A September 2016 position paper by the AAFP expa nded previous practice guidelines and preconception interventions for men with a goal "to ensure positive outcomes of their reproductive and sexual behaviors while minimizing negative consequences of unhealthy lifestyle choices." Male counseling and care should cover contraceptive methods, fertility issues and overall wellness. It should also offer guidance on how to support partners during pregnancy and postpartum recovery as well as the impact smoking and STIs may have on a partner's health.
|Read ACOG's Committee Opinion on pre-pregnancy counseling in its entirety or in PDF form.|
An even more expansive approach, one that requires a shift in clinical theory and practice, is to address the specific reproductive health of all patients, regardless of gender and orientation. To encourage this transition, the American College of Obstetricians and Gynecologists (ACOG) and the American Society for Reproductive Medicine (ASRM) jointly released their first Committee Opinion on pre-pregnancy counseling in January 2019. The recommendation states, in part, that "all those planning to initiate a pregnancy should be counseled, including heterosexual, lesbian, gay, bisexual, transgender, queer, intersex, asexual and gender nonconforming individuals." While these guidelines are intended to be used primarily by OB/GYNs, PCPs who are prepared to address these matters will only further strengthen patient relations, outcomes and satisfaction.
Offer options, not judgments
If patients or couples would like to conceive in the next year, physicians should shift their focus to counseling patients about preconceptual health, such as maintaining a healthy body mass index and the cessation of alcohol, tobacco, cannabis and illicit drug use. Verifying immunization status, ensuring current medications are compatible with pregnancy and managing chronic conditions like diabetes and hypertension is also imperative.
When conception is not desired, then screening for pregnancy risk and reviewing current contraceptive methods is warranted. The AAFP recommends physicians have detailed discussions with patients about all available contraceptive options, where and how to obtain them, as well as the associated failure rates and reliability of each.
"I am a stickler for discussing the abysmal failure rates of most contraceptives," Skop says. Unlike LARCs, most contraceptive methods require daily user action such as taking a pill, so disclosure of both the perfect and real-world use failure rates allows patients to make more informed decisions.
When a pregnancy occurs, whether intended or not, physicians should discuss next steps with patients and help them develop a realistic plan going forward, independent of their personal feelings about those choices. "Pregnancy options counseling means providing nondirective, evidence-based information to newly diagnosed pregnant patients about all of their options for continuing or terminating the pregnancy and [making] referrals as necessary," Martin says. "This is an integral part of the public health prevention framework for addressing unintended pregnancy and is considered a clinical best practice."
As with many other aspects of primary care, this ultimately boils down to equipping patients with the facts and encouraging them to take control of their health, lives and futures. "Beyond preventing unintended pregnancies, [primary care] physicians can help empower patients," Martin says. Through reproductive care services, STI screenings and preconception and pregnancy counseling, patients are more aware of available options.
Dehlendorf agrees. "Our role as providers of family planning services should be to assess patient needs and support them to make a decision that reflects these needs, without judgment or stigma," Dehlendorf says. "In this way, we can advance our patients' reproductive health and work to ensure their reproductive autonomy."
Steph Weber is an award-winning freelance journalist hailing from the Midwest. She writes about healthcare, human resources and small business.
Recommended physician and patient resources:
- AAFP Family Planning and Contraception
- ACOG Clinical Guidelines Search
- PRH's Health Adolescent Reproductive and Sexual Health Education Program (ARSHEP)
- SFP's Clinical Guidelines
- AAP Adolescent Sexual Health Policy and Guidelines
- The Kinsey Institute for Sex Research – Indiana University
- AAPLOG Practice Bulletins
- PCRHP's Clinical Research
- Reproductive Health Access Project
- The Contraceptive Initiative
- Answer Sex Ed Honestly
- My Birth Control
- National Abortion Federation