Maternal Health

Despite being one of the wealthiest countries in the world, the United States has one of the highest maternal mortality rates, especially among Black women. These disparities are rooted in systemic racism, social determinants of health, and implicit bias in the healthcare system.

Reproductive Life Plans

Reproductive life plans are personal roadmaps that outline people’s reproductive goals. RLPs focus on decisions about whether they want to become parents and, if they do, how many children they would like to have and when. The plans should also contain strategies to achieve these desired family outcomes, which may include the use of contraceptives or incorporating counseling and care resources to optimize health before pregnancy to improve birth outcomes. 

Importance and Benefits of a Reproductive Life Plan

The world we live in is different from the one our mothers and grandmothers grew up in. Today, many young women are encouraged to focus on their education and careers. Because of this and other factors, people now tend to have children later in life compared to generations before. However, while the timeline of starting a family has shifted to a later period, biology has not changed to accommodate this lifestyle choice. Kimberly D. Gregory, MD, MPH, writing for the American College of Obstetricians and Gynecologists, explains that a person’s ability to get pregnant peaks between the ages of 18 and 25. From there, fertility declines, especially once women reach their mid-30s. A pregnant person who is 35 years or older is considered to be at advanced maternal age, which means healthcare providers would categorize that pregnancy as high-risk. As a person gets older, the risk of developing health complications for both themselves and their fetus gradually increases. As a result, by the time some people are ready to start a family, they might face fertility challenges and other age-related health problems.

Pregnancy can be demanding on the body, especially for people at advanced maternal age. A reproductive life plan can be a helpful resource that empowers individuals at any age to make informed decisions about their reproductive health and future. The University of Wisconsin Population Health Institute’s County Health Ranking & Roadmaps shares that the expected benefits of a reproductive life plan include:

• Increased preconception planning
• Improved reproductive health
• Improved birth outcomes
• Increased use of contraceptives
• Improved health-related knowledge
• Increased healthy behaviors

Building a Reproductive Life Plan

A reproductive life plan revolves around personal values, relationships, and financial or emotional readiness. According to sources such as Wiley’s Online Library, a good plan should be flexible and consider the following topics:

• Self-Reflection and Goal Setting 
  • What are your overall life goals, career aspirations, and financial plans?
  • Do you want to have a child? If so, when, how many, and how far apart?
  • If you are planning on getting pregnant soon, do you have a support system in place, and do you feel that you are ready to start your pregnancy journey?

• Partner and Relationship Planning 

• • If you have a partner, have you discussed having a child with them?
  • Is your relationship strong enough to support a child and provide a healthy environment for them?

• Financial and Emotional Preparation

• • Have you considered the financial and emotional cost that comes with raising a child?
  • Do you have the capacity to take on the challenges that having a child may bring?

• Family History 

• • Do you or your partner have any family history of illnesses or birth defects that you should discuss with your health care provider before conception?

• Contraception

• • If you are not interested in having children, have you researched or discussed with your healthcare provider which forms of contraception best suit your lifestyle and needs?
  • If you want children but not right away, do you have a plan in place to prevent pregnancy until you are ready?

• Health 

• • Have you been focusing on maintaining a healthy lifestyle, including a balanced diet, exercise, and reducing excessive alcohol consumption?
  • If you plan to have children, do you have any existing health problems or take any medications that could affect you or your fetus while you are pregnant and beyond?

Examples of Reproductive Life Plans

• Reproductive Life Plan, from the Women's Health & Family Planning Center at Columbus Public Health
• Goals for a Healthier me and baby-to-be!, from the National Center on Birth Defects and Developmental Disabilities of the Centers for Disease Control and Prevention
• Preconception Health and Health Care: My Reproductive Life Plan, from the U.S. Department of Health and Human Services
• My Reproductive Life Plan, from Toronto Public Health
• Set Your Mind. Set Your Goals, from Delaware Health and Social Services

References

Gregory, K. D. (2023). “Reproductive Life Planning: A Tool to Shape Your Future.”  American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/experts-and-stories/the-latest/reproductive-life-planning-a-tool-to-shape-your-future

University of Wisconsin Population Health Institute. “Reproductive life plans.” County Health Rankings & Roadmaps. https://www.countyhealthrankings.org/strategies-and-solutions/what-works-for-health/strategies/reproductive-life-plans

Wiley Online Library (2023). “Planning Your Family: Developing a Reproductive Life Plan.” Journal of Midwifery & Women's Health, 68(6), 797-798. https://doi.org/10.1111/jmwh.13592.

Preconception health refers to the health of individuals before becoming pregnant. According to the Boston Public Health Commission, promoting women's health before, during, and after childbirth may reduce adverse pregnancy-related outcomes.

Preconception counseling is health education that provides risk assessment, intervention, and medical care before pregnancy to help reduce the risk of unfavorable obstetric, maternal, and fetal outcomes

Pregnancy is the period during which a fetus develops inside the womb. Measured from the last menstrual period to delivery, pregnancy usually lasts about 40 weeks, or just over 9 months. However, this is not always the case. Some pregnancies may be unexpectedly shorter or last longer. The length of pregnancy can depend on various factors, including an individual's health, family history, and environment.

Prenatal nutrition, also known as maternal nutrition, focuses on nutrient recommendations before and during pregnancy to help inform parents-to-be about the foods that are beneficial for fetal development. During pregnancy, the body experiences several physiological changes that can impact long-term health and well-being, such as changes in the cardiovascular, endocrine, nervous, and digestive systems. As a result, healthcare professionals and academics have increasingly highlighted the close relationship between nutrition and pregnancy.

Heat waves are becoming more frequent in major U.S. cities according to the Environmental Protection Agency, from an average of 2 heat waves per year in the 1960s to 6 heat waves per year in the 2010s and 2020s. Extreme heat can be a risk factor for many, especially pregnant individuals.

Postpartum, also known as postnatal, is the time after childbirth when the body returns to its pre-pregnancy state. Although this period typically lasts for six to eight weeks, some physical and emotional changes after giving birth can last for much longer.