Reproductive Life Goals Conversations in Non-Clinical Settings
Talking about sexual and reproductive health with clients might feel intimidating or overwhelming if you’ve never done it before. This page of the “No Wrong Door for Reproductive Life Goals Conversations” toolkit will give you the necessary information, and tools, to do so with confidence. On this page, we will:
- Define and provide background on reproductive life goals (RLG) conversations
- Share how to create an RLG conversation-friendly environment
- Teach the PATH framework
- Learn how to continue the conversation beyond the initial RLG questions
- Discuss unconscious biases
What is an RLG Conversation?
An RLG conversation explores feelings about if, when, or how to become pregnant, have children, or avoid pregnancy. Given those feelings, information might be given, and actions might be discussed and taken.
The provider’s role in a reproductive life goals conversation is to:
Explore how the client feels about having children (now or in the future)
Acknowledge that pregnancy intentions aren’t always as simple as trying to prevent or achieve pregnancy
Maintain and promote the client’s sexual and reproductive autonomy
Provide unbiased information, guided by the client’s values and preferences
Previously, the public health field asked clients about their reproductive life plans (RLPs), but switched to discussing reproductive life goals (RLGs) in order to promote client autonomy while increasing access to sexual and reproductive healthcare.
The word ‘plan’ isn’t used in RLG conversations. That’s because planning pregnancy isn’t how it works for many people, and intentions around pregnancy aren’t as simple as yes or no. Discussing goals instead of plans makes space for mixed feelings around pregnancy and prevention. It creates the opportunity to discuss preconception care, and/or contraception, with people who feel ambivalent. It also provides the opportunity to provide evidence-based information about other sexual and reproductive health topics that are unlikely to come up in the context of a plan.
Creating the Right Environment for RLGs
Preparing clients for an RLG conversation starts as soon as they enter the door of your organization. Hang up posters and put out brochures with positive messaging related to sexual and reproductive health. This sends the message that your organization is a safe place to talk about sexual and reproductive health needs. Include materials with people of various backgrounds, genders, ages, and sexual orientations to create an environment of acceptance. Display your organization's non-discrimination policies too.
Here are some options for materials to use:
How do I Engage my Client in an RLG Conversation?
The two most frequently used methods for engaging clients in RLG conversations are PATH and One Key Question (OKQ). Both methods were developed to be client-centered and acknowledge that feelings around pregnancy can be complicated.
With OKQ, the provider asks a single question: Would you like to become pregnant in the next year? This question excludes people that can cause a pregnancy or want to have children through other means, and places all responsibility on those that can carry a pregnancy.
Every Body Texas promotes the PATH framework within all its work but because OKQ is quick and easy to learn, it can be appropriate for some settings.
Depending on the client’s responses, the conversation could go in numerous directions. We'll discuss strategies for continuing the conversation below.
It’s likely that you will have clients from diverse cultural and social backgrounds, some of whom may have experienced trauma. Part of client-centered reproductive life goals conversations is considering each client's unique circumstances.
We developed a brief learning module for culturally informed and population specific RLG conversations.
Strategies for Continuing the RLG Conversation
The client’s responses to the initial RLG questions can lead the conversation in multiple directions and will influence what information and resources you’ll share with them.
Most clients will either be preventing pregnancy, considering or trying to get pregnant, not sure, or okay either way. Some clients might not fit into any of those categories, but will have other sexual and reproductive health needs. Depending on what categories they fall into, there are different questions to ask, subjects to talk about, and various services you might refer them to.
If They’re Considering or Trying to Get Pregnant
Continue the conversation by asking, “Would you like to discuss ways to prepare for a healthy pregnancy?”. You can then talk about preconception care, and if needed, provide a referral. You could also give them the following handout: Key Steps for a Healthy Pregnancy, Pasos importantes para un embarazo saludable.
For information and resources about preconception care, look at the Sexual and Reproductive Health 101 page in this toolkit.
If your client has been trying to get pregnant for more than a year, you might consider referring them to a TitleX clinic for basic infertility services. Experiencing infertility can lead to psychological struggle, marital instability, and economic hardship. You could also consider referring your client for mental health services, if they’re interested. Unfortunately, because infertility treatment can be so expensive and isn’t covered by Medicaid, people with low incomes or from marginalized populations are less likely to have access to services.
If your client expresses interest in wanting to build their family through adoption or foster care, share the Adoption/Foster Parent Texas Department of Family and Protective Services website.
If They’re Wanting to Prevent Pregnancy
Continue the conversation by asking, “Do you have a sense of what is important to you about your birth control method?”. That way, you can focus on sharing information about methods that align with their values, and not overwhelm them with all potential options.
Consider pulling up the interactive Bedsider birth control finder with your client as you talk through their options and preferences, and consider sharing Besider BC Benefits for help accessing birth control.
For information and resources about contraception, take a look at the Sexual and Reproductive Health 101 page in this toolkit.
If They Aren’t Sure, or Okay Either Way
After engaging with the PATH questions, a client may be unclear or ok either way about their pregnancy intention. When it’s not clear or distinct where the client’s intention lies, you can take different directions based on what they have shared about their feelings, preferences, and how important it is to them to prevent pregnancy. If it feels appropriate, continue the conversation by asking, “Are you interested in talking about ways to prepare for a healthy pregnancy?”. You can also ask, “Are you interested in talking about birth control options?”. Let the client lead, and always respect that they may not want this information.
Remember, the goal isn’t to have the client decide one way or another, but to discuss their feelings, answer questions, provide appropriate, accurate information, and refer for care as appropriate.
If They are Already Pregnant
You might have clients that disclose an early pregnancy to you as you begin an RLG conversation. This is a good opportunity to discuss their feelings about the pregnancy and connect them with prenatal care and doula services. If they do not want to be pregnant, or are feeling ambivalent about their pregnancy, you may want to talk about their options, whether it’s continuing the pregnancy, adoption, or abortion.
Here are some resources to share with pregnant clients:
If They Could Benefit From General Sexual and Reproductive Health Information and Services
Regardless of their reproductive life goals, all clients can likely benefit from sexual and reproductive health information. Continue the conversation by asking questions like, “Are there any topics in particular you would like to learn more about?”, or “Do you want to learn more about how your reproductive health system works?”.
Take a look at the Sexual and Reproductive Health 101 page of the toolkit for more information and resources about sexual and reproductive health topics including STIs, sexual pleasure, sexuality, gender identity, and the menstrual cycle.
These problematic assumptions often lead to reproductive coercion and stratified reproduction (the fertility of some valued more than others).
Research has shown that these biases influence clinical decision-making, and cause patients to, understandably, mistrust the healthcare system. When healthcare providers were given scenarios of patients asking for permanent contraception, with patient descriptions, they were more willing to provide it to older, poor, postpartum, or Black women. One study with Black and Latina women showed that they often felt pressured to select a specific method during contraceptive counseling, even if it didn’t align with their goals and values. This frequently resulted in choosing that method but quickly discontinuing it.
Unconscious biases can negatively impact RLG conversations. When having an RLG conversation, it’s very important that your feelings have no impact on the conversation. It isn’t your place to have an opinion on what the client’s reproductive life goals should be. This often comes up when having RLG conversations with adolescents. You might believe that an adolescent should be trying to prevent pregnancy, but your role isn’t to encourage contraception, it’s to respect their reproductive autonomy and support their personal reproductive life goals.
Having unconscious biases doesn’t make you a bad person, but it does need to be addressed. While there are no evidence-based ways to eliminate unconscious biases, we can learn to identify our own biases and prevent them from influencing how we interact with our clients.
These quizzes are a great tool to help identify your own unconscious biases.
Organizations can work to reduce the impact of unconscious bias by:
Creating a safe learning environment
Encouraging staff to examine their biases regularly
Using a standardized process for RLG conversations (like PATH)
Normalizing bias while emphasizing that it must be addressed
Practicing RLG conversations using role plays and a structured debrief with opportunities for redos
Discussing what to do if a client perceives bias and reacts negatively to a standard RLG question. This involves acknowledging their lived experience, apologizing, and explaining more about RLGs in order to restore trust
The content on this page was written and reviewed in June 2023.