Reproductive life plans
Reproductive life plans (RLPs) provide a structured format for women and men to think about their desires related to having or not having children and establish goals based on those desires. RLPs are short statements that are consistent with personal values and current life circumstances; plans can evolve as an individual progresses through life1. Health care providers can introduce RLPs during primary care, outpatient, and hospital visits as a prompt to discuss patients’ intentions to have or not have a child or additional children2, 3 and use that information to optimize health, prevent unintended pregnancies, and address other health needs prior to desired pregnancies4. RLPs can also be introduced in community settings through home visiting programs, health education curricula, family support programs, and other initiatives3.
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
Improved health-related knowledge
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased healthy behaviors
What does the research say about effectiveness?
Reproductive life plans (RLPs) are a suggested strategy to increase preconception planning, improve reproductive health, birth outcomes, and health knowledge2, 4, 5, and are considered especially important in populations at risk for adverse outcomes, such as black women3. Pilot studies in Sweden and the United States indicate RLPs may improve preconception and health knowledge6, 7. Early studies of RLP use at publically funded family planning clinics suggest that RLP counseling may not affect contraceptive use8, and that written RLP protocols may lead to more frequent RLP assessment, which is associated with an increased likelihood of preconception care9. However, additional evidence is needed to confirm effects on behavior and birth outcomes and to determine effective implementation strategies.
Patients at a Chicago community health center who completed a reproductive health self-assessment tool (RH-SAT), a type of RLP, before a primary care visit found it acceptable and reported initiating productive, focused discussions about reproductive health with their providers. Providers indicated that the RH-SAT facilitated improved communication and supported delivery of patient-focused counseling10.
RLPs, like other consumer-focused health literature, should be designed to be understandable, culturally sensitive, and responsive to the needs of those who use them3.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
Various efforts are underway to incorporate reproductive life plans (RLPs) into preconception care efforts and make materials available to providers and the public. DE Thrives, a collaboration between the Delaware Division of Public Health and the Delaware Healthy Mother and Infant Consortium, for example, began providing RLP resources for women and teens in 2011 and men in 201211. The Preconception Health Council of California’s Every Woman California program1 and the online Region I Title X Family Planning Training Center serving New England12 also provide RLPs for women and teens.
Implementation Resources
DE Thrives - DE Thrives. Let's all Thrive! Healthy women. Healthy babies. Healthy families. Healthy communities.
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.
Footnotes
* Journal subscription may be required for access.
1 EWCA - Every Woman California (EWCA). Educational resources for public health professionals & providers. Preconception Health Council of California.
2 Farahi 2013 - Farahi N, Zolotor A. Recommendations for preconception counseling and care. American Family Physician. 2013;88(8):499-506.
3 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.
4 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.
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 Stern 2013 - Stern J, Larsson M, Kristiansson P, Tyden T. Introducing reproductive life plan-based information in contraceptive counselling: An RCT. Human Reproduction. 2013;28(9):2450-2461.
7 Mittal 2014 - Mittal P, Dandekar A, Hessler D. Use of a modified reproductive life plan to improve awareness of preconception health in women with chronic disease. The Permanente Journal. 2014;18(2):28-32.
8 Bommaraju 2015 - Bommaraju A, Malat J, Mooney JL. Reproductive life plan counseling and effective contraceptive use among urban women utilizing Title X services. Women’s Health Issues. 2015;25(3):209-215.
9 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.
10 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.
11 DE Thrives - DE Thrives. Let's all Thrive! Healthy women. Healthy babies. Healthy families. Healthy communities.
12 Region I FPTC - Region I Title X Family Planning Training Center (FPTC). Resources: Reproductive life planning.
Related What Works for Health Strategies
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countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/reproductive-life-plans
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countyhealthrankings.org/whatworks