Stakeholder perspectives in New York State on reproductive health and pregnancy intention screening in primary care: A qualitative study

Objective: To assess New York State stakeholders' perspectives regarding providing reproductive health services in primary care settings, including asking patients about pregnancy intentions and providing long-acting reversible contraception (LARC).

Study design: We conducted semistructured key-informant interviews (n = 22) with stakeholders representing diverse sectors, including primary care (family medicine) and specialty (obstetrician/gynecologist) physicians, health educators/promoters, advocates, and public health/health care professionals. Grounded theory methodology informed sampling and thematic analysis within and across sectors.

Results: Key informants across sectors supported integrating reproductive health services into primary care. Pregnancy intention screening was considered appropriate yet required improved measures. Such screening was viewed as fostering childbearing discussions and counseling for contraception/preconception health that could benefit patients while also requiring attention to concerns from the patient (e.g., potential for coercion, access barriers) and health care systems (e.g., buy-in, training) contexts. Three themes related to LARC included provider bias, knowledge and training, counseling and patient education, and logistics/financial situation, which were differentially emphasized by stakeholder sector; providers expressed greater concern regarding training, bias, and logistical considerations, whereas health educators and advocates focused on patient education and autonomous decision-making. Similarly, awareness of reproductive justice principles varied by sector.

Conclusion: There is consensus among informants from the 5 sectors for expanding reproductive health services in primary care. This will require reproductive health-related training for providers, organizational buy-in, and system protocol changes, including unbiased contraceptive counseling of all methods, specifically balancing discussion of LARC effectiveness with information regarding side effects. Incorporating reproductive justice principles may increase informed patient decision-making and reproductive autonomy.

Implications: Expanding reproductive health services in primary care requires provider training and protocols for patient-centered care, including unbiased provision of all contraceptive options. The reproductive justice framework offers the possibility of addressing diverse stakeholders' concerns for both preconception and contraceptive care with patient decision-making at the forefront.