Women's Perspectives on Reproductive Health Services in Primary Care.

Abstract

Primary care providers (PCPs) are increasingly offering reproductive health (RH) services to help address patients' unmet contraceptive needs and improve pregnancy outcomes. We sought to understand patient perspectives on receipt of RH services in primary care settings. We used a purposeful stratified sampling approach to recruit women aged 21 to 40 years into focus groups (FGs) and in-depth interviews (IDIs). We held all four FGs in two New York City neighborhoods and all 18 IDIs in two upstate NY suburban/rural neighborhoods (each with half of the neighborhoods above and below the median county income in each setting type). We explored participants' preferences for RH services from PCPs, including their feelings about being asked about pregnancy intentions. We also asked their opinions on three distinct pregnancy intention screening and reproductive health needs assessment questions. Data analysis involved an iterative process of excerpt coding and interpretive analysis to identify key themes. We conducted four FGs and 18 IDIs with a total of 39 women. Participants were receptive to the availability of RH services in primary care and the benefits to streamlining this care, provided clinicians approach these services in a manner that respects patient autonomy and reproductive desires. They discussed a lack of preconception care counseling and concerns about primary care providers' training and/or comfort with RH, as well as time spent with patients. Participants had the most positive response to the proposed question "Can I help you with any reproductive health services today, such as birth control or planning for a healthy pregnancy?" based on its open-endedness, inclusiveness, and promotion of reproductive autonomy. The findings of this study support the continued expansion of RH services in primary care settings. Future research should test the preferred RH service needs question to understand how it may affect service delivery, patient satisfaction, reproductive autonomy, as well as unmet contraceptive need and indicators of maternal and child health.