Introduction
Sexual and reproductive health (SRH) is a key aspect of people’s overall health and quality of life that is defined as a state of physical, emotional, mental, and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction, or infirmity.1, 2
Quality SRH care supports United States public health objectives, including improving birth outcomes, reducing the rate of sexually transmitted infections (STI), and preventing pregnancy-related mortality and morbidity.3 These recommendations outline how to provide people of reproductive age with high-quality SRH services, including family-building services, contraceptive services, pregnancy testing and counseling, early pregnancy management, STI and human immunodeficiency virus (HIV) prevention and testing services, and other screening and preventive health services. These recommendations aim to enable health care providers to help ensure that all people, regardless of individual characteristics such as sex, gender identity, sexual orientation, age, ability, race, or ethnicity, can meet their SRH goals and needs.
These recommendations were developed by the Office of Population Affairs (OPA) within the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services (HHS). OPA promotes health across the reproductive lifespan through innovative, evidence-based adolescent health and family planning programs, services, strategic partnerships, evaluation, and research. OPA’s Title X family planning program has served as the national leader in direct family planning service delivery since the Title X program was established in 1970.4
These recommendations represent an update to Providing Quality Family Planning Services: Recommendations of the CDC and the U.S. Office of Population Affairs, originally published in 2014.4 OPA followed a rigorous process in consultation with a wide array of experts in the fields of family planning (FP), SRH, and health equity (see List of Contributors). These recommendations intend to set the standard of SRH care and can be used by all current and potential providers of SRH services.
These recommendations can be implemented in varied settings, including primary care, specialty care (for example, obstetrics/gynecology, neurology, rheumatology), and community settings (for example, mobile clinics, schools, pharmacies). These recommendations are specifically intended for all current and potential providers of SRH services, including, but not limited to, those funded by the Title X family planning program. These recommendations apply to care delivered both in person and by telehealth. This update offers specific recommendations for how to provide high-quality SRH care and connects users to guidelines, primary research, and other resources to inform practice.
In addition to incorporating new evidence, this update includes newer approaches to care by adopting a health equity lens and recognizing the impact of structural and interpersonal racism, classism, ableism, and bias based on sexual orientation and/or gender identity on health and SRH care. The main revisions since the 2014 report are summarized in Exhibit 1.
Exhibit 1: Main Differences Between 2014 Report and 2024 QFP Update
| 2014 QFP Report | 2024 QFP Update |
|---|---|
| Defined quality of care according to National Academies of Sciences, Engineering and Medicine (NASEM) (formerly IOM) six dimensions of quality (safe, effective, timely, patient-centered, efficient, and equitable)5 | Maintains multidimensional definition of quality, with expanded emphasis on person centeredness and equity by using a sexual and reproductive health equity framework |
| Focused on women as recipients of care, with some specific content for male clients | Takes a gender-inclusive approach and uses language throughout to recognize that people of all genders may need and access SRH care |
| Described how to consider the needs of and provide care to special populations, including adolescents, people with disabilities, and others with reduced access to quality care | Integrates and prioritizes the needs of groups and individuals who experience SRH inequities in shaping the recommendations, rather than considering “special populations” separately; when relevant, highlights evidence or recommendations that may be specific to or more relevant for some groups or individuals |
| Focused on care provided within the formal health care system, particularly specialized family planning service sites | Includes care from a broad range of provider specialties in varied settings, both within and beyond the formal health care system, including patient-led and self-care options |
| Drew from existing guidelines and published evidence in establishing recommendations; when evidence was inconclusive or incomplete, recommendations were made on the basis of expert opinion | In addition to incorporating published scientific evidence and existing guidelines, includes more expansive types of evidence, including qualitative evidence and direct input from users and people with lived experience, as well as expert opinion |
| Offered recommendations on how to provide quality family planning services, including contraceptive services, pregnancy testing and counseling, helping clients achieve pregnancy, basic infertility services, “preconception health services,” and STI services | Adds technical content and expands the scope of services to encompass more elements of SRH care, including the following:
|
| Recommended that all persons capable of having a child should have a reproductive life plan (RLP) and that providers should discuss the RLP with clients receiving contraceptive, pregnancy testing and counseling, basic infertility, sexually transmitted disease, and preconception health services | Advises discussing reproductive desires with a person-centered approach that focuses on open-ended communication and nonjudgmental counseling and support; does not endorse a single framework |