Family planning is one of the 10 great public health achievements of the 20th century.
The availability of family planning services allows individuals to achieve desired birth spacing and family size, and contributes to improved health outcomes for infants, children, women, and families.
Family planning services include:
• Contraceptive services
• Pregnancy testing and counseling
• Pregnancy–achieving services including preconception health services
• Basic infertility services
• Sexually transmitted disease services
• Broader reproductive health services, including patient education and counseling
• Breast and pelvic examinations
• Breast and cervical cancer screening
• Sexually transmitted infection (STI) and human immunodeficiency virus (HIV) prevention education, counseling, testing, and referral
Abstinence from sexual activity is the only 100% effective way to avoid unintended pregnancy. For individuals who are sexually active, correct and consistent contraceptive use is highly effective at preventing unintended pregnancy. The most effective methods to prevent unintended pregnancy include long-acting reversible contraceptives such as intrauterine devices (IUDs) and contraceptive implants, followed by other hormonal contraceptives including oral contraceptives (pills), the patch, the ring, and the Depo-Provera shot (DMPA). Condoms protect against both unintended pregnancy and STIs, and their use should be encouraged. Both men and women should be counseled about using condoms at every act of sexual intercourse when not in a long-term, mutually monogamous sexual relationship.
IMPORTANCE OF FAMILY PLANNING
For many women, a family planning clinic is their entry point into the health care system and one they consider their usual source of care.
In 2015, publicly funded family planning services helped prevent 1.9 million unintended pregnancies, including 440,000 teen pregnancies.
Unintended pregnancies include pregnancies that are reported by women as being mistimed or unwanted. Almost half (45%) of the 6.1 million annual pregnancies are unintended.
Unintended pregnancies are associated with many negative health and economic consequences.
For women, negative outcomes associated with unintended pregnancy can include:
• Delays in initiating prenatal care
• Reduced likelihood of breastfeeding
• Increased risk of maternal depression
• Increased risk of physical violence during pregnancy.
Births resulting from unintended pregnancies (in most cases) can have negative consequences including birth defects and low birth weight.
Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood, and have lower educational attainment and more behavioral issues in their teen years.
The negative consequences associated with unintended pregnancies are greater for teen parents and their children.
Eighty-two percent of pregnancies to mothers ages 15 to 19 are unintended.
Twenty percent of all unintended pregnancies occur among teens.
Similarly, early fatherhood is associated with lower educational attainment and lower income.
Moreover, children of teen parents are more likely to have lower cognitive attainment and exhibit more behavior problems.
Sons of teen mothers are more likely to be incarcerated, and daughters are more likely to become adolescent mothers.
Unintended pregnancies occur among women of all incomes, educational levels, and ages. However, there are disparities in unintended pregnancy rates.
The rates of unintended pregnancy are highest among the following groups:
• Women ages 18 to 24
• Women who were cohabiting
• Women whose income is below the poverty line
• Women with less than a high school diploma
• Black or Hispanic women
In addition, men are less likely to have access to and receive family planning services than women.
Barriers to people’s use of family planning services include:
• Cost of services
• Limited access to publicly funded services
• Limited access to insurance coverage
• Family planning clinic locations and hours that are not convenient for clients
• Lack of awareness of family planning services among hard-to-reach populations
• No or limited transportation
• Inadequate services for men
• Lack of youth-friendly services.
Emerging Issues in Family Planning
Many women of reproductive age can benefit from preconception care (care before pregnancy).
Preconception care has been defined as a set of interventions designed to identify and reduce risks to a woman’s health and improve pregnancy outcomes through prevention and management of health conditions.
Preconception care can significantly reduce birth defects and disorders caused by preterm birth.
Elements of preconception care should be integrated into every primary care visit for women of reproductive age.
Preconception care must not be limited to a single visit to a health care provider, but should rather be a process of care designed to meet the needs of an individual.
As part of comprehensive preconception care, providers should encourage patients to develop a reproductive life plan.
A reproductive life plan is a set of goals and action steps based on personal values and resources about whether and when to become pregnant and have (or not have) children.
Providers also must educate patients about how their reproductive life plan impacts contraceptive and medical decision-making.
Increased awareness of the importance of preconception care can be achieved through public outreach and improved collaboration between health care providers. Currently, only about 30.3% of women report receiving pre-pregnancy health counseling.
Future efforts should promote research to further define the evidence-based standards of preconception care, determine its cost-effectiveness, and improve tracking of the proportion of women obtaining these services.
