Maternal and Child Health Journal

, Volume 23, Issue 1, pp 47–53 | Cite as

Examining Temporal Trends in Documentation of Pregnancy Intentions in Family Planning Health Centers Using Electronic Health Records

  • Hannah R. SimonsEmail author
  • Julia E. Kohn


Objectives Few studies have examined the extent to which providers assess pregnancy intentions during clinical encounters. Our objective was to assess temporal trends in documentation of patient pregnancy intentions in electronic health records (EHR). Methods In this retrospective observational study using EHR data from 627,399 female patients visiting 214 family planning centers in 2012–2014, we assessed changes in the prevalence of pregnancy intention documentation with piecewise log-binomial regression models. We examined bivariate associations between patient/visit characteristics and pregnancy intention documentation in each year, and associations between patients’ pregnancy intentions and contraceptive methods. Results The proportion of patients with a documented pregnancy intention increased sharply from the end of 2012 (42%) to the midpoint of 2013 (85%; adjusted quarterly prevalence ratio [APR] = 1.40, 95% CI 1.36–1.45). Thereafter, the rate of change slowed as documentation approached the maximum possible frequency (93%; APR = 1.01, 95% CI 1.00–1.02). Documentation varied by all patient/visit characteristics in 2012 and 2013; in 2014, there were no clinically significant differences. Among patients with a documented intention, 97% were not planning a pregnancy in the next year. Women not planning a pregnancy were more likely to use a most/moderately effective contraceptive method than those planning a pregnancy (73 vs. 35%, p < 0.0001). Conclusions for Practice Improvements in pregnancy intention documentation co-occurred with changes to EHR templates (e.g., placement of structured data fields) and with provider-focused initiatives promoting reproductive life planning. Patients’ pregnancy intentions aligned with contraceptive use; however, these findings cannot address whether assessment of intentions affects contraceptive use.


Pregnancy intentions Reproductive life plan Family planning Title X Electronic health records 



The authors would like to thank Amandi Clarke and Stephanie Küng for their assistance with the literature review; Kellan Smith and Erin Barringer-Sterner for their assistance in identifying EHR data fields and extracting the data and Susanne Mauney for additional consultation; and Zoe Unger and Monika Grzeniewski for their review of the manuscript.


The research received no external funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest to disclose.


  1. Bellanca, H. K., & Hunter, M. S. (2013). ONE KEY QUESTION®: Preventive reproductive health is part of high quality primary care. Contraception, 88(1), 3–6. Scholar
  2. Bommaraju, A., Malat, J., & Mooney, J. L. (2015). Reproductive life plan counseling and effective contraceptive use among urban women utilizing Title X services. Women’s Health Issues, 25(3), 209–215. Scholar
  3. Brückner, H., Martin, A., & Bearman, P. S. (2004). Ambivalence and pregnancy: Adolescents’ attitudes, contraceptive use and pregnancy. Perspectives on Sexual and Reproductive Health, 36(06), 248–257. Scholar
  4. Callegari, L. S., et al. (2017). Addressing potential pitfalls of reproductive life planning with patient-centered counseling. American Journal of Obstetrics & Gynecology, 216(2), 129–134. Scholar
  5. Centers for Disease Control and Prevention. (2010). Preconception health and health care: Reproductive life plan tool for health professionals. Retrieved from
  6. Centers for Disease Control and Prevention. (2015). Effectiveness of family planning methods. Retrieved from
  7. Clark, M. (2014). Reproductive life plan: Creating healthy families in Ohio. Contraception, 90(2), 198–199. Scholar
  8. Datamark Inc. (2013). Unstructured data in electronic health records: Challenges and solutions. White paper. Retrieved from
  9. Finer, L. B., & Zolna, M. R. (2016). Declines in unintended pregnancy in the United States, 2008–2011. New England Journal of Medicine, 374(9), 843–852. Scholar
  10. Gavin, L., et al. (2014). Providing quality family planning services: Recommendations of the CDC and the U.S. Office of Population Affairs. MMWR Recommendations and Reports, 63(RR04), 1–29.Google Scholar
  11. Higgins, J. A., Popkin, R. A., & Santelli, J. S. (2012). Pregnancy ambivalence and contraceptive use among young adults in the United States. Perspectives on Sexual and Reproductive Health, 44(4), 236–243. Scholar
  12. Kontopantelis, E., Doran, T., Springate, D. A., Buchan, I., & Reeves, D. (2015). Regression based quasi-experimental approach when randomization is not an option: Interrupted time series data. BMJ, 350, h2750. Scholar
  13. Lu, M. (2007). Recommendations for preconception care. American Family Physician, 76 (3), 397–400.Google Scholar
  14. McQuillan, J., Greill, A. L., & Shreffer, K. M. (2011). Pregnancy intentions among women who do not try: Focusing on women who are okay either way. Maternal Child Health Journal, 15(2), 178–187.CrossRefGoogle Scholar
  15. Robbins, C. L., Gavin, L., Carter, M. W., & Mokosky, S. B. (2017). The link between reproductive life plan assessment and provision of preconception care at publicly funded health centers. Perspectives on Sexual and Reproductive Health, 49(3), 167–172. Scholar
  16. Santelli, J., Rochat, R., Hatfield-Timajchy, K., et al. (2003). The measurement and meaning of unintended pregnancy. Perspectives on Sexual and Reproductive Health, 35(2), 94–101. Scholar
  17. Schwarz, E. B., Lohr, P. A., Gold, M. A., & Gerbert, B. (2007). Prevalence and correlates of ambivalence towards pregnancy among nonpregnant women. Contraception, 75(4), 305–310. Scholar
  18. Taljaard, M., Mckenzie, J. E., Ramsay, C. R., & Grimshaw, J. M. (2014). The use of segmented regression in analysing interrupted time series studies: An example in pre-hospital ambulance care. Implementation Science, 9(1), 77. Scholar
  19. Trussell, J. (2011). Contraceptive failure in the United States. Contraception, 83(5), 397–404. Scholar
  20. U.S. Department of Health and Human Services. (2016). Title X family planning program priorities. Retrieved from

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Research & Clinical Quality Improvement DepartmentPlanned Parenthood Federation of AmericaNew YorkUSA

Personalised recommendations