Addressing potential pitfalls of reproductive life planning with patient-centered counseling

Planned, unplanned and in-between: the meaning and context of pregnancy planning for young people

“…Researchers have long acknowledged the problematic nature of binary definitions of pregnancies as either planned or unplanned, particularly in informing contraceptive counseling practices [2,3,34–37]. Indeed, we found that while many participants held up planned pregnancies as an ideal, the majority of our sample also felt that a status in between planned and unplanned pregnancy existed.…”

“…Some providers may base their counseling approach on their perception of their patient’s readiness to parent owing to age, career or relationship status [5,42], while others may implicitly problematize pregnancy and pregnancy desire among certain groups or young women [5–7]. Based on the existing literature and our results, we find that a reframing of pregnancy planning that is inclusive of a variety of perspectives is necessary [2,3,34–37]. Moreover, providers should recognize that pregnancies may not always be planned or unplanned and make every effort to provide non-judgmental family planning care to patients who may have distinct family planning priorities and values of their own [5–7,37].…”

“…Based on the existing literature and our results, we find that a reframing of pregnancy planning that is inclusive of a variety of perspectives is necessary [2,3,34–37]. Moreover, providers should recognize that pregnancies may not always be planned or unplanned and make every effort to provide non-judgmental family planning care to patients who may have distinct family planning priorities and values of their own [5–7,37]. …”

“…This is just one of many examples of the chasm between family planning practices and people’s lived reproductive health experiences. Indeed, studies have found that family planning providers can implicitly or explicitly perpetuate normative ideals about childbearing [5–7,37]. Some providers may base their counseling approach on their perception of their patient’s readiness to parent owing to age, career or relationship status [5,42], while others may implicitly problematize pregnancy and pregnancy desire among certain groups or young women [5–7].…”

Beyond intent: exploring the association of contraceptive choice with questions about Pregnancy Attitudes, Timing and How important is pregnancy prevention (PATH) questions

“…One Key Question [4] asks clients “Would you like to become pregnant in the next year?” However, given the complexity of pregnancy preferences, the use of timing alone might not be sufficient to understand a patient’s contraceptive needs and pregnancy intentions. PATH, which stands for P regnancy A ttitudes, T iming, H ow important is prevention [5], was originally a conversation guide to support client-centered contraceptive counseling and preconception care in the clinical setting. Key components of the PATH clinical tool include: prompts about patient pregnancy intentions; questions about whether and when pregnancy might be desired; and questions about the importance of preventing a pregnancy and happiness about a hypothetical pregnancy.…”