Welcome to the Toolkit

The Quality Family Planning Recommendations (QFP), developed collaboratively by the Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs (OPA), outlines 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 (STD) services. The goal of the QFP is to support agencies 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 QFP also provides guidance about how to support the health of women and men who choose not to have children.

This toolkit offers suggested action steps, tools, and other resources to support staff at Title X-funded agencies to implement the QFP recommendations. Explore the QFP Training Topics for additional training and resources about these recommendations.

 

Illustration of a couple meeting with a doctor in an office.

The resources in this toolkit can be used in any order, depending on needs and priorities. The trainings and materials are organized in the following categories, aligned with QFP:

  • Determining the Client’s Need for Services
  • Discussing Reproductive Goals
  • Pregnancy Testing and Counseling
  • Contraceptive Counseling and Education
  • Support for Achieving Pregnancy
  • Basic Infertility Services
  • Preconception Health Services
  • STD Services

 

Family planning clients may need a range of services, in addition to their stated reasons for a visit. For clients seeking to prevent or achieve pregnancy, providers should assess whether they need other related services and offer them. When clients visit a provider for a reason not related to preventing or achieving pregnancy, the provider 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 and address those needs.

Action Steps Supportive Resources

Assess the client’s primary reason for the visit and address it to the extent possible.

Putting the QFP into Practice Series: How to Begin—Determining the Client’s Need for Services Webinar

Clinical Pathway for Family Planning Services Chart

If the client’s primary reason for the visit is not related to preventing or achieving pregnancy, assess the need for family planning, preconception health, STD and other related services based on the client’s age and sex. Provide these services as appropriate.

Family Planning and Related Preventive Health Services Checklists for Women and Men

If the client’s primary reason for the visit is related to preventing or achieving pregnancy, assess the need for other related health services. Provide services or refer the client as appropriate.

 

Discussing reproductive goals with all clients can help guide the provision of their care. For clients whose initial reason for seeking services is not related to preventing or achieving pregnancy, asking questions about their reproductive goals may help identify unmet reproductive health care needs. Asking the question, “Do you think you would like to have (more) children someday?” can start a conversation about options for preventing or achieving pregnancy.

Action Steps Supportive Resources

Ask about the client’s attitudes toward becoming a parent, the desired timing of pregnancy (if applicable), and the importance of pregnancy prevention.

Client-Centered Reproductive Goals & Counseling Flow Chart

Use open-ended questions to explore the client’s reproductive goals and need for preconception care, contraception, and/or fertility services.

Efficient Questions for Client-Centered Contraceptive Counseling Palm Card

Adjust staff roles and workflow to ensure that discussion of the client’s reproductive goals is routinely integrated, regardless of the initial reason for the visit.

 

Putting the QFP into Practice Series: Integrating Reproductive Life Planning into Your Family Planning Session Webinar

Pregnancy testing is a common reason for clients to visit family planning service providers. Family planning providers should offer pregnancy testing and counseling as part of core family planning services, in accordance with the recommendations of professional medical associations, such as the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP).

Action Steps Supportive Resources

Ask about the client’s attitudes toward becoming a parent and use open-ended questions to explore the client’s reproductive goals.

Client-Centered Reproductive Goals & Counseling Flow Chart

In response to a positive pregnancy test, describe the options available to the client.

UPDATE: Per the 2019 Title X Regulations, non-directive pregnancy options counseling is permitted but not required. Referral for abortion as a method of family planning is prohibited. However, referral for abortion is permitted in cases of medical emergency, rape, or incest.

Putting the QFP into Practice Series: Pregnancy Testing and Counseling eLearning

Exploring All Options: Pregnancy Counseling Without Bias Video

Adoption as an Option in Family Planning Settings Webinar

In response to a negative pregnancy test, explore the client’s reproductive goals and unmet reproductive health care needs related to contraception, STD services, preconception care, and/or fertility services.

 

Efficient Questions for Client-Centered Contraceptive Counseling Palm Card

Family planning services include providing contraception to clients who want to prevent pregnancy or space births. If the client wants to prevent pregnancy, the provider should counsel according to the QFP recommendations for quality counseling. A shared decision-making approach to contraceptive counseling allows clients and their providers to make health care decisions together that take into account the best scientific evidence, as well as clients’ values and preferences. The goal is to support clients, so that they can make informed and appropriate decisions for themselves.

Action Steps Supportive Resources

Provide client-centered contraceptive counseling to help the client identify contraceptive methods that align with overall preferences.

Quality Contraceptive Counseling and Education: A Client-Centered Conversation eLearning

Discuss birth control methods based on the client’s preferences and answer all related questions.

Birth Control Methods Options Chart

Provide the contraceptive method 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.

 

Explaining Contraception for Healthcare Providers eLearning

Clients who are not pregnant but are trying to be should be offered services to help achieve pregnancy or basic infertility services, as appropriate. Providers should advise clients who want to become pregnant in accordance with the recommendations of professional medical organizations, such as the American Society for Reproductive Medicine (ASRM).

Action Steps Supportive Resources

Counsel the client about how to maximize the ability to achieve a healthy pregnancy.

Putting the QFP into Practice Series: Achieving Pregnancy: Assessment, Counseling and Education Webinar

Determine if the client or couple also needs basic infertility, preconception care, STD services, and/or other resources.

 

Providers should offer basic infertility care in accordance with the recommendations of professional medical organizations, such as ACOG, ASRM, and the American Urological Association (AUA).

Action Steps Supportive Resources

Assess the client’s need for basic infertility services and develop a plan of care as needed.

Basic Infertility Protocol Job Aid

Counsel the client about ways to maximize natural fertility.

 

Family planning providers should offer preconception health services to all clients to improve pregnancy and birth outcomes as well as the client’s overall health. Preconception care is a set of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management. Preconception care 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.

Action Steps Supportive Resources

Identify the client’s need for preconception health services by:

  • Assessing reproductive goals
  • Taking a medical history
  • Conducting a sexual health assessment

Family Planning and Related Preventive Health Services Checklists for Women and Men

Client-Centered Reproductive Goals & Counseling Flow Chart

Sexual Health Assessment Job Aid

Provide screening services, health promotion recommendations, and referrals as needed, related to:

  • Intimate partner violence
  • Alcohol and other drug use
  • Tobacco use
  • Immunizations
  • Depression
  • Folic acid
  • Health, weight, and body mass index
  • Blood pressure
  • Diabetes

 

Preconception Counseling Checklist

Family planning services include providing STD testing and treatment to prevent tubal infertility and improve the health of women, men, and infants. STD services should be provided in accordance with CDC’s STD Treatment Guidelines and U.S. Selected Practice Recommendations for Contraceptive Use.

Action Steps Supportive Resources

Discuss the client’s practices, pregnancy prevention, partners, past STD history, and protection from STDs.

Sexual Health Assessment Job Aid

Provide STD screening and treatment in accordance with CDC recommendations.

Sexually Transmitted Diseases (STD) Treatment Guidelines, 2015

Provide client-centered STD prevention education and counseling.

Putting the QFP into Practice Series: STD Services in the Family Planning Setting Webinar