In my role as Chief Digital Technologist at Rackspace, not only do I get to own the digital point of view, but I it is my job to speak at events and conferences. In an average lifetime you will spend 25 years in bed, 8 years eating and 18 months in the bathroom. Corresponding preparers: Loretta Gavin, PhD, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. This report provides recommendations developed collaboratively by CDC and the Office of Population Affairs (OPA) of the U.S. The United States continues to face substantial challenges to improving the reproductive health of the U.S. This report can assist primary care providers in offering family planning services that will help women, men, and couples achieve their desired number and spacing of children and increase the likelihood that those children are born healthy. The United States continues to face challenges to improving the reproductive health of the U.S. Family planning services can help address these and other public health challenges by providing education, counseling, and medical services (5). This report provides recommendations for providing care to clients of reproductive age who are in need of family planning services. Women of reproductive age often report that their family planning provider is also their usual source of health care (8). The central premise underpinning these recommendations is that improving the quality of family planning services will lead to improved reproductive health outcomes (10–12). The recommendations were developed jointly under the auspices of CDC's Division of Reproductive Health and OPA, in consultation with a wide range of experts and key stakeholders. CDC and OPA used the input from the subject matter experts to develop a set of core recommendations and asked the Expert Work Group to review them.
The evidence used to prepare these recommendations will appear in background papers that will be published separately.
The primary audience for this report is all providers or potential providers of family planning services to clients of reproductive age, including providers working in clinics that are dedicated to family planning service delivery, as well as private and public providers of more comprehensive primary care.
This report can be used by medical directors to write clinical protocols that describe how care should be provided. In this report, the term "provider" refers to any staff member who is involved in providing family planning services to a client. The recommendations are designed to guide general clinical practice; however, health-care providers always should consider the individual clinical circumstances of each person seeking family planning services. Family planning services are embedded within a broader framework of preventive health services (Figure 1). Providers of family planning services should be trained and equipped to offer all family planning and related preventive health services so that they can provide optimal care to clients, with referral for specialist care, as needed.
These recommendations apply to two types of encounters with women and men of reproductive age. A clinical pathway of family planning services for women and men of reproductive age is provided (Figure 2). The individual client's needs should be considered when determining what services to offer at a given visit. The delivery of preconception, STD, and related preventive health services should not become a barrier to a client's ability to receive services related to preventing or achieving pregnancy.
In addition, professional recommendations for how to address the needs of diverse clients, such as LGBTQ persons (26–32) or persons with disabilities (33), should be consulted and integrated into procedures, as appropriate.
Providers should offer contraceptive services to clients who wish to delay or prevent pregnancy.
Key steps in providing contraceptive services, including contraceptive counseling and education, have been outlined (Box 3).
For clients who have completed childbearing or do not plan to have children, permanent sterilization (female or male) is an option that may be discussed. When educating clients about the range of contraceptive methods, providers should ensure that clients have information that is medically accurate, balanced, and provided in a nonjudgmental manner. When working with male clients, when appropriate, providers should discuss information about female-controlled methods (including emergency contraception) encourage discussion of contraception with partners, and provide information about how partners can access contraceptive services. The provider should help the client consider potential barriers to using the method(s) under consideration.
Blood pressure should be taken before initiating the use of combined hormonal contraception. Providers should assess the current pregnancy status of clients receiving contraception (42), which provides guidance on how to be reasonably certain that a woman is not pregnant at the time of contraception initiation.
Weight measurement is not needed to determine medical eligibility for any method of contraception because all methods generally can be used among obese women. Unnecessary medical procedures and tests might create logistical, emotional, or economic barriers to contraceptive access for some women, particularly adolescents and low-income women, who have high rates of unintended pregnancies (1,51,52).
For male clients, no physical examination needs to be performed before distributing condoms.
Providers should encourage clients to anticipate reasons why they might not use their chosen method(s) correctly or consistently, and help them develop strategies to deal with these possibilities.
As noted previously, if a client chooses a method that is not available on-site or during the visit, the provider should schedule a follow-up visit with the client or provide a referral for her or him to receive the method. The teach-back method may be used to confirm the client's understanding by asking the client to repeat back messages about risks and benefits and appropriate method use and follow-up. When serving contraceptive clients who return for ongoing care related to contraception, providers should ask if the client has any concerns with the method and assess its use. Providers should give comprehensive information to adolescent clients about how to prevent pregnancy (55–57). Providers of family planning services should offer confidential services to adolescents and observe all relevant state laws and any legal obligations, such as notification or reporting of child abuse, child molestation, sexual abuse, rape, or incest, as well as human trafficking (58,59). Providers should encourage and promote communication between the adolescent and his or her parent(s) or guardian(s) about sexual and reproductive health (71–86). Services for adolescents should be provided in a "youth-friendly" manner, which means that they are accessible, equitable, acceptable, appropriate, comprehensive, effective, and efficient for youth as recommended by the World Health Organization (34). Providers of family planning services should offer pregnancy testing and counseling services as part of core family planning services, in accordance with recommendations of major professional medical organizations, such as the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) (95–97). Pregnancy testing is a common reason for a client to visit a provider of family planning services.
Options counseling should be provided in accordance with recommendations from professional medical associations, such as ACOG and AAP (95–97). If the pregnancy test is positive, the clinical visit should include an estimation of gestational age so that appropriate counseling can be provided. Referral to appropriate providers of follow-up care should be made at the request of the client, as needed. For clients who are considering or choose to continue the pregnancy, initial prenatal counseling should be provided in accordance with the recommendations of professional medical associations, such as ACOG (97).
Women who are not pregnant and who do not want to become pregnant at this time should be offered contraceptive services, as described previously. Women who are not pregnant and who are trying to become pregnant should be offered services to help achieve pregnancy or basic infertility services, as appropriate (see "Clients Who Want to Become Pregnant" and "Basic Infertility Services"). Providers should advise clients who wish to become pregnant in accordance with the recommendations of professional medical organizations, such as the American Society for Reproductive Medicine (ASRM) (100). Providers should ask the client (or couple) how long she or they have been trying to get pregnant and when she or they hope to become pregnant. The client should be educated about peak days and signs of fertility, including the 6-day interval ending on the day of ovulation that is characterized by slippery, stretchy cervical mucus and other possible signs of ovulation. Women with regular menstrual cycles should be advised that vaginal intercourse every 1–2 days beginning soon after the menstrual period ends can increase the likelihood of becoming pregnant. Smoking, consuming alcohol, using recreational drugs, and using most commercially available vaginal lubricants should be discouraged as these might reduce fertility. Providers should offer basic infertility care as part of core family planning services in accordance with the recommendations of professional medical organizations, such as ACOG, ASRM, and the American Urological Association (AUA) (96,101,102).
Infertility commonly is defined as the failure of a couple to achieve pregnancy after 12 months or longer of regular unprotected intercourse (101).
The clinical visit should focus on understanding the client's reproductive life plan (24) and her difficulty in achieving pregnancy through a medical history, sexual health assessment and physical exam, in accordance with recommendations developed by professional medical associations such as ASRM (101) and ACOG (96). Infertility services should be provided for the male partner of an infertile couple in accordance with recommendations developed by professional medical associations such as AUA (102). Counseling provided during the clinical visit should be guided by information elicited from the client during the medical and reproductive history and the findings of the physical exam.
Providers of family planning services should offer preconception health services to female and male clients in accordance with CDC's recommendations to improve preconception health and health care (24). Preconception health services are beneficial because of their effect on pregnancy and birth outcomes and their role in improving the health of women and men.
Preconception health-care services for women aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcomes through prevention and management.
In the family planning setting, providers may prioritize screening and counseling about preconception health for couples that are trying to achieve pregnancy and couples seeking basic infertility services. Recommendations for improving the preconception health of men also have been identified, although the evidence base for many of the recommendations for men is less than that for women (103). Other preconception health services for women and men should include discussion of a reproductive life plan and sexual health assessment (Boxes 2 and 4), as well as the screening services described below (24,103,105). Providers should screen women of childbearing age for intimate partner violence and provide or refer women who screen positive to intervention services, in accordance with USPSTF (Grade B) recommendations (106).
For female and male adult clients, providers should screen for alcohol use in accordance with the USPSTF recommendation (Grade B) for how to do so, and provide behavioral counseling interventions, as indicated (107). For female and male clients, providers should screen for tobacco use in accordance with the USPSTF recommendation (111,112) for how to do so.
For female and male clients, providers should screen for immunization status in accordance with recommendations of CDC's Advisory Committee on Immunization Practices (113) and offer vaccination, as indicated, or provide referrals to community providers for immunization. For all clients, providers should screen for depression when staff-assisted depression care supports are in place to ensure accurate diagnosis, effective treatment, and follow-up (114,115). Providers also may follow American Psychiatric Association (116) and American Academy of Child and Adolescent Psychiatry (117) recommendations to assess risk for suicide among persons experiencing depression and other risk factors. For all clients, providers should screen adult (Grade B) and adolescent (Grade B) clients for obesity in accordance with the USPSTF recommendation, and obese adults should be referred for intensive counseling and behavioral interventions to promote sustained weight loss (118,119). Providers should offer STD services in accordance with CDC's STD treatment and HIV testing guidelines (36,123,124).
STD services should be provided for persons with no signs or symptoms suggestive of an STD. For female clients, providers should screen all sexually active women aged ?25 years for chlamydia annually, in addition to sexually active women aged >25 years with risk factors for chlamydia infection (36). For male clients, chlamydia screening can be considered for males seen at sites with a high prevalence of chlamydia, such as adolescent clinics, correctional facilities, and STD clinics (36,125,126).
For female clients, providers should screen clients for gonorrhea, in accordance with CDC's STD treatment guidelines (36).
For male clients, providers should screen MSM for gonorrhea at anatomic sites of exposure, in accordance with CDC's STD treatment guidelines (36). For female and male clients, providers should screen clients for syphilis, in accordance with CDC's STD treatment guidelines (36).
For female and male clients, CDC recommends one-time testing for hepatitis C (HCV) without prior ascertainment of HCV risk for persons born during 1945–1965, a population with a disproportionately high prevalence of HCV infection and related disease. I am very lucky that Rackspace have invested in training for me and encourage my personal development. These are all necessities, while you can certainly skip meals here and there, the time you take to actually perform vital tasks can’t be reduced by much.
Initially this was quite a daunting task until I learned to control my nerves and develop my presenting style. With the aim of being more productive in 2015, I started by reviewing what I’d done in the previous 12 months and made a list of goals for the coming months. The report provides recommendations for how to help prevent and achieve pregnancy, emphasizes offering a full range of contraceptive methods for persons seeking to prevent pregnancy, highlights the special needs of adolescent clients, and encourages the use of the family planning visit to provide selected preventive health services for women, in accordance with the recommendations for women issued by the Institute of Medicine and adopted by HHS. CDC has a long-standing history of developing evidence-based recommendations for clinical care, and OPA's Title X Family Planning Program (7) has served as the national leader in direct family planning service delivery since the Title X program was established in 1970.
These recommendations are intended for all current or potential providers of family planning services, including those funded by the Title X program. IOM defines health-care quality as the extent to which health-care services improve health outcomes in a manner that is consistent with current professional knowledge (10,13).
These recommendations integrate other CDC recommendations about which contraceptive methods can be provided safely to women with various medical conditions, and integrate CDC and U.S.
These recommendations encourage taking a client-centered approach by 1) highlighting that the client's primary purpose for visiting the service site must be respected, 2) noting the importance of confidential services and suggesting ways to provide them, 3) encouraging the availability of a broad range of contraceptive methods so that clients can make a selection based on their individual needs and preferences, and 4) reinforcing the need to deliver services in a culturally competent manner so as to meet the needs of all clients, including adolescents, those with limited English proficiency, those with disabilities, and those who are lesbian, gay, bisexual, transgender, or questioning their sexual identity (LGBTQ).
These recommendations highlight the importance of ensuring that services are provided to clients in a timely manner. These recommendations identify a core set of services that providers can focus on delivering, as well as ways to maximize the use of resources. These recommendations address how to remove barriers to contraceptive use, use the family planning visit to provide access to a broader range of primary care and behavioral health services, use the primary care visit to provide access to contraceptive and other family planning services, and strengthen links to other sources of care. These recommendations highlight the need for providers of family planning services to deliver high-quality care to all clients, including adolescents, LGBTQ persons, racial and ethnic minorities, clients with limited English proficiency, and persons living with disabilities. More information about the processes used to conduct systematic reviews, the role of technical experts in reviewing the evidence, and the process of using the evidence to develop recommendations is provided (Appendix A). The members of the Expert Work Group were more familiar with the family planning service delivery context than the members of the Technical Panel and thus could better comment on the feasibility and appropriateness of the recommendations, as well as the supporting evidence. Providers of dedicated family planning services might be less familiar with the specific recommendations for the delivery of preconception services.
This includes physicians, physician assistants, nurse practitioners, nurse-midwives, nursing staff, and health educators.
Similarly, these recommendations might need to be adapted to meet the needs of particular populations, such as clients who are HIV-positive or who are substance users. An initial section provides an overview of steps to assess the needs of a client and decide what family planning services to offer. These include preventive health services for women that were not included above (6), as well as preventive services for men.
Other preventive health services should be available either on-site or by referral, but these recommendations do not address this category of services. The following questions can help providers determine what family planning services are most appropriate for a given visit.


It is essential to understand the client's goals for the visit and address those needs to the extent possible. Understanding whether a provider is the main source of primary care for a client will help identify what preventive services a provider should offer. Preconception health services (such as screening for obesity, smoking, and mental health) are a subset of all preventive services for women and men. Whether the client needs related preventive health services, such as breast and cervical cancer screening for female clients, should be assessed.
It might not be feasible to deliver all the needed services in a single visit, and they might need to be delivered over the course of several visits. For these clients, receiving services related to preventing or achieving pregnancy is the priority; if other family planning services cannot be delivered at the initial visit, then follow-up visits should be scheduled.
For example, as noted before, providers should avoid making assumptions about a client's gender identity, sexual orientation, race, or ethnicity; all requests for services should be treated without regard to these characteristics. Contraceptive services should include consideration of a full range of FDA-approved contraceptive methods, a brief assessment to identify the contraceptive methods that are safe for the client, contraceptive counseling to help a client choose a method of contraception and use it correctly and consistently, and provision of one or more selected contraceptive method(s), preferably on site, but by referral if necessary.
These key steps are in accordance with the five principles of quality counseling (Appendix C). A medical history should be taken to ensure that methods of contraception being considered by a client are safe for that particular client. A sexual history and risk assessment that considers the client's sexual practices, partners, past STD history, and steps taken to prevent STDs (36) is recommended to help the client select the most appropriate method(s) of contraception.
Work with the client interactively to select the most effective and appropriate contraceptive method. Before the health-care visit, clients might have only limited information about all or specific methods of contraception (37). This information should include an explanation that long-acting reversible contraceptive methods are safe and effective for most women, including those who have never given birth and adolescents (35).
Both female and male sterilization are safe, are highly effective, and can be performed in an office or outpatient surgery setting (40,41). A contraceptive method's rate of typical effectiveness, or the percentage of women experiencing an unintended pregnancy during the first year of typical use, is an important consideration (Figure 3; Appendix D) (38,42). The mode of administration and understanding how to use the method correctly might be important considerations for the client when choosing a method.
Many contraceptives have noncontraceptive benefits, in addition to preventing pregnancy, such as reducing heavy menstrual bleeding.
Providers should inform the client about risks and side effects of the method(s) under consideration, help the client understand that certain side effects of contraceptive methods might disappear over time, and encourage the client to weigh the experience of coping with side effects against the experience and consequences of an unintended pregnancy.
Clients should be informed that contraceptive methods other than condoms offer no protection against STDs, including HIV.
To assist clients in making informed decisions, providers should educate clients in a manner that can be readily understood and retained. Male clients should also be reminded that condoms should be used correctly and consistently to reduce risk of STDs, including HIV. Social-behavioral factors might influence the likelihood of correct and consistent use of contraception (47). Current and past intimate partner sexual or domestic violence might impede the correct and consistent use of contraception, and might be a consideration when choosing a method (47–49). In most cases, a detailed history provides the most accurate assessment of pregnancy risk in a woman about to start using a contraceptive method. However, measuring weight and calculating BMI at baseline might be helpful for monitoring any changes and counseling women who might be concerned about weight change perceived to be associated with their contraceptive method. Provide the contraceptive method along with instructions about correct and consistent use, help the client develop a plan for using the selected method and for follow-up, and confirm client understanding. Referrals for methods not available onsite should be provided for clients who indicate they prefer those methods. Using a method incorrectly or inconsistently and having gaps in contraceptive protection because of method switching both increase the likelihood of an unintended pregnancy (37).
Providers should discuss an appropriate follow-up plan with the client to meet their individual needs, considering the client's risk for discontinuation.
The client should be provided another method to use until she or he can start the chosen method.
If providers assess the client's understanding, then the check box or written statement can be used in place of a written method-specific informed consent form.
The provider should assess any changes in the client's medical history, including changes in risk factors and medications that might affect safe use of the contraceptive method.
Confidentiality is critical for adolescents and can greatly influence their willingness to access and use services (60–67). Adolescents who come to the service site alone should be encouraged to talk to their parents or guardians. In most cases, a qualitative urine pregnancy test will be sufficient; however, in certain cases, the provider may consider performing a quantitative serum pregnancy test, if exact hCG levels would be helpful for diagnosis and management. A female client might wish to include her partner in the discussion; however, if a client chooses not to involve her partner, confidentiality must be assured.
If a woman is uncertain about the date of her last normal menstrual period, a pelvic examination might be needed to help assess gestational age. The contraceptive counseling session should explore why the client thought that she was pregnant and sought pregnancy testing services, and whether she has difficulties using her current method of contraception. They also should be offered preconception health and STD services (see "Preconception Health Services" and "STD services"). If the client's situation does not meet one of the standard definitions of infertility (see "Basic Infertility Services"), then she or he may be counseled about how to maximize fertility. Earlier assessment (such as 6 months of regular unprotected intercourse) is justified for women aged >35 years, those with a history of oligo-amenorrhea (infrequent menstruation), those with known or suspected uterine or tubal disease or endometriosis, or those with a partner known to be subfertile (the condition of being less than normally fertile though still capable of effecting fertilization) (101).
Providers should discuss the client's reproductive life plan, take a medical history, and conduct a sexual health assessment. If there is no apparent cause of infertility and the client does not meet the definition above, providers should educate the client about how to maximize fertility (see "Clients Who Want to Become Pregnant"). The term preconception describes any time that a woman of reproductive potential is not pregnant but at risk of becoming pregnant, or when a man is at risk for impregnating his female partner.
It promotes the health of women of reproductive age before conception, and thereby helps to reduce pregnancy-related adverse outcomes, such as low birthweight, premature birth, and infant mortality (24).
Women who are using contraception to prevent or delay pregnancy might also benefit from preconception health services, especially those at high risk of unintended pregnancy.
Services should be provided in accordance with the cited clinical recommendations, and any needed follow up (further diagnosis, treatment) should be provided either on-site or through referral.
Screening adults for other drug use and screening adolescents for alcohol and other drug use has the potential to reduce misuse of alcohol and other drugs, and can be recommended (105,108,109). Adults (Grade A) who use tobacco products should be provided or referred for tobacco cessation interventions, including brief behavioral counseling sessions (<10 minutes) and pharmacotherapy delivered in primary care settings (111). Staff-assisted care supports are defined as clinical staff members who assist the primary care clinician by providing some direct depression care, such as care support or coordination, case management, or mental health treatment. Providers also may follow AAP's recommendation that adolescents receive annual blood pressure screening (109). It is important to test for chlamydia annually among young sexually active females and for gonorrhea routinely among all sexually active females at risk for infection because they can cause tubal infertility in women if left untreated. STD diagnostic management recommendations are not included in these guidelines, so providers should refer to CDC's STD treatment guidelines (36) when caring for clients with STD symptoms. Assess: The provider should discuss the client's reproductive life plan, conduct a standard medical history and sexual health assessment (see text box above), and check immunization status.
Women aged >25 years at higher risk include sexually active women who have a new or more than one sex partner or who have a partner who has other concurrent partners. Providers should screen men who have sex with men (MSM) for chlamydia at anatomic sites of exposure, in accordance with CDC's STD treatment guidelines (36). Males with symptoms suggestive of gonorrhea (urethral discharge or dysuria or whose partner has gonorrhea) should be tested and empirically treated at the initial visit.
Providers should follow CDC recommendations that all clients aged 13–64 years be screened routinely for HIV infection and that all persons likely to be at high risk for HIV be rescreened at least annually (123). One of the things I absolutely love about working in the IT industry is trying out new productivity tool configurations. Over the last few years I have improved significantly, and I put this down to practice and experience.
Having a plan is important, it helps you focus on progressing your career or another project.
The recommendations outline how to provide quality family planning services, which include contraceptive services, pregnancy testing and counseling, helping clients achieve pregnancy, basic infertility services, preconception health services, and sexually transmitted disease services.
Nearly one half of all pregnancies are unintended, with more than 700,000 adolescents aged 15–19 years becoming pregnant each year and more than 300,000 giving birth. Preventive Services Task Force (USPSTF) recommendations on STD, preconception, and related preventive health services. Organizational policies, governance structures, and individual attitudes and practices all contribute to the cultural competence of a health-care entity and its staff.
A multistage process was used to develop the recommendations that drew on established procedures for developing clinical guidelines (20,21).
Providers of more comprehensive primary care might be less familiar with the delivery of contraceptive services, pregnancy testing and counseling, and services to help clients achieve pregnancy.
The term "service site" represents the numerous settings in which family planning services are delivered, which include freestanding service sites, community health centers, private medical facilities, and hospitals. Subsequent sections describe how to provide each of the following services: contraceptive services, pregnancy testing and counseling, helping clients achieve pregnancy, basic infertility services, preconception health services, STD services and related preventive health services. Screening for lipid disorders, skin cancer, colorectal cancer, or osteoporosis are examples of this type of service. If a provider is the client's main source of primary care, it will be important to assess the client's needs for the other services listed in this report. For clients whose initial reason for coming to the service site was not related to preventing or achieving pregnancy, asking questions about his or her reproductive life plan might help identify unmet reproductive health-care needs.
Preconception health care is intended to promote the health of women and men of reproductive age before conception, with the goal of improving pregnancy-related outcomes (24). Many clients requesting contraceptive services also might meet the criteria for being at risk of one or more STDs. The federal and professional medical recommendations cited in this report should be followed when determining which related preventive health services a client might need. Similarly, services for adolescents should be provided in a "youth-friendly" manner, which means that they are accessible, equitable, acceptable, appropriate, comprehensive, effective, and efficient for youth, as recommended by the World Health Organization (34). Contraceptive counseling is defined as a process that enables clients to make and follow through on decisions about their contraceptive use.
To help a client who is initiating or switching to a new method of contraception, providers should follow these steps. Providers should ask clients about their medical history to identify methods that are safe. Providers should work with the client interactively to select an effective and appropriate contraceptive method. For example, receiving a contraceptive injection every 3 months might not be acceptable to a woman who fears injections.
Although the noncontraceptive benefits are not generally the major determinant for selecting a method, awareness of these benefits can help clients decide between two or more suitable methods and might enhance the client's motivation to use the method correctly and consistently. Condoms, when used correctly and consistently, help reduce the risk of STDs, including HIV, and provide protection against pregnancy.
The content, format, method, and medium for delivering education should be evidence-based (see Appendix E). For example, an IUD might be preferred because it does not require the partner's participation. The medical history might provide information about the signs of such conditions or behaviors, and if not, providers should ask clients about substance use behaviors or mental health disorders, such as depression or anxiety, that might interfere with the motivation or ability to follow through with contraceptive use.
Most women will need no or few examinations or laboratory tests before starting a method of contraception.
After the method has been provided, or a plan put into place to obtain the chosen method, providers should help the client develop an action plan for using the selected method.
Providers also may inform clients about the availability of emergency contraceptive pills and may provide clients an advance supply of emergency contraceptive pills on-site or by prescription, if requested. Follow-up provides an opportunity to inquire about any initial difficulties the client might be experiencing, and might reinforce the perceived accessibility of the provider and increase rapport. If the client is using the method correctly and consistently and there are no concerns about continued use, an appropriate follow-up plan should be discussed and more contraceptive supplies given (42).
If the adolescent indicates that she or he will be sexually active, providers should give information about contraception and help her or him to choose a method that best meets her or his individual needs, including the use of condoms to reduce the risk of STDs. As a result, multiple professional medical associations have emphasized the importance of providing confidential services to adolescents (68–70).
Educational materials and programs can be provided to parents or guardians that help them talk about sex and share their values with their child (72,87).
Among live births, only 1% of infants are placed for adoption within their first month of life (99). The test results should be presented to the client, followed by a discussion of options and appropriate referrals. In addition, clients should receive information about the normal signs and symptoms of early pregnancy, and should be instructed to report any concerns to a provider for further evaluation.
For example, providers might provide a resource listing or directory of providers to help the client identify options for care. A negative pregnancy test also provides an opportunity to discuss the value of making a reproductive life plan. An early evaluation also might be warranted if risk factors of male infertility are known to be present or if there are questions regarding the male partner's fertility potential (102). ACOG notes the importance of addressing the emotional and educational needs of clients with infertility and recommends that providers consider referring clients for psychological support, infertility support groups, or family counseling (96).
Moreover, the preconception health services recommended here are equally important because they contribute to the improvement of women's health and well-being, regardless of her childbearing intentions.
Moreover, these services are important for improving the health of men regardless of their pregnancy intention. However, the USPSTF recommendation for screening for other drugs in adults, and for alcohol and other drugs in adolescents, is an "I," and patients should be informed that there is insufficient evidence to assess the balance of benefits and harms of this screening (107,110). Adolescents (Grade B) should be provided intervention to prevent initiation of tobacco use (112).


In addition, ACOG recommends that rubella titer be performed in women who are uncertain about MMR immunization (108). The lowest effective staff supports consist of a screening nurse who advises primary care clinicians of a positive screen and provides a protocol facilitating referral to behavioral therapy.
These interventions typically comprise 12 to 26 sessions in a year and include multiple behavioral management activities, such as group sessions, individual sessions, setting weight-loss goals, improving diet or nutrition, physical activity sessions, addressing barriers to change, active use of self-monitoring, and strategizing how to maintain lifestyle changes.
Clients also should follow CDC's recommendations for testing for hepatitis C (124), and the Advisory Committee on Immunization Practice's recommendations on reproductive health-related immunizations (113).
Females with chlamydia infection should be rescreened for re-infection at 3 months after treatment.
Males with symptoms suggestive of chlamydia (urethral discharge or dysuria or whose partner has chlamydia) should be tested and empirically treated at the initial visit.
Males with gonorrhea infection should be re-screened for reinfection at 3 months after treatment (36,126–128). Populations at risk include MSM, commercial sex workers, persons who exchange sex for drugs, those in adult correctional facilities and those living in communities with high prevalence of syphilis (36).
Persons likely to be at high risk include injection-drug users and their sex partners, persons who exchange sex for money or drugs, sex partners of HIV-infected persons, and MSM or heterosexual persons who themselves or whose sex partners have had more than one sex partner since their most recent HIV test. I’m going to post more about my new role soon, but you can certainly expect more detailed ecommerce and digital strategy in my forthcoming 2016 content. Preparation is at the heart of any good venture, be that a summer holiday, a child’s party or even your career.
Over the last two years, with the help of this blog and social media interaction (primarily on Twitter), I’ve started building a personal brand. The primary audience for this report is all current or potential providers of family planning services, including those working in service sites that are dedicated to family planning service delivery as well as private and public providers of more comprehensive primary care. One of eight pregnancies in the United States results in preterm birth, and infant mortality rates remain high compared with those of other developed countries. For example, they will have increased opportunities to serve new clients and to serve as gateways for their clients to other essential health-care services. Cultural competency within a health-care setting refers to attitudes, practices, and policies that enable professionals to work effectively in cross-cultural situations (14–16). First, an Expert Work Group* was formed comprising family planning clinical providers, program administrators, and representatives from relevant federal agencies and professional medical associations to help define the scope of the recommendations. In certain cases, when the evidence from the literature reviews was inconclusive or incomplete, recommendations were made on the basis of expert opinion.
A final section on quality improvement describes actions that all providers of family planning services should consider to ensure that services are of high quality. Although important in the context of primary care, these have no direct link to family planning services. For clients seeking to prevent or achieve pregnancy, providers should assess whether the client needs other related services and offer them to the client. If the client receives ongoing primary care from another provider, the provider should confirm that the client's preventive health needs are met while avoiding the delivery of duplicative services. Preconception health services are also important because they improve the health of women and men, even if they choose not to become pregnant. Screening for chlamydia and gonorrhea is especially important in a family planning context because these STDs contribute to tubal infertility if left untreated. For example, clients who are trying to achieve pregnancy and those at high risk of unintended pregnancy should be given higher priority for preconception health services.
Education is an integral component of the contraceptive counseling process that helps clients to make informed decisions and obtain the information they need to use contraceptive methods correctly. These steps most likely will be implemented iteratively when working with a client and should help clients adopt, change, or maintain contraceptive use. In addition, to learn more about factors that might influence a client's choice of a contraceptive method, providers should confirm the client's pregnancy intentions or reproductive life plan, ask about the client's contraceptive experiences and preferences, and conduct a sexual health assessment. Clients considering combined hormonal contraception should be asked about smoking tobacco, in accordance with CDC guidelines on contraceptive use (35). CDC recommendations for how to conduct a sexual health assessment have been summarized (Box 4). Specifically, providers should educate the client about contraceptive methods that the client can safely use, and help the client consider potential barriers to using the method(s) under consideration. It is not appropriate to omit presenting information on a method solely because the method is not available at the service site. Clients interested in sterilization should be referred to an appropriate source of care if the provider does not perform the procedure. Similarly, oral contraceptives might not be acceptable to a woman who is concerned that she might not be able to remember to take a pill every day. Clients also should be informed about warning signs for rare, but serious, adverse events with specific contraceptive methods, such as stroke and venous thromboembolism with use of combined hormonal methods. The medical history might provide information on signs of current or past violence and, if not, providers should ask clients about relationship issues that might be potential barriers to contraceptive use. If needed, clients with mental health disorders or risky substance use behaviors should be referred for appropriate care. Guidance on necessary examinations and tests related to initiation of contraception is available (42). Alternative modes of follow-up other than visits to the service site, such as telephone, e-mail, or text messaging, should be considered (assuming confidentiality can be assured), as needed. If the client or provider has concerns about the client's correct or consistent use of the method, the provider should ask if the client would be interested in considering a different method of contraception. Long-acting reversible contraception is a safe and effective option for many adolescents, including those who have not been pregnant or given birth (35).
When both parent or guardian and child have agreed, joint discussions can address family values and expectations about dating, relationships, and sexual behavior. If ectopic pregnancy or other pregnancy abnormalities or problems are suspected, the provider should either manage the condition or refer the client for immediate diagnosis and management. Depending upon a client's needs, the provider may make an appointment for the client, or call the referral site to let them know the client was referred.
If there might be delays in obtaining prenantal care, the client should be provided or referred for any needed STD screening (including HIV) and vaccinations (36). Ideally, these services will be offered in the same visit as the pregnancy test because clients might not return at a later time for contraceptive services.
Infertility visits to a family planning provider are focused on determining potential causes of the inability to achieve pregnancy and making any needed referrals to specialist care (101,102). A review of systems should emphasize symptoms of thyroid disease, pelvic or abdominal pain, dyspareunia, galactorrhea, and hirsutism (101).
CDC recommends that preconception health services be integrated into primary care visits made by women of reproductive age, such as family planning visits (24). A woman is at lower risk of unintended pregnancy if she is using a highly effective method, such as an IUD or implant, or has an established history of using methods of contraception, such as injections, pills, patch, or ring correctly and consistently (38,39). Vaccination for human papillomavirus (HPV) and hepatitis B are also important parts of STD services and preconception care (113). It is important to follow these guidelines both to ensure that clients receive needed services and to avoid unnecessary screening.
Pregnant women should be screened for chlamydia at the time of their pregnancy test if there might be delays in obtaining prenatal care (36). Pregnant women should be screened for syphilis at the time of their pregnancy test if there might be delays in obtaining prenatal care (36).
CDC further recommends that screening be provided after the patient is notified that testing will be performed as part of general medical consent unless the patient declines (opt-out screening) or otherwise prohibited by state law.
One of the primary things that helped me overcome this, was knowing my material and believing in the story. Well, it is the application suite, online services and hardware that helps me do my job in the most effective way.
That is really where I wanted to kick this year off – with a look at setting personal goals and the possibilities that a New Year can offer. I had a revelation at the start of 2015 – I have never really planned what my future working life might look like! Some of the most successful and productive people in history recognised the need to spend their time completing important goals. If you are comfortable with what you are going to say, you can concentrate on delivering the message clearly and with confidence. In this article I’ll talk about the importance of developing your online presence, some of the key benefits and my tips on how to grow and improve.
Approximately one of eight pregnancies in the United States results in a preterm birth, and infant mortality rates remain high compared with other developed countries (3,4). In addition, primary care and other providers who provide a range of health-care services will be expected to integrate family planning services for all persons of reproductive age, including those whose primary reason for their health-care visit might not be family planning.
Finally, CDC and OPA staff considered the individual feedback from Expert Work Group members when finalizing the core recommendations and writing the recommendations document.
More detailed information about selected topics addressed in the recommendations is provided (Appendices A–F). In the second type of encounter, the primary reason for a client's visit to a health-care provider is not related to preventing or achieving pregnancy. The federal and professional medical recommendations cited in this report should be followed when determining which preconception health services a client might need. In some cases, the provider will deliver the initial screening service but then refer to another provider for further diagnosis or follow-up care. If not all methods are available at the service site, it is important to have strong referral links in place to other providers to maximize opportunities for clients to obtain their preferred method that is medically appropriate.
Dual protection can be achieved through correct and consistent use of condoms with every act of sexual intercourse, or correct and consistent use of a condom to prevent infection plus another form of contraception to prevent pregnancy. In addition, clients experiencing intimate partner violence or sexual violence should be referred for appropriate care.
A list of assessments that need to be conducted when providing reversible contraceptive services to a female client seeking to initiate or switch to a new method of reversible contraception is provided (Table 1) (42). Providers also should assess the client's social support and refer her to appropriate counseling or other supportive services, as needed.
Clients who do not want to become pregnant should also be provided preconception health services, since they are recommended by USPSTF for the purpose of improving the health of adults.
Other risk factors that place women at increased risk include a previous gonorrhea infection, the presence of other STDs, new or multiple sex partners, inconsistent condom use, commercial sex work, and drug use.
In order to make sure the delivery is professional and message is interesting I have developed a process for building a great presentation. By doing it in a methodical way I can save time and be more efficient. Before I dive in to the various sections, I should start by saying this is certainly not rocket-science. Each year most people set a resolution with the aim achieving some sort of self-improvement.
Without knowing where I want to get to, how can I measure success and how can I know that I’m making the right decisions? Your middle aged years are when you should be building your career, making a name for yourself and getting things done. Earlier this month, I was lucky enough to attend a course run by Body Talk UK, they help people develop their technique. A strong brand can help you get a new job, secure funding, start a business or attract investment.
Moreover, all of these outcomes affect racial and ethnic minority populations disproportionately (1–4). Strengthened, multidirectional care coordination also will be needed to improve health outcomes. The results were presented to three technical panels† comprising subject matter experts (one panel for each priority topic) who considered the quality of the evidence and made suggestions for what recommendations might be supported on the basis of the evidence.
A description of how the recommendations link to the evidence is provided together with the rationale for the inclusion of each recommendation in this report (Appendix B). The federal recommendations cited in this report should be followed when determining which STD services a client might need. For a male client, a medical history should include use of condoms, known allergies to condoms, partner use of contraception, recent intercourse, whether his partner is currently pregnant or has had a child, miscarriage, or termination, and the presence of any infectious or chronic health condition.
Clinical evaluation of a client electing permanent sterilization should be guided by the clinician who performs the procedure. Patients also should be asked about their female partners' history of pelvic inflammatory disease, their partners' histories of STDs, and problems with sexual dysfunction.
Females with gonnorrhea infection should be re-screened for re-infection at 3 months after treatment. In this article I’ll take you through how I move from idea to slides, with some useful tips along the way. I’m not re-inventing the wheel or revealing some incredible new method of working that will revolutionise your day!
Not sticking to these goals and failing to make any significant progress can be a demoralising experience and it can actually have a negative impact on your development and career. In this article I’ll talk about a system they teach which helps you write a effective and captivating presentation. For example, this type of care coordination will be needed with clients referred to specialist care after initial screening at a family planning visit, as well as with specialists referring clients with family planning needs to family planning providers.
In a separate process, existing clinical recommendations on women's and men's preventive services were compiled from more than 35 federal and professional medical associations, and these results were presented to two technical panels of subject matter experts, one that addressed women's clinical services and one that addressed men's clinical services. In this situation, providers not only should address the client's primary reason for the visit but also assess the client's need for services related to preventing or achieving pregnancy. Pregnant women should be screened for gonorrhea at the time of their pregnancy test if there might be delays in obtaining prenatal care (36). However, I hope this productivity tool kit might make you stop and think about the various ways you organise your day and deliver results.
The panels provided individual feedback about which clinical preventive services should be offered in a family planning setting and which clinical recommendations should receive the highest consideration. Perhaps there is something you don’t to, or have thought about trying and perhaps this might be the push you need to try. If that’s the case I would love to hear what you think in the comments at the end of this post.



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