Screening for Reproductive Desires and Related Care

A variety of approaches have been tested for screening patients for those SRH services that relate to preventing or preparing for pregnancy—that is, contraceptive care, family building, and preventive health services. There is not sufficient evidence to recommend a particular tool or approach. Given the centrality of these topics in quality SRH care, this section describes a range of evidence or theory-based and person-centered approaches and how to integrate them into care. 

In addition to pregnancy-related services, there are a variety of other preventive health services that may be relevant for people, depending on their health needs and goals (for example, STI screening/testing, tobacco cessation, treatment for substance use disorder). Screening tools for other health care services are described more in depth in pertinent sections. People should be made aware of services available on-site and by referral.

There are two main frameworks for approaching screening for reproductive desires and related care: (1) reproductive desires and (2) service based. Exhibit 7 offers sample tools for conducting each screening approach, though more are available.70 Providers and health care settings may select a tool or suite of tools to use based on where these tools have been tested, the population(s) being served, and health records considerations. It is generally recommended to screen patients at first encounter and then on a regular basis as determined by a schedule that providers or their organizations create based on patient needs, performance indicators, and other factors. It is not recommended to screen at every clinical encounter.

Screening for Reproductive Desires

Multiple studies show that screening for reproductive desires can increase counseling rates and patient satisfaction.70 Using these screening tools enables providers to offer appropriate services for those patients who are seeking to avoid pregnancy as well as for those who are open to or seeking pregnancy and those interested in other mechanisms to build their families. These tools can be broadly used. In particular, they can open the door for discussing reproductive desires in non-SRH-related encounters or in settings for all people—particularly among those for whom such discussions may be medically relevant (for example, people with chronic medical conditions or those considering a therapeutic treatment that may affect current or future fertility or pregnancy health). They can also be helpful to initiate discussion of family-building interest among LGBTQI+ people and others who may need or desire medical assistance to build their family. Additionally, many people build their families outside of a pregnancy (adoption, fostering, surrogacy).

Screening for reproductive desires is not synonymous with reproductive life planning (RLP), the approach endorsed in the previous QFP recommendations.73 The RLP framework encourages providers to work with all patients to identify their reproductive goals and construct a life plan based on these goals, including shaping their clinical care. This approach is no longer endorsed, given the body of literature suggesting that many people do not relate to the idea of RLP and that a strict pregnancy planning framework may be discordant with many people’s lived realities.74, 75 Reproductive desires can be discussed with a person-centered approach that focuses on open-ended communication and nonjudgmental counseling and support.73

Service-Based Screening

Concepts such as “pregnancy intention” or “planning pregnancy” do not always resonate with people because they do not accommodate nuanced, fluctuating, and sometimes contradictory thoughts and feelings that people can hold regarding future pregnancy. Sometimes pregnancy ambivalence stems from unstable social and structural circumstances, such as housing, relationship, and employment or income insecurity74, 76, 77  that can influence reproductive decision making. Service-based approaches have emerged that involve simply offering a health service such as contraception or the provision of health information about ways to prepare for a potential future pregnancy. Another advantage of service-based screening approaches is that they are more applicable for people who are interested in contraception for reasons other than pregnancy prevention (for example, menstrual regulation).

Exhibit 7. Approaches and Sample Tools for Screening for Reproductive Desires and Related Care

Reproductive Desires Sample Tools

Tool:	Parenthood/Pregnancy Attitude, Timing, and How important is pregnancy prevention (PATH)73
	Three questions: Do you think you might like to have (more) children at some point? When do you think that might be? How important is it to you to prevent pregnancy (until then)? Considerations: Can be used for people of any gender Job aids and other resources available through Envision SRH and RHNTC
Tool:	One Key Question© (OKQ)78
	Single question/prompt: Would you like to become pregnant in the next year?  You can answer yes, no, unsure, or okay either way Considerations: Copyright and fee based Not applicable for people who cannot become pregnant and may lead to bias in screening Most studied of these tools and approaches Can be programmed into EHR and used in conjunction with electronic clinical quality measures (eCQMs) Training and resources, including follow-up prompts, available through Power to Decide

Service-Based Sample Tools

Tool:	Self-Identified Need for Contraception (SINC)79
	Single question/prompt: We ask everyone about their reproductive health needs.  Do you want to talk about contraception or pregnancy prevention during your visit today? Considerations: Should be asked at least once per calendar year Can be programmed into EHR and used in conjunction with eCQMs Implementation resources, including follow-up prompts, available through University of California San Francisco Person-Centered Reproductive Health Program
Tool:	Reproductive Health Services Screening Question80
	Single question/prompt: Can I help you with any reproductive health services today, such as preventing pregnancy or planning a healthy pregnancy? Considerations: Can be used for people of any gender
Source:	Tools suggested identified by an environmental scan commissioned by OPA.