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 circumstances1; reproductive life plans can evolve over time1. 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 children2 and use that information to provide contraception or preconception services as appropriate1 and address other health needs prior to desired pregnancies3. RLP is considered a key component of well woman visits4 and can also be introduced in community settings through home visiting programs, health education curricula, family support programs, and other initiatives2.
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 outcomes3, 5, increase contraceptive use, and increase autonomy for women around reproductive health6. 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 change1, 7. RLP prompts prior to visits may increase discussions with providers1, 8. Little evidence is available for adolescent populations, though digital and online tools may engage this population9. However, additional evidence is needed to confirm effects; knowledge and awareness may not lead to changes in behavior1.
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 welcomed6. 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 them2.
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 counseling8, 10. Written RLP protocols for providers may lead to more frequent RLP assessment, which is associated with an increased likelihood of preconception care11.
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 marginalized6, though it is considered especially important in populations at risk for adverse outcomes, such as women who are Black2. 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 Black8, and incarcerated women who may be released within 6 months21.
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 all6.
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. states22. This change in law, and other increased barriers to abortion, may increase existing disparities in maternal and infant health23 as more unwanted pregnancies are carried to term22.
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 approach12 and the Pregnancy, Attitudes, Timing and How important is pregnancy prevention (PATH) framework13, as well as teen specific tools such as TeenSource14. 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 Patients15.
DE Thrives from the Delaware Division of Public Health, for example, provides RLP resources for women16, men17, and teens18. The Preconception Health Council of California’s Every Woman California program19 and the online Region I Title X Family Planning Training Center serving New England20 also provide RLPs.
Implementation Resources
‡ Resources with a focus on equity.
OKQ - Power to Decide. (n.d.). One key question online. Retrieved October 21, 2024.
Envision SRH-PATH framework - Envision Sexual and Reproduction Health. (n.d.). Patient-centered reproductive goals counseling. (The PATH framework). Retrieved October 14, 2024.
TeenSource-RLP - TeenSource.org. (n.d.). What’s your (Reproductive life) plan? Retrieved October 21, 2024.
EWCA - Every Woman California (EWCA). Educational resources for public health professionals & providers. Preconception Health Council of California.
Region I FPTC - Region I Title X Family Planning Training Center (FPTC). Resources: Reproductive life planning.
NCSH 2023 - National Coalition for Sexual Health. (2023). Sexual health questions to ask all patients. Retrieved October 21, 2024.
Footnotes
* Journal subscription may be required for access.
1 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.
2 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.
3 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.
4 ACOG 2012 - The American College of Obstetricians and Gynecologists (ACOG). Prediction and prevention of preterm birth. Obstetrics & Gynecology. 2012;120(4):964-73.
5 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.
6 Morse 2018 - Morse, J. E., & Moos, M.-K. (2018). Reproductive life planning: Raising the questions. Maternal and Child Health Journal, 22(4), 439–444.
7 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.
8 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.
9 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.
10 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.
11 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.
12 OKQ - Power to Decide. (n.d.). One key question online. Retrieved October 21, 2024.
13 Envision SRH-PATH framework - Envision Sexual and Reproduction Health. (n.d.). Patient-centered reproductive goals counseling. (The PATH framework). Retrieved October 14, 2024.
14 TeenSource-RLP - TeenSource.org. (n.d.). What’s your (Reproductive life) plan? Retrieved October 21, 2024.
15 NCSH 2023 - National Coalition for Sexual Health. (2023). Sexual health questions to ask all patients. Retrieved October 21, 2024.
16 DE Thrives-RLP women - Delaware Thrives. (n.d.). My life, my plan: Women. Delaware Division of Public Health. Retrieved October 10, 2024.
17 DE Thrives-RLP men - Delaware Thrives. (n.d.). Men’s health. Delaware Division of Public Health. Retrieved October 10, 2024.
18 DE Thrives-RLP teens - Delaware Thrives. (n.d.). My life, my plan: Teen. Delaware Division of Public Health. Retrieved October 10, 2024.
19 EWCA - Every Woman California (EWCA). Educational resources for public health professionals & providers. Preconception Health Council of California.
20 Region I FPTC - Region I Title X Family Planning Training Center (FPTC). Resources: Reproductive life planning.
21 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.
22 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.
23 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.
Related What Works for Health Strategies
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