Reproductive life plans
Reproductive life planning (RLP) is a collaborative process between patients of reproductive age and health care providers to think about and discuss patients’ desires related to having or not having children and establish goals based on those desires, consistent with personal values and current life circumstances (Hipp 2019); reproductive life plans can evolve over time (Hipp 2019). Health care providers can introduce RLP during primary care, outpatient, and hospital visits as a prompt to discuss patients’ intentions to have or not have a child or additional children (Malnory 2011) and use that information to provide contraception or preconception services as appropriate (Hipp 2019) and address other health needs prior to desired pregnancies (Moos 2008). RLP is considered a key component of well woman visits (ACOG 2012) and can also be introduced in community settings through home visiting programs, health education curricula, family support programs, and other initiatives (Malnory 2011).
We at times use “women” or “maternal” when referring to people who may become pregnant or who may give birth. We acknowledge that not all people who can become pregnant or give birth identify as women, however current research on reproductive life planning has primarily focused on those who identify as women.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
- Increased preconception planning
- Improved reproductive health
- Improved birth outcomes
- Increased use of contraception
- Improved health-related knowledge
- Increased healthy behaviors
What does the research say about effectiveness? -+
Reproductive life planning (RLP) is a suggested strategy to increase preconception planning, improve maternal and child health outcomes (CDC MMWR-Johnson 2006, Moos 2008), increase contraceptive use, and increase autonomy for women around reproductive health (Morse 2018). Available evidence for adults suggests RLP appears to be well-accepted by patients and providers in clinical practice, but there is limited evidence of effects on knowledge or behavior change, and evidence on contraceptive use suggests little change (Chuang 2019, Hipp 2019). RLP prompts prior to visits may increase discussions with providers (Hipp 2019, Bello 2013). Little evidence is available for adolescent populations, though digital and online tools may engage this population (Boyle 2022). However, additional evidence is needed to confirm effects; knowledge and awareness may not lead to changes in behavior (Hipp 2019).
Experts suggest reproductive life planning be patient centered, concentrating more on a patient’s feelings about pregnancy and not just pregnancy timing. Not all women choose to plan their pregnancies, and unintended pregnancies may still be welcomed (Morse 2018). Any written materials for reproductive life plans, like other consumer-focused health literature, should be designed to be understandable, culturally sensitive, and responsive to the needs of those who use them (Malnory 2011).
Studies with providers in the U.S and Sweden suggest RLP tools filled out prior to visits facilitate communication and support delivery of patient-focused reproductive counseling (Bello 2013, Koo Andersson 2020). Written RLP protocols for providers may lead to more frequent RLP assessment, which is associated with an increased likelihood of preconception care (Robbins 2017).
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities. -+
It is unclear what impact reproductive life planning (RLP) may have on disparities in pregnancy and birth outcomes among groups who have been marginalized (Morse 2018), though it is considered especially important in populations at risk for adverse outcomes, such as women who are Black (Malnory 2011). Available evidence suggests that RLP is acceptable and valuable to women from groups that have been marginalized, including women who have low incomes and are Black (Bello 2013), and incarcerated women who may be released within 6 months (Perrigo 2020).
What is the relevant historical background? -+
The concept of reproductive life planning arose in the 1980s, with more formalized frameworks developing over time as efforts to improve maternal and child health outcomes expanded into preconception care. In 2014 recommendations on family planning services from the Centers for Disease Control and Prevention (CDC) and the U.S. Office of Population Affairs included RLP as a core service for all (Morse 2018).
Addressing preconception health is important for all people, as many pregnancies are unintended. Unwanted pregnancies could be terminated in all 50 states prior to the 2022 Dobbs v. Jackson Women’s Health Organization Supreme Court decision which made abortion illegal in almost half of U.S. states (Haiman 2023). This change in law, and other increased barriers to abortion, may increase existing disparities in maternal and infant health (KFF-Hill 2022) as more unwanted pregnancies are carried to term (Haiman 2023).
Equity Considerations -+
- What disparities in birth and maternal outcomes exist in your community?
- What resources are available for health care in your community? Are certain groups less able to access the care and services available?
- What are the barriers to high quality, linguistically, and culturally appropriate care?
Implementation Examples -+
Reproductive life planning (RLP) factors into many preconception care efforts and varied materials are available to providers and the public.
RLP tools often used by providers include the One Key Question approach (OKQ) and the Pregnancy, Attitudes, Timing and How important is pregnancy prevention (PATH) framework (Envision SRH-PATH framework), as well as teen specific tools such as TeenSource (TeenSource-RLP). Providers may incorporate RLP into their sexual health history tools, such as the National Coalition for Sexual Health’s Sexual Health Questions to Ask All Patients (NCSH 2023).
DE Thrives from the Delaware Division of Public Health, for example, provides RLP resources for women (DE Thrives-RLP women), men (DE Thrives-RLP men), and teens (DE Thrives-RLP teens). The Preconception Health Council of California’s Every Woman California program (EWCA) and the online Region I Title X Family Planning Training Center serving New England (Region I FPTC) also provide RLPs.
Implementation Resources -+
Envision SRH-PATH framework - Envision Sexual and Reproduction Health. (n.d.). Patient-centered reproductive goals counseling. (The PATH framework). Retrieved October 14, 2024.
EWCA - Every Woman California (EWCA). Educational resources for public health professionals & providers. Preconception Health Council of California.
NCSH 2023 - National Coalition for Sexual Health. (2023). Sexual health questions to ask all patients. Retrieved October 21, 2024.
OKQ - Power to Decide. (n.d.). One key question online. Retrieved October 21, 2024.
Region I FPTC - Region I Title X Family Planning Training Center (FPTC). Resources: Reproductive life planning.
TeenSource-RLP - TeenSource.org. (n.d.). What’s your (Reproductive life) plan? Retrieved October 21, 2024.
Citations -+
* Journal subscription may be required for access.
ACOG 2012* - The American College of Obstetricians and Gynecologists (ACOG). Prediction and prevention of preterm birth. Obstetrics & Gynecology. 2012;120(4):964-73.
Bello 2013* - Bello JK, Adkins K, Stulberg DB, Rao G. Perceptions of a reproductive health self-assessment tool (RH-SAT) in an urban community health center. Patient Education and Counseling. 2013;93(3):655-63.
Boyle 2022 - Boyle, J. A., Yimer, N. B., Hall, J., Walker, R., Jack, B., & Black, K. (2022). Reproductive life planning in adolescents. Seminars in Reproductive Medicine, 40(01/02), 124–130.
CDC MMWR-Johnson 2006 - Johnson K, Posner SF, Biermann J, et al . Recommendations to improve preconception health and health care - United States. Morbidity and Mortality Weekly Report (MMWR). 2006;55(RR-6):1-23.
Chuang 2019* - Chuang, C. H., Weisman, C. S., Velott, D. L., Lehman, E., Chinchilli, V. M., Francis, E. B., Moos, M., Sciamanna, C. N., Armitage, C. J., & Legro, R. S. (2019). Reproductive life planning and contraceptive action planning for privately insured women: The MyNewOptions study. Perspectives on Sexual and Reproductive Health, 51(4), 219–227.
DE Thrives-RLP men - Delaware Thrives. (n.d.). Men’s health. Delaware Division of Public Health. Retrieved October 10, 2024.
DE Thrives-RLP teens - Delaware Thrives. (n.d.). My life, my plan: Teen. Delaware Division of Public Health. Retrieved October 10, 2024.
DE Thrives-RLP women - Delaware Thrives. (n.d.). My life, my plan: Women. Delaware Division of Public Health. Retrieved October 10, 2024.
Envision SRH-PATH framework - Envision Sexual and Reproduction Health. (n.d.). Patient-centered reproductive goals counseling. (The PATH framework). Retrieved October 14, 2024.
EWCA - Every Woman California (EWCA). Educational resources for public health professionals & providers. Preconception Health Council of California.
Haiman 2023 - Haiman, M. D., & Cubbin, C. (2023). Impact of geography and rurality on preconception health status in the United States. Preventing Chronic Disease, 20(E101), 230104.
Hipp 2019* - Hipp, S. L., Chung-Do, J., & McFarlane, E. (2019). Systematic review of interventions for reproductive life planning. Journal of Obstetric, Gynecologic & Neonatal Nursing, 48(2), 131–139.
KFF-Hill 2022 - Hill L, Artiga S, Ranji U. Racial disparities in maternal and infant health: Current status and efforts to address them. KFF. 2022.
Koo Andersson 2020* - Koo Andersson, M., & Tydén, T. (2020). Implementation of reproductive life planning (RLP) in primary health care supported by an evidence-based website. The European Journal of Contraception & Reproductive Health Care, 25(1), 1–7.
Malnory 2011* - Malnory ME, Johnson TS. The reproductive life plan as a strategy to decrease poor birth outcomes. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2011;40(1):109-121.
Moos 2008* - Moos MK, Dunlop AL, Jack BW, et al. Healthier women, healthier reproductive outcomes: Recommendations for the routine care of all women of reproductive age. American Journal of Obstetrics and Gynecology. 2008;199(6 Suppl 2):280-9.
Morse 2018* - Morse, J. E., & Moos, M.-K. (2018). Reproductive life planning: Raising the questions. Maternal and Child Health Journal, 22(4), 439–444.
NCSH 2023 - National Coalition for Sexual Health. (2023). Sexual health questions to ask all patients. Retrieved October 21, 2024.
OKQ - Power to Decide. (n.d.). One key question online. Retrieved October 21, 2024.
Perrigo 2020* - Perrigo, J. L., Nguyen, B. T., Hayes, C., Nattell, N. A., Cortessis, V. K., & Natavio, M. (2020). Incarcerated women’s perceptions of a reproductive life-planning class: A qualitative study. Women & Criminal Justice, 30(3), 188–203.
Region I FPTC - Region I Title X Family Planning Training Center (FPTC). Resources: Reproductive life planning.
Robbins 2017* - Robbins CL, Gavin L, Carter MW, Moskosky SB. The link between reproductive life plan assessment and provision of preconception care at publicly funded health centers. Perspectives on Sexual and Reproductive Health. 2017;49(3):167-172.
TeenSource-RLP - TeenSource.org. (n.d.). What’s your (Reproductive life) plan? Retrieved October 21, 2024.