The purpose of the study was to examine reproductive life planning practices among Title X family planning health care providers and clinical staff. Reproductive life planning is a program priority for Title X clinics, those that receive federal money for providing family planning services to low-income women and men. The goal of reproductive life planning is to decrease unwanted and unintended pregnancies and improve preconception health care however; this practice has not been described. First, a conceptual analysis was conducted to create a definition of reproductive life planning that was consistent with the literature. Reproductive life planning is a process that is centered on reproductive and other life goals and is personalized, collaborative, fluid, and focused on health-promotion. Second, a mixed methods design was used to examine reproductive life planning practices and qualitative interviews were conducted to explore barriers and facilitators to implementing reproductive life planning practices. Data were obtained from health care providers and clinical staff employed at Title X clinics in Illinois, Iowa, Minnesota, Missouri, Nebraska, and North Dakota. A total of 148 clinicians completed a web-based survey which was analyzed to describe which types of patients, the topics covered, and the frequency with which reproductive life planning was discussed during an office visit. Surveys were then examined to identify 20 providers to conduct qualitative interviews with to further explore reproductive life planning practices. The qualitative interviews were also performed to explore the barriers and facilitators clinicians face to practicing reproductive life planning. The results of the web-based questionnaire were examined mainly with medians and frequencies to examine reproductive life planning practices. Qualitative interviews were coded using a content analysis approach to two aims; one to examine how reproductive life planning was using during clinic visits and two, to identify the barriers and facilitators clinicians face when discussing reproductive life planning with patients. Findings from the survey and the interviews suggest that most clinicians are discussing pregnancy intentions with their patients. However, from the interviews, three types of scope of reproductive life planning emerged; those clinicians who screened their patients’ pregnancy intentions, those who planted the seed in the patient’s mind, and those who explored the context of a patient’s life and their goals to contextualize how pregnancy and childbearing would fit into their lives in order to clarify pregnancy intention and move toward the corresponding health behaviors. It is argued that the third group of providers is using reproductive life planning as intended by experts. Finally, barriers to RLP discussions were examined as well as approached providers used to overcome the barriers. In conclusion, many clinicians are practicing reproductive life planning as intended, however many are not. Improved training and protocols are needed to ensure clinicians are providing their patients with the best reproductive life planning discussions. Additionally, systemic structures, like access to quality family planning services, need to be improved to aid clinicians in helping their patient plan their families.

Mycket pekar på att det finns en brist hos många svenska unga kvinnor vad gäller kunskap om fertilitet och reproduktion. Det finns ett behov av att formulera ett evidensbaserat redskap för barnmorskor att använda sig av i samtal om en Reproduktiv Livsplan och för att ge hälsoförebyggande information inför en eventuell graviditet. Syfte: Studiens syfte var att genomföra en pilotstudie beträffande implementering av en Reproduktiv Livsplan i svensk vårdkontext. Ett andra syfte var att testa ett instrument och proceduren inför kommande forskningsprojekt samt att utvärdera dess effekt. Metod: Föreliggande studie hade en kvantitativ ansats och hade designats som en randomiserad kontrollerad interventionsstudie. Totalt deltog 75 unga kvinnor i tre grupper; interventionsgruppen (IG), kontrollgrupp 1 (CG1) och kontrollgrupp 2 (CG2). Data samlades in via enkäter vid baslinje och telefonintervju vid uppföljning. Av de 75 kvinnorna var det 70 som fullföljde studien. Resultat: Få kvinnor uppgav att de tidigare hade funderat speciellt mycket på frågor kring fertilitet. Kunskapen om reproduktion och fertilitet var jämn mellan grupperna vid baslinjemätningen. Vid uppföljningen visade resultaten en kunskapsökning bland den tredjedel av kvinnorna som tagit del av interventionen. Det mest utmärkande fyndet var att flertalet av kvinnorna i interventionsgruppen var ganska eller mycket positiva till att barnmorskan frågade dem om deras Reproduktiva Livsplan. Alla kvinnorna svarade att det var ganska eller mycket sannolikt att de skulle vända sig till sin barnmorska om de hade fler frågor angående fertilitet. Flertalet ansåg att vårdpersonal borde ha som rutin att diskutera frågor om en Reproduktiv Livsplan. Slutsats: Det finns ett behov av att formulera ett evidensbaserat redskap för barnmorskor att använda sig av i samtal med unga kvinnor vad gäller deras Reproduktiva Livsplan och för att informera om hälsoförebyggande faktorer inför en graviditet. Genomförbarheten för denna studie var god och materialet väl lämpat för syftet, därmed kan det även rekommenderas för kommande forskning. Ytterligare visade det sig även att kvinnorna som deltog i interventionen ställde sig positiva till samtalet med barnmorskan om en reproduktiv livsplan. / Research indicates that there is a shortage among Swedish young women in terms of knowledge about fertility and reproduction. There is a need to formulate an evidence-based tool for midwives to use in conversation about a Reproductive Life Plan and to provide information about health prevention before a possible pregnancy. Objective: The aim of this study was to conduct a pilot study on the implementation of a Reproductive Life Plan in a Swedish caring context. A second aim was to test the instrument and procedure for future research projects and to evaluate its effect. Method: The present study had a quantitative approach and was designed as a randomized controlled intervention study. In total, 75 young women participated in three groups; intervention group (IG), control group 1 (CG1) and control group 2 (CG2). Data were collected via questionnaires at baseline and at follow-up by telephone interview. Out of the 75 women, 70 completed the study. Results: Few women reported that they had previously thought much about issues surrounding fertility. The knowledge of reproduction and fertility was similar between the groups at baseline. At follow-up there was a knowledge increase among the third of the women who took part of the intervention. The most striking finding was that most of the women in the intervention group were somewhat or very positive about the midwife asking them about their Reproductive Life Plan. All the women replied that it was somewhat or very likely that they would turn to their midwife if they had more questions about fertility. The majority felt that healthcare professionals should routinely discuss issues of a Reproductive Life Plan. Conclusion: There is a need to formulate an evidence-based tool for midwives to use in conversations with young women in terms of their Reproductive Life Plan and to provide information on health prevention factors before pregnancy. The feasibility of this study was good, and the material well suited for the purpose, thus it can be recommended for future research. Furthermore the results also showed that the women that participated in the intervention where positive to the talk they had with the midwife concerning the reproductive life plan.