To the extent possible, relevant documents will be timed to include findings from a forthcoming Cochrane review on first-trimester cervical preparation before abortion.  

This document is anticipated to serve as a revision to the Society’s current guidance on cervical preparation before abortion: (1) Cervical dilation before first-trimester surgical abortion (<14 weeks’ gestation), (2) Cervical preparation for second-trimester surgical abortion prior to 20 weeks’ gestation, and (3) Cervical preparation for dilation and evacuation at 20-24 weeks’ gestation. 

This Committee Statement will highlight the importance of offering pregnancy options counseling and timely access to abortion care, if desired, at the time of pregnancy diagnosis; at times when new information is identified about the pregnancy, such as changes in the health status of the pregnant person or fetus; and upon request by the pregnant person. This document will not include a list of serious medical conditions, life-limiting conditions, or specific personal considerations that would warrant offering pregnancy options counseling. This document will include information on patient-centered decision-making that centers the pregnant patient’s desires and outcomes as the standard of care, including the risks to the pregnant individual around remaining pregnant (eg, infection, cesarean delivery, medical conditions, mortality) and ethical concerns around forcing individuals to remain pregnant. 

This Clinical Recommendation series will provide evidence-informed guidance for pain and anxiety management for procedural abortion across gestational durations. It will include a Committee Statement on the context of pain management in abortion care and one to three Clinical Recommendations focused on interventions for pain management. Collectively, these documents will address guidance on local anesthesia; minimal, moderate, and deep sedation; general anesthesia, including new approaches, such as ketamine; and medication, doses, timing, and prescription approaches for oral anxiolytics (eg, on-site vs off-site dispensing, advanced prescription). They will also address the differences between and overlap of anxiety and pain management. We anticipate collaborating with partner organizations that specialize in providing anesthesia care.

This series will serve as an update to the Society’s current guidance: Society of Family Planning clinical guidelines pain control in surgical abortion part 1 — local anesthesia and minimal sedation (2018) and Pain control in surgical abortion part 2 – Moderate sedation, deep sedation, and general anesthesia (2021). 

This Clinical Recommendation will be jointly developed with the Society for Maternal-Fetal Medicine and will provide evidence-informed guidance on abortion in the setting of placenta accreta spectrum (PAS). While this may overlap with PAS management in a desired pregnancy, the focus would be abortion management specifically and include recommendations regarding identifying the optimal abortion techniques and setting, standardized counseling, and risk-reducing preoperative measures. It will build on the Society-endorsed SMFM Consult #63: Cesarean scar ectopic pregnancy. We anticipate collaborating with partner organizations that care for pregnant individuals with PAS and cesarean scar ectopic pregnancies.

This Committee Statement will update the Society’s current Interim Clinical Recommendation on Self-managed abortion (2022). It will provide expanded evidence-informed guidance to include information about community-supported abortion outside the formal healthcare setting. It will also incorporate a discussion on residual products of conception (RPOC). We anticipate this document can be scoped to supplement and align with the upcoming Clinical Recommendation on Medication abortion up to 13 6/7 weeks of gestation.