Public Health Family Planning Program and Strategy

Family Planning

Annually 6.1 million pregnancies are recorded in the US and about 45% are reported as unplanned or untimed according to Healthy People 2020, a national program managed by the Office of Disease Prevention and Health Promotion. Healthy People 2020 sets national goals that, when met, advance the health of all in the United States. Health problems facing the nation range from chronic kidney disease to healthcare access and goals are created to eliminate these problem so people can live healthy full lives.

Unintended pregnancies are a health problem and fall under the topic of family planning. The goal of family planning is to stop unintended pregnancies, enable individuals to better plan when they want to become pregnant and plan for adequate spacing between pregnancies (Healthy People 2020, 2019). When family planning services are absent the rate of pregnancies increase, especially among those below the poverty line; and the impact is generally negative (Sonfield, Hasstedt & Gold, 2014). Healthy People 2020 objectives list for family planning are outlined in detail. Caregivers can freely access this information and incorporate it into their care plans. Nurses are the main educators in clinical settings so their participation in and inclusion of Healthy People 2020 objectives into their care plans are vital (Kelsey, 2017). Including family planning into care plans will contribute to meeting Healthy People 2020 objectives and contribute to healthier more financially stable communities across the nation.

Literature Review

Family planning is a comprehensive health program and is listed as one of the top achievements in Public Health (Achievements in Public Health, 1900-1999: Family Planning, 1999). Its intention is health promotion by means of access to education, community resources and medical services to effectively prevent unintended pregnancies (From the World Health Organization, 2018). Prevention is an intrinsic theme in family planning. In order to preclude unplanned pregnancies family planning services enables individuals to plan their preferred family size and have adequate spacing between births (Healthy People 2020, 2019). Family planning services empowers individuals to have more control of their reproductive health, reinforces their right to purposefully plan family size and provides a variety of contraceptive methods for women and men to achieve that goal (From the World Health Organization, 2018).

Family planning offers contraceptive services which include various types of birth control: barriers such as male and female condoms, hormonal treatment in the form of a daily pill, and periodic injections or implantable devices. In addition to contraception services: pregnancy, infertility, sexually transmitted infections and HIV testing and counseling; breast and cervical screening and examinations are offered as well. Overall physical and sexual health are vital parts of this programs health promotion. Preventing unintended pregnancies is the crux of family planning but clearly it is not the sole purpose of what the program sets out to accomplish.

Publicly funded contraceptive services played a major role in averting almost 2 million unintended pregnancies, according to a 2015 report from the Guttmacher Institute (Frost, Frohwirth, Blades, Zolna, Douglas-Hall & Bearak, 2017). Although progress is evident, unintended pregnancies still happen. Finer & Zolna (2016) compiled a list and groups highest in unintended pregnancies were among women who were under 25 years of age, low income, no high school diploma and women of color, specifically who identified as AA and Hispanic. A multitude of factors may be inhibiting these groups or others from accessing contraceptive services such as: affordability, no insurance, travel distance, inapt services for youth or the individual not knowing services exist (Healthy People 2020, 2019). The consequences of not having access to family planning services are, unfortunately, negative for those identified as high risk. Health and economic impacts of unintended pregnancies increase a mother’s chance of experiencing postpartum depression, infants have higher rates of birth defects, low birth weight, low mental health and often have behavioural issues and teen mothers typically earn less and rely on federal aid for longer periods (Healthy People 2020, 2019).

The importance of family planning services cannot be overstated. As the program becomes more accessible and effective at preventing unintentional pregnancies it will help improve mother, infant and family health outcomes while helping to build stronger communities through education and support.

Current Nursing Interventions

Daniels, Daugherty & Jones (2014) demonstrated in their survey a growing utilization of family planning services and provided data showing almost 62% of the female population aged 15-44 were employing a type of contraceptive method when engaging in sexual activity. Because not all contraception is a barrier method that requires education and typically not specifically education from a health professional, it’s plausible the remaining birth control methods do and from licensed medical professionals like a pharmacists, doctors, and nurses since these methods also require prescriptions.

Kelsey (2017) acknowledges that in clinical settings, it is the nurse who is responsible for educating the patient on how to use the most effective method. And before settling on a specific method the nurse takes into account pertinent information collected in the patients assessment (King, 1992). Furthermore since the method is derived and specific to each patient it is the responsibility of the nurse to deliver the education therefore it cannot be delegated (Taylor et al, 2015). It is also an opportunity for the nurse to factually recenter the patient or set the record straight and offer factual information pertaining to her chosen method of birth control (King, 1992). Nurses set the tone for most patients adherence to nursing care plans. Dehlendorf et. al. emphasized how patients who felt listened to, not rushed and respected had better outcomes adhering to the prescribed method of birth control than those who were not spoken to respectfully. A negative encounter inhibits effectiveness of the goal of family planning.

Nursing Care Plan

Scenario

Roman Martel is a 31 year old female in clinic with her husband Julien for her 6 week postpartum check-up. Blood Pressure 98/64, pulse 66, weight 145 lbs and respirations within normal range.They are first time parents adjusting well to having a new baby. Baby present at visit and breastfed most of the visit. They plan on having another child but for now would like information on contraceptive methods that are available. Roman admits to taking an oral birth control pill but stated “I hate the pill and always forget to take it anyway”. She says she would like a birth control that is not in pill form, not taken on a daily basis and has little to no maintenance because she states “when I forget to take my pill I get anxiety, so I want a birth control that I don’t have to think about everyday”. She has a history of migraines so would like a contraceptive that does not aggravate or induce migraines. She has requested information on short term and long term birth control and said specifically “I am not a fan of inserting anything vaginally”.

Assessment

Subjective

Martel expresses a dislike of taking an oral contraceptives by stating “I hate the pill and always forget to take it anyway.” She admits to wanting an easier birth control method by stating “when I forget to take my pill I get anxiety, so I want a birth control that I don’t have to think about everyday”.

History of Migraines

Does not want any contraceptive that she has to manage by stating “I am not a fan of inserting anything vaginally”.

Objective

• Blood Pressure 98/64
• Pulse 66
• Weight back to prepregnancy weight of 145 lbs
• No redness, pain and warmth in either breast
• Baby latches well to breastfeed and is gaining weight

Diagnosis

• Ineffective therapeutic regimen management related to missed birth control pill doses as evidence by patient stating “I hate the pill and always forget to take it anyway.”
• Deficient knowledge related to lack of information about current birth control methods available as evidence by patient stating she’s only looked up information about pills and condoms.
• Readiness for enhanced knowledge related to choosing a new contraceptive method as evidence by patient requesting information printouts about various contraceptive methods.

Planning Goals

• Roman will verbalize understanding between non oral long and short term birth control today (3/20/19).
• Roman will choose an IUD, injection or implant as a method for birth control (3/20/19).
• Roman will receive an injection today or schedule a future appointment today to have the implant or IUD placed (3-25-19).
• Implementation (3 I for each goal = 9 total)
• Nurse will provide a list of options for female non oral contraception and how they prevent pregnancies (Ricci, Kyle, & Carmen 2017).
• Address patient and husband equally to engage both to make a decision on birth control method together (Ricci, Kyle, & Carmen 2017).
• Nurse will provide written information that supports what is said during the teaching of non oral contraceptives available (Ricci, Kyle, & Carmen 2017).
• Nurse will compare the effectiveness of preventing pregnancies when using an IUD, an implant or an injection (Ricci, Kyle, & Carmen 2017).
• Nurse will review dietary needs for having an IUD, if getting an injection and getting an implant (Ricci, Kyle, & Carmen 2017).
• Patient will demonstrate understanding of any contraindications and side effects by stating which method will not put her at risk of inducing a migraine (Ricci, Kyle, & Carmen 2017).
• Nurse will discuss when to schedule maintenance for an IUD and when to schedule appointments for injections and placing implant to maintain therapeutic effectiveness (Ricci, Kyle, & Carmen 2017).
• Patient will fill out informed consent forms as per facilities protocols for procedures and drug therapies (Ricci, Kyle, & Carmen 2017).
• Patient will confirm appointment for injection, IUD or implant.
• Evaluation (eval for each goal = 3)
• Goal met on 3/20/19, Roman verbalized the differences between an IUD, injection and implant as no oral methods of birth control.
• Goal met on 3/20/19, Roman chose Depo Provera as a preferred short term method of birth control over the other options.
• Goal met on 3-20-19, Roman will receive her first Depo Provera injection today and make a future appointment for her next injection.

Healthy People 2020 and Nursing Implications

What and individual nurse does impacts the nation’s health the same way a person impacts their environment when they compost food scraps. Alone small compostable green bags may not seem like much but when a whole city participates the end result is a mountain of fertile usable compost. The same goes for that individual nurse who is not alone in health promoting patient care. Healthy People 2020 is an extreme version of a nursing care plan because it’s on a national level.

Nurses who work in clinics are able to capture women and properly educate them on contraceptive options. Every opportunity matters so good interpersonal communication can make or break a patient’s confidence and willingness to follow a health plan (Dehlendorf, Krajewski & Borrero, 2014). The nurse in the scenario gained the trust and respect of the patient and was then able to educate the patient in a way that would be best for her, lots of readings for her to take home to maul over and come to a decision in a timely manner. The nurse was effective at forwarding the FP-16.1 objective which has a goal to get women to start or continue using a birth control method that works (Healthy People 2020, 2018). The nurse is directly involved in a nationwide effort to meet that accomplish that objective on patient at a time. And Since this is on the national scale the work of one adds to the work of many and the progress is tangible.

Conclusion

Every ten years national health objectives will be added to Healthy People 2020 and will likely always remain on the list. With the cost of healthcare rising, access always being an issue and women's health still a benefit that’s not seen as important as it should be, the percentage of unintended pregnancies will still exist. But that percentage may not be the almost 50% in the future. Already the rates of unintended pregnancies have decreased but it’s still on the professional healthcare providers and especially the nurses to not become lax in their efforts to continually work to decrease percent of unintended births until it reaches single digits.