What is the assessment for family planning (FP)?

From the Guidelines

A comprehensive family planning assessment should prioritize a detailed medical history, reproductive goals, and contraceptive preferences, while also considering preconception health services to improve pregnancy and birth outcomes, as recommended by the CDC and the U.S. Office of Population Affairs 1. When conducting a family planning assessment, it is essential to begin by asking about the patient's age, obstetric history (pregnancies, births, miscarriages), menstrual patterns, sexual activity, and previous contraceptive use, including any side effects experienced.

• Screen for contraindications to specific methods by reviewing medical conditions like hypertension, diabetes, migraines with aura, history of blood clots, smoking status, and current medications.
• Discuss the patient's future pregnancy intentions, desired family size, and timing preferences.
• Present all contraceptive options, ranging from long-acting reversible contraceptives (LARCs) like IUDs (hormonal and copper) and implants (Nexplanon), to hormonal methods (combined oral contraceptives, patch, ring, injections like Depo-Provera), barrier methods (condoms, diaphragms), and permanent options (tubal ligation, vasectomy) if appropriate.
• Explain effectiveness rates, side effects, benefits, and proper use of each method, considering factors like convenience, cost, privacy needs, and partner involvement in the decision-making process. As part of the assessment, preconception health services should be offered to female and male clients, including counseling on folic acid supplementation, reproductive life planning, and sexual health assessment, as recommended by the CDC 1 and the USPSTF 1.
• A physical assessment related to contraceptive use should be conducted when warranted, following the guidelines provided by the CDC and the U.S. Office of Population Affairs 1.
• Unnecessary medical procedures and tests should be avoided, as they may create barriers to contraceptive access, particularly for adolescents and low-income women 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Family Planning Assessment

• Family planning is essential for women's health, and access to comprehensive and culturally appropriate reproductive life planning is crucial 2.
• The Family Planning Quotient (FPQ) and Reproductive Life Index (RepLI) tool can facilitate discussions between patients and providers about family planning and reproductive life goals 2.
• Contraceptive effectiveness is determined by a combination of drug or device efficacy, individual fecundability, coital frequency, and user adherence and continuation 3.
• Oral contraceptive pills are the most commonly used reversible method of contraception, but long-acting methods like intrauterine devices and subdermal implants have higher effectiveness and lower failure rates 3.
• Optimal contraceptive selection requires patient and clinician discussion of the patient's tolerance for risk of pregnancy, menstrual bleeding changes, other risks, and personal values and preferences 3.

Contraceptive Options

• Combined oral contraceptive pills can offer benefits beyond contraception, but other options should be discussed, and the pill with the lowest effective dose of oestrogen and progestogen should be prescribed 4.
• Extended-cycle oral contraceptives are increasing in popularity, and a new extended-cycle OC with the lowest doses of ethinyl estradiol and levonorgestrel is available 5.
• Estrogen-containing methods increase the risk of venous thrombosis, whereas progestin-only and nonhormonal methods have rare serious risks 3.
• Hormonal contraceptives can improve medical conditions associated with hormonal changes related to the menstrual cycle, such as acne, endometriosis, and premenstrual dysphoric disorder 3.

Importance of Family Planning

• Family planning is one of the principle tools of human development, and ensuring that all babies are wanted and planned reduces health care and social costs 6.
• The provision of highly effective contraceptive methods represents an important priority of primary medical care, and medical and surgical specialists need to understand how contraception and pregnancy will interact with underlying conditions 6.
• Human numbers will increase to 11 billion by the end of this century, and human activities are the leading cause of environmental change that threatens our health and happiness, making family planning a crucial aspect of human development 6.