In recent years, the U.S. teen pregnancy rate has declined significantly. In 2011, the rate was 52.4 pregnancies per women ages 15-19, the lowest rate in four decades and a decline of 23% since 2008, when the rate was 68.2 per 1,000.1 The change has been attributed nearly entirely to changes in contraceptive use among adolescents, as the rates of sexual activity have remained steady. Increase in contraceptive use, as well as an increase in the uptake of more effective methods among young patients, have resulted in major decreases in teen pregnancy, as well as teen birth and abortion rates.2

Reproductive Life Plan

One approach to discussing contraception and other ways to avoid unintended pregnancies and plan for healthy future pregnancies is for providers to engage patients in developing a reproductive life plan (RLP). An RLP is a set of personal goals regarding whether, when, and how to have children based on individual priorities, resources, and values.3

The CDC recommends all persons capable of having a child create an RLP.4 The American College of Obstetricians and Gynecologists (ACOG) also “strongly supports women’s access to comprehensive and culturally appropriate reproductive life planning.”5

In practice, reproductive life planning is a series of questions that can be integrated into any healthcare visit to assess a patient’s goals around childbearing.

Here are some examples of reproductive life planning questions:

  • Do you plan to have (more) children at any time in your future?
  • How long would you like to wait until you become a parent?
  • What can I do today to help you achieve your plan?

For those not desiring pregnancy, consider using these questions:

  • What family planning method(s) do you plan to use until you (or your partner) are ready to become pregnant?
  • How sure are you that you can use that method without problems?

These questions can be asked by a clinician, integrated into the electronic health record, or be included in intake materials so that the answers can be part of a more focused discussion in the limited time of a visit. Incorporating these questions into visits with patients of all genders, even visits not scheduled for family planning services, can provide an opportunity to help patients who wish to become parents to address health issues or behaviors that can complicate a healthy pregnancy, such as smoking.

Those wishing to avoid pregnancy can engage in a patient-centered discussion about a contraceptive method that will work for their lifestyle. Creating an RLP also may be useful for the many patients, adolescents, or adults who express pregnancy ambivalence.

Interpreting the Data

Although the CDC recommends an RLP for any patient of reproductive capacity, there is limited data about its use as a tool when working with adolescent patients. Authors of one study of 247 female patients ages 12-18 in Atlanta found an RLP to be a useful tool in patient-centered counseling, using the adolescent’s stated goals regarding pregnancy as a motivation to connect her with the best contraceptive for her.6

Despite limited data, some state health departments already have created dedicated written and online materials aimed at reproductive life planning for adolescents. The Delaware Division of Health created the “My Life, My Plan” tool in collaboration with adolescents (http://bit.ly/2izOGwp). The site includes tools for young people to consider and identify their goals around education, career, healthy relationships, nutrition, exercise, and parenting. California also uses a comprehensive life plan approach and offers resources for teens and healthcare providers (http://bit.ly/2iAkayp).

The definition of an RLP used by Every Woman California may be better suited for working with adolescents: “A plan to attain a state of sexual and reproductive health that begins in infancy and continues throughout the life of the individual regardless of a person’s choice to reproduce.”7 This take on the RLP emphasizes that reproductive health is important at any age, having a baby is a significant event, and planning for it is essential. Instead of using only the risk-based approach of focusing solely on pregnancy prevention, creating an RLP highlights the need to plan and consider an important decision like becoming a parent. It also provides an opportunity to talk about positive aspects of parenting, whereas some risk-based pregnancy prevention materials paint young parenthood as only a negative experience.

If integrating reproductive life planning into patient care, it remains essential to recognize that a patient’s reproductive life plan may change over time and should be revisited to account for changing circumstances, such as partner changes, financial effects, or completion of goals, such as education or employment.

Reproductive life planning may not be the approach that works for each patient or provider, but it is quickly becoming one of the tools many clinicians use to help adolescent and adult patients plan for their futures.

REFERENCES

  1. Kost K, Maddow-Zimet I. U.S. Teenage Pregnancies, Births and Abortions, 2011: National Trends By Age, Race and Ethnicity. New York: Guttmacher Institute; 2016. Available at: http://bit.ly/1syILsw. Accessed Dec. 21, 2016.
  2. Lindberg L, Santelli J, Deshi S. Understanding the decline in adolescent fertility in the United States, 2007-2012. J Adolesc Health 2016;59:577-583.
  3. Centers for Disease Control and Prevention. Reproductive Life Plan Tool For Health Professionals. Available at: http://bit.ly/2hMY4cd. Accessed Dec. 21, 2016.
  4. Johnson K, Posner SF, Biermann J, et al. Recommendations to improve preconception health and health care — United States: A report of the CDC/ATSDR Preconception Care Work Group and the Select Panel of Preconception Care. MMWR Recomm Rep 2006;55(RR-6):1-23.
  5. American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women. Committee opinion no. 654 summary: Reproductive life planning to reduce unintended pregnancy. Obstet Gynecol 2016;127:415.
  6. Metcalfe ND, Kottke M. Does an adolescent’s reproductive life plan influence her use or method of contraception? J Pediatr Adolesc Gynecol 2015;28:e61-e62.
  7. Malin K. California Department of Public Health Maternal Child and Adolescent Health Division. Knowing myself inside and out: Helping youth take charge of their reproductive futures. Presented at Teen Now Conference. September 2009.