being encouraging and demonstrating empathy and acceptance. Am J Psychiatry 2003;160(Suppl):160. National Vital Statistics Reports 2012;61(1). Health Affairs 2002;21:8090. Remember to get permission from the woman or couple for the observer to be present if you will be carrying out this activity in a real situation rather than a role-play, Ask the observer to give you feedback on your strengths and weaknesses during the counselling process using the points outlined above as a checklist. The United States continues to face substantial challenges to improving the reproductive health of the U.S. population. July 19, 2010. Alternate Text: The figure shows three layers of family planning and related and other preventive health services. Unintended pregnancy in the United States: incidence and disparities, 2006. Average number of days to the next appointment. FIGURE 1. You could also ask her to demonstrate the use of certain methods such as condoms or diaphragms, or you could consider demonstrating their use to her first, asking for her to repeat back the demonstration afterwards to ensure that she has fully understood. Screening for gonorrhea. Family planning services can help address these and other public health challenges by providing education, counseling, and medical services ( 5 ). Once the baby reaches six months, or receives complementary foods or the mothers' periods have returned, she should use another family planning method. DISCLAIMER: The topics and articles published on this website including text, graphics, videos info graph and other material are for informational purposes only and should not be substituted for professional medical advice. Available at, US Department of Health and Human Services, Office of Population Affairs. Obstet Gynecol 2011;118:14548. Providers should follow CDC recommendations that all clients aged 1364 years be screened routinely for HIV infection and that all persons likely to be at high risk for HIV be rescreened at least annually (123). Develop a deeper understanding of the PFCE Framework family engagement outcome, "Families as Advocates and Leaders." When families participate in decision-making, organizing, and policy development, they strengthen their own leadership and advocacy skills. Moos M. Preconceptional health promotion: progress in changing a prevention paradigm. provided as a service to MMWR readers and do not constitute or imply The clinical visit should focus on understanding the client's reproductive life plan (24) and her difficulty in achieving pregnancy through a medical history, sexual health assessment and physical exam, in accordance with recommendations developed by professional medical associations such as ASRM (101) and ACOG (96). Women and adolescents with incomes of less than 250 percent of the federal poverty level are the target population of the Family Planning Program. Our World in Data 2020 [cited 2020 August 20, 2020]; Available from: World Health Organization. Clinical evaluation of a client electing permanent sterilization should be guided by the clinician who performs the procedure. Pediatrics 2004;114:15509. Federal government websites often end in .gov or .mil. Female clients aged 1126 years should be offered either human papillomavirus (HPV) 2 or HPV4 vaccine for the prevention of HPV and cervical cancer if not previously vaccinated, although the series can be started in persons as young as age 9 years (113); recommendations include starting at age 1112 years and catch up vaccine among females aged 1326 who have not been vaccinated previously or have not completed the 3-dose series through age 26. This information should clarify that avoiding sex (i.e., abstinence) is an effective way to prevent pregnancy and STDs. Background: Women with physical disabilities may have special requirements in terms of which methods are suitable for their situation and disability. pelvic examinations, unless inserting an intrauterine device (IUD) or fitting a diaphragm; cervical cytology or other cancer screening, including clinical breast exam; human immunodeficiency virus (HIV) screening; and. Pediatrics 2007;120:e83245. If not all methods are available at the service site, it is important to have strong referral links in place to other providers to maximize opportunities for clients to obtain their preferred method that is medically appropriate. The content, format, method, and medium for delivering education should be evidence-based (see Appendix E). The contraceptive counseling session should explore why the client thought that she was pregnant and sought pregnancy testing services, and whether she has difficulties using her current method of contraception. RR-6). When providing contraception, providers should instruct the client about correct and consistent use and employ the following strategies to facilitate a client's use of contraception: Begin contraception at the time of the visit rather than waiting for next menses (also known as "quick start") if the provider can reasonably be certain that the client is not pregnant (. Providers are encouraged to present information on potential reversible methods of contraception by using a tiered approach (i.e., presenting information on the most effective methods first, before presenting information on less effective methods) (38,39). Frey K, Navarro S, Kotelchuck M, Lu M. The clinical content of preconception care: preconception care for men. CDC has a long-standing history of developing evidence-based recommendations for clinical care, and OPA's Title X Family Planning Program (7) has served as the national leader in direct family planning service delivery since the Title X program was established in 1970. Knowledge, attitude and practice of family planning in Eastern Nigeria: implications, prospects and suggestions. American College of Obstetricians and Gynecologists. PMC Randomized trial of a parent intervention: parents can make a difference in long-term adolescent risk behaviors, perceptions, and knowledge. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. . Note: Javascript is disabled or is not supported by your browser. Family planning saves mothers and infants lives by decreasing unintended pregnancies as well as promoting better maternal and infant health with longer interpregnancy intervals. Maternal Mortality. Frost J, Finer L, Tapales A. These skills can benefit their children, peers, and communities as well. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval. Contraceptive counseling is defined as a process that enables clients to make and follow through on decisions about their contraceptive use. One wife in Jharkhand shared, Earlier he would not help too much with the children. A multistage process was used to develop the recommendations that drew on established procedures for developing clinical guidelines (20,21). An initial section provides an overview of steps to assess the needs of a client and decide what family planning services to offer. Both female and male sterilization are safe, are highly effective, and can be performed in an office or outpatient surgery setting (40,41). Braverman P, Breech L. Gynecologic examination for adolescents in the pediatric office setting. * Source: Institute of Medicine. Steps in providing contraceptive services, including contraceptive counseling* and education. Waiting to become pregnant at least 24 months after birth can lead to health benefits for the mother and baby. Proportion of clients who report that his or her care provider follows up to give test results, has up-to-date information about care from specialists, and discusses other prescriptions. Berwick D. A user's manual for the IOM's "Quality Chasm" Report. Conduct a physical assessment related to contraceptive use, only when warranted. Available at. A woman's ability to space and limit her pregnancies has a . Olds DL, Kitzman H, Hanks C, et al. Moreover, all of these outcomes affect racial and ethnic minority populations disproportionately ( 1-4 ). US Preventive Services Task Force. The Strong African American Families Program: translating research into prevention programming. Proportion of total family planning encounters that are encounters with ongoing or continuing users. US Department of Health and Human Services, Office of Population Affairs. AUA recommends that the medical history include a reproductive history (102). A woman is at lower risk of unintended pregnancy if she is using a highly effective method, such as an IUD or implant, or has an established history of using methods of contraception, such as injections, pills, patch, or ring correctly and consistently (38,39). Burden of unintended pregnancy in the United States: potential savings with increased use of long-acting reversible contraception. If the client desires pregnancy testing, then provide pregnancy testing and counseling. FP is the use of contraception to delay or prevent pregnancy, and is a key preventive health service with well-documented effects on improving maternal and child health outcomes. New York, NY: Guttmacher Institute; 2013. Yet in developing regions, an estimated 218 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack . The following questions should be considered when selecting performance measures (143): Performance measures should consider the quality of the structure of services (e.g., the characteristics of the settings in which providers deliver health care, including material resources, human resources, and organizational structure), the process by which care is provided (whether services are provided correctly and completely, and how clients perceive the care they receive), and the outcomes of that care (e.g., client behaviors or health conditions that result) (149). like older men, older women have a higher chance of having a child with autism or down syndrome; the chances of having multiple births increases, which cause further late-pregnancy risk; they have an increased chance of developing gestational diabetes; the need for a caesarian section is greater; and the risk of prolonged labor is higher, putting Stormo A, Hawkins N, Cooper C, Saraiya M. The pelvic examination as a screening tool: practices of US physicians. Adolescents who come to the service site alone should be encouraged to talk to their parents or guardians. American College of Obstetricians and Gynecologists. U.S. medical eligibility criteria for contraceptive use 2010. Providers should assess the current pregnancy status of clients receiving contraception (. The immense benefit of investing in family planning for positive womens health, social well-being, economic empowerment, and human capital development in the long term cannot be ignored. conclusion: sbc programs interested in improving family planning outcomes could potentially achieve large gains in contraceptive use-even without large-scale changes in socio-economic and health services factors-by designing and implementing effective sbc interventions that improve knowledge, encourage spousal/partner communication, and work In some cases women may feel more comfortable if their partners are not present or if their partners are counselled on their own and/or by a male counsellor. Performance measures: guiding quality improvement for family planning services. Unnecessary medical procedures and tests might create logistical, emotional, or economic barriers to contraceptive access for some women, particularly adolescents and low-income women, who have high rates of unintended pregnancies (. Some women who have recently given birth or who are breastfeeding may be unable to use certain methods (see. 90% of the study participants were successful overall, including those that strayed from the instructions. The screening components for each family planning and related preventive health service are provided in summary checklists for women (Table 2) and men (Table 3). The degree to which health-care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge., Process. tni.ohw@snoissimrep). For male clients, chlamydia screening can be considered for males seen at sites with a high prevalence of chlamydia, such as adolescent clinics, correctional facilities, and STD clinics (36,125,126). Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2008. Sexually transmitted diseases treatment guidelines, 2010. Washington, DC: The National Academies Press; 2010. Oringanje C, Meremikwu MM, Eko H, Esu E, Meremikwu A, Ehiri JE. Zavodny M. Fertility and parental consent for minors to receive contraceptives. What is the performance level of the facility? Adolescents (Grade B) should be provided intervention to prevent initiation of tobacco use (112). US Department of Health and Human Services Coverage of certain preventive services under the Affordable Care Act: final rules. Approximately one of eight pregnancies in the United States results in a preterm birth, and infant mortality rates remain high compared with other developed countries (3,4). is 7 days after spontaneous or induced abortion. GRADE Working Group. Family planning contributes directly to Targets 3.7 and 5.6:. If a client chooses a method that is not available on-site or the same day, provide the client another method to use until she or he can start the chosen method. Other preconception health services for women and men should include discussion of a reproductive life plan and sexual health assessment (Boxes 2 and 4), as well as the screening services described below (24,103,105). Although too much information can be unhelpful or off-putting, there are some key pieces of information that must be explained: How effective it is at preventing pregnancy, Side-effects: what the user can expect, and what to do about them, What to do in case of a mistake in the use of the method or problems (missed pills, late for injection, condom splits), Information on when to return to the clinic. Lyren A, Kodish E, Lazebnik R, O'Riordan MA. Obtain clinical and social information from the client. When both parent or guardian and child have agreed, joint discussions can address family values and expectations about dating, relationships, and sexual behavior. The term preconception describes any time that a woman of reproductive potential is not pregnant but at risk of becoming pregnant, or when a man is at risk for impregnating his female partner. USPSTF recommends that women be asked about family history that would be suggestive of an increased risk for deleterious mutations in BRCA1 or BRCA2 genes (e.g., receiving a breast cancer diagnosis at an early age, bilateral breast cancer, history of both breast and ovarian cancer, presence of breast cancer in one or more female family members, multiple cases of breast cancer in the family, both breast and ovarian cancer in the family, one or more family members with two primary cases of cancer, and Ashkenazi background). Site has written agreements (e.g., MOUs) with the key partner agencies for health care (especially prenatal care, primary care, HIV/AIDS) and social service (domestic violence, food stamps) referrals. CDC. If you are working in a group carry out this activity as a role-play rotating the roles. you should drink of water per day. Heterosexual males aged 2226 years may be vaccinated (131). Available at. For female and male clients, CDC recommends one-time testing for hepatitis C (HCV) without prior ascertainment of HCV risk for persons born during 19451965, a population with a disproportionately high prevalence of HCV infection and related disease. Adults (Grade A) who use tobacco products should be provided or referred for tobacco cessation interventions, including brief behavioral counseling sessions (<10 minutes) and pharmacotherapy delivered in primary care settings (111). Forste R, Morgan J. | Explore the latest full-text research PDFs . Populations at risk include MSM, commercial sex workers, persons who exchange sex for drugs, those in adult correctional facilities and those living in communities with high prevalence of syphilis (36). The report provides recommendations for how to help prevent and achieve pregnancy, emphasizes offering a full range of contraceptive methods for persons seeking to prevent pregnancy, highlights the special needs of adolescent clients, and encourages the use of the family planning visit to provide selected preventive health services for women, in accordance with the recommendations for women issued by the Institute of Medicine and adopted by HHS. You can support her and her partner in choosing a method that meets their needs: The partner should be encouraged to take part in family planning counselling sessions, especially if the chosen method involves his cooperation, for example, condoms or natural methods. Women who have a very high individual likelihood of STD exposure (e.g., those with a currently infected partner) generally should not undergo IUD insertion (U.S. Medical Eligibility Criteria 3) (Source: CDC. MMWR 2010;59(No. Many women also reported that men became more involved in child care. However, since quality cuts across all aspects of a program, not all domains of quality can necessarily be considered at all times. If an infection is present or suspected, advise her to avoid intercourse until the infection is ruled out or fully treated. Side effects (e.g., irregular vaginal bleeding) are a primary reason for method discontinuation (54), so providers should discuss ways the client might deal with potential side effects to increase satisfaction with the method and improve continuation (42). MMWR 2010;59[No. The evidence used to prepare these recommendations will appear in background papers that will be published separately. These recommendations focus on the direct delivery of care to individual clients. Additionally, being involved means being supportive and present and championing the actions of your partner, whether in family planning or other activities in the household. Assess the family planning needs of individual women. The 3 investment primary outcomes of the PAS project at national level are: 1) Strengthened institutionalization of accountability mechanisms and standards in the new FP Blueprint (2019-2023) and in the review FP related policies such as the Task; Women and men should be counseled that these procedures are not intended to be reversible and that other highly effective, reversible methods of contraception (e.g., implants or IUDs) might be an alternative if they are unsure about future childbearing. Research has explored predictors of contraceptive use and unintended pregnancy, but there is a lack of research regarding access to preferred contraceptive method(s) and the complex pathways from sociodemographic factors to these family planning outcomes. Depending upon a client's needs, the provider may make an appointment for the client, or call the referral site to let them know the client was referred. J Biosoc Sci. U.S. medical eligibility criteria for contraceptive use 2010. Testing for syphilis, HIV/AIDS, and hepatitis C should be conducted as recommended (36,123,124). Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2012. you can ask if she knows about family planning, what she has heard about it, and if she knows it is important; explain that it is important to know that she can become pregnant soon after giving birth if she is not exclusively breastfeeding; you should also ask whether the woman or couple already have a family planning method in mind those people who receive the method that they have planned for are much more likely to use it successfully. * In cases in which access to health care might be limited, the blood pressure measurement can be obtained by the woman in a nonclinical setting (e.g., pharmacy or fire station) and self-reported to the provider. Crossing the quality chasm: a new health system for the 21st century. Contact GPO for current prices. Several frameworks for conducting quality improvement have been developed (144146). Evidence-based public health: an evolving concept. Obstet Gynecol 2013;121:82946. Prev Sci 2007;8:24960. US Preventive Services Task Force. Perspect Sex Reprod Health 2003;35:25660. Your email address will not be published. 12, FAMILY PLANNING COUNSELLING. Am J Obstet Gynecol 2008;199(Suppl B):S26679. For female and male clients, providers should screen for immunization status in accordance with recommendations of CDC's Advisory Committee on Immunization Practices (113) and offer vaccination, as indicated, or provide referrals to community providers for immunization. Washington, DC: Research Triangle Institute; 2012. Recommendations on the use of quadrivalent human papillomavirus vaccine in malesAdvisory Committee on Immunization Practices (ACIP). During late pregnancy, after giving birth and after an abortion, it is important that the woman or the couple receives and discusses correct and appropriate information so that they can choose a method which best meets their needs. Efficacy of a parent-based sexual-risk prevention program for African American preadolescents: a randomized controlled trial. Results: MMWR 2006;55(No. 2017;17(1):942. doi: 10.1186/s12889-017-4934-z. her and her partner's HIV status or risk factors for HIV; regularity of sexual intercourse (especially for adolescents or unmarried women); partner's or family's views about family planning methods; You can then discuss various family planning methods based on the needs and situation of the woman and her partner. Parents matter: your children want to learn about the facts of life from you. Women who are not pregnant and who are trying to become pregnant should be offered services to help achieve pregnancy or basic infertility services, as appropriate (see "Clients Who Want to Become Pregnant" and "Basic Infertility Services"). Practice parameter on gay, lesbian or bisexual orientation, gender nonconformity, and gender discordance in children and adoelscents. For clients without a primary care provider, the following screening services should be provided, with appropriate follow-up, if needed, while linking the client to a primary care provider. Screening for depression in adults. Los Angeles, CA: Family Planning Councils of America; ND. Options counseling should be provided in accordance with recommendations from professional medical associations, such as ACOG and AAP (9597). U.S. Cambridge, MA: Institute for Healthcare Improvements; 2012. Family planning is a cost-effective public health and development intervention. Providers of family planning services should offer preconception health services to female and male clients in accordance with CDC's recommendations to improve preconception health and health care (24). A relatively modest investment in FP/RH services today can yield substantial future savings. US Preventive Services Task Force. Family planning investments are also cost-effective. Stanton BF, Li X, Galbraith J, et al. American College of Obstetricians and Gynecologists. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel. Rockville, MD: US Department of Health and Human Services, Agency for Healthcare Research and Quality; 2009. Guidance on necessary examinations and tests related to initiation of contraception is available (42). During the plan's creation, be clear about what your desired outcomes are from the plan. One of the main ways you can do this is through counselling on family planning methods during late pregnancy, the postpartum and the post-abortion periods. J Adolesc Health 2007;41:33342. In some places research has shown that family planning method use is more successful when partners choose and agree upon a method together. Ann Intern Med 1997;127:7338. Is it used continuously, or only used when needed? Preconception health services are beneficial because of their effect on pregnancy and birth outcomes and their role in improving the health of women and men. Cochrane Database Syst Rev 2009:CD005215. Screening for intimate partner violence and abuse of elderly and vulnerable adults. Indicates that screening is suggested only for those persons at highest risk or for a specific subpopulation with high prevalence of infection or other condition. Family planning; Nigeria; Social and behavior change. Although adolescent birth rates declined by more than 61% during 19912012, the United States has one of the highest adolescent pregnancy rates in the developed world, with >700,000 adolescents aged 1519 years becoming pregnant each year and >300,000 giving birth (2,3). Institute of Medicine. CDC health disparities and inequalities reportUnited States, 2011. In the family planning setting, providers may prioritize screening and counseling about preconception health for couples that are trying to achieve pregnancy and couples seeking basic infertility services. Practice guideline for the assessment and treatment of patients with suicidal behaviors. Background Family planning is a key means to achieving many of the Sustainable Development Goals. This goal is being monitored by Family Planning 2020 (FP2020), a global partnership created as an outcome of the Summit. Effects of nurse home visiting on maternal and child functioning: age-9 follow-up of a randomized trial. Most women do not require additional STD screening at the time of IUD insertion if they have already been screened according to CDC's STD treatment guidelines (Sources: CDC. BMJ 2008;337:a308.
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