In Reply:

We appreciate Dr. Callegari et al’s letter in response to our recent commentary “Reproductive life planning: Raising the questions”. We are encouraged to see that the thought leaders in the field of patient-centered approaches to women’s reproductive health are, as we hoped, “raising the questions” about the role of reproductive life planning.

Although we agree that a planning paradigm may not fully embrace the breadth of women’s lives and fertility behaviors, we would still reiterate the importance of some marker of time within a counseling tool. As you articulately describe (Aiken et al. 2016), the primary concern around a pregnancy is not its timing but a woman’s emotional response to it. However, for many women, that response is in part dependent on when the pregnancy occurs. Reactions to a pregnancy tomorrow (“Yikes, we just met!”) may be different than six months from now (“That would be cool. We might be living together by then”) or a year from now (“Gulp… I’ll be graduating then”). Perhaps the concept of reproductive goals, as you suggest, can encompass the flexibility of forward thinking without the rigidity of a predetermined plan.

We encourage ongoing questioning from our community of health care providers and advocates—as well as from women- about how we can develop truly patient-centered reproductive health assessment and counseling tools that prioritize women’s preferences (or goals?) within the full context of their lives. We recognize the power of semantics and again reiterate the need for ongoing research to more firmly establish the most empowering way to guide these crucial conversations.