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If you have attended a major national reproductive health conference in the last six months, chances are you have heard about the QFP — the acronym for Providing Quality Family Planning Services — Recommendations of CDC and the U.S. Office of Population Affairs.1
The QFP is the newest member in the “suite” of family planning recommendations from the Centers for Disease Control and Prevention (CDC), says Michael Policar, MD, MPH, clinical professor of obstetrics, gynecology, and reproductive science at the University of California, San Francisco. It joins the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 (U.S. MEC), the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 (SPR), the Recommendations for Improving Preconception Health Care, the Sexually Transmitted Diseases Treatment Guidelines, 2010, and the Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women In Health-Care Settings.2-6 (Contraceptive Technology Update reported on the QFP. See “New guidance uses best evidence to direct family planning services,” August 2014, p. 85.)
According to Policar, the new guidance does the following:
completes, and ties together, the CDC suite of family planning guidelines;
defines and prioritizes the core content of contraceptive services;
defines the borders between family planning and other preventive services;
specifies which interventions are recommended for each of the seven family planning service types;
emphasizes the role and content of contraceptive counseling;
refines the content of male family planning services.7
The new recommendations integrate and fill in the gaps in the other guidelines for the family planning setting, explains Policar. The recommendations include guidance on pregnancy testing and counseling, achieving pregnancy, basic infertility, preconception health, preventive health screening of women and men, and contraceptive counseling, including reproductive life planning, all of which constitute the core of family planning services.
How are core family planning services different from “well woman” care? Policar explains that core family planning services focus on three vital aspects: avoiding pregnancy or becoming pregnant, safe and effective contraceptive use, and protection of reproductive health.
More preventive services might be performed by the patient’s primary care provider or family planning clinic, in the absence of a primary care provider. “Given limitations of time and resources, provision of core family planning services is our top priority,” Policar states.
The National Clinical Training Center for Family Planning offers handy checklists of family planning and preventive services for women and men, says Policar. (Access the checklists at http://bit.ly/11c4o4e.)
Preconception health services should be offered to all female and male patients, says Policar. Priority populations include those who are trying to achieve pregnancy, including negative pregnancy test visits, those coming in for removal of an intrauterine device or implant to become pregnant, those seeking infertility services, and those at high risk of unintended pregnancy, he states.
Questions that can cover a patient’s reproductive life plan include:
Do you hope to have any (more) children?
How many children do you hope to have?
How long do you plan to wait until you next become pregnant?
How much space do you plan to have between your pregnancies?
What do you plan to do until you are ready to become pregnant?
What can I do today to help you achieve your plan?
The “One Key Question” program advocated by the Oregon Foundation for Reproductive Health offers one way to enter into such a discussion, says Policar. By asking “Would you like to become pregnant in the next year?” healthcare providers can open the door to providing preconception, prenatal, or contraceptive care. (Information on the program is at www.onekeyquestion.org.)