MAQ Tools
Checklist to Rule Out Pregnancy: Instructions for Use
Goal of the Checklist Tool:
Family planning providers should always rule out pregnancy when providing hormonal methods or IUDs. However, pregnancy tests may not be available in all clinics or affordable for all clients. In such cases, this checklist provides workers with an easy-to-use tool to help non-menstruating clients safely initiate their method of choice. The checklist is based on criteria (1) for ruling out pregnancy recognized by the World Health Organization (WHO). Tests of the checklist’s effectiveness in family planning clinics showed that the tool was more than 99% effective at ruling out pregnancy. (2)
Using the Checklist:
The checklist is used to rule out pregnancy if no pregnancy tests are available. The provider simply asks the client each of the six questions (or includes them in history-taking). If the client answers "Yes" to any one question, and has no signs or symptoms of pregnancy, then she can safely be provided with her method of choice. It is very important that the provider trust what the client says. For example, if the client says her menstrual period started within the past seven days, the provider should accept the client’s word.
Pregnancy cannot always be ruled out. In these cases, the woman may go for a pregnancy test elsewhere, or use a temporary barrier method while awaiting her menses. If a pill client chooses to wait for her menses, she should be given the option of carrying home a cycle of pills to initiate when her menses returns.
Adapting the Checklist:
Some programs may choose to adapt the checklist to their own unique situations. For example, since a provider does not need to continue asking questions once a client answers "yes", a program can re-order the checklist questions to reflect locally common reasons that exclude pregnancy. However, programs should take care to ensure that the meaning of the original questions remains unchanged when adapting or translating the checklist.
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Technical Guidance/Competence Working Group (TG/CWG), Recommendations for Updating Selected Practices in Contraceptive Use: Volume II, United States Agency for International Development, 1997.
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Stanback J, Qureshi Z, Sekadde-Kigondu C, Gonzalez B, Nutley T. "Checklist For Ruling Out Pregnancy Among Family-Planning Clients in Primary Care," Lancet; August 14, 1999; 354(9178):566
