Understanding - What does the term “family planning” mean to you?
When interview respondents were asked what they understood by the term family planning, by far the most common responses were that family planning meant contraception or pregnancy prevention.
“Trying not have children”. MP5 - Male, Age 38, White, GCSEs, has two children, does not want more.
“Family planning is just making sure you have knowledge about contraception really” MP7 - Male, Age 35, Chinese, Degree qualification, has no child, would like in future.
“It is an umbrella term for the use of contraception methods.” MP10 - Male, Age 33, White, GCSEs, has no child, unsure about having children.
“It’s obviously when you’re trying to plan so that you don’t end up having a baby that you don’t want to.” FP5 - Female, Age 30, Asian, A levels, has one child, would like more.
“Family planning means using contraception.” HCP4- Consultant, Male, Age 45, has three children, does not want more.
Interestingly, the majority of interviewees did not overthink this question. The view that the family planning terminology is used within the context of pregnancy prevention was simply an automatic response. However, some respondents were cognisant of the fact that together, the two words,’ family’ and ‘planning’, should mean planning a family which could include having children.
“For me family planning, I would think of it as trying to talk people out of having children before they’re ready and able to support them and bring them up in a stable and secure environment. Family planning for me almost exclusively has a negative connotation, and I don’t mean negative as in it shouldn’t happen. I mean negative as in it should be trying to help people plan properly for a family rather than prevention therefore holding them back rather than encouraging them to have a family.” MP9 - Male, Age 43, White, Degree qualification, has three children, does not want more.
For some respondents, the scope of the terminology goes beyond contraception and pregnancy prevention; it also covers preventing sexually transmitted infections, usage of screening services, abortion clinics and including other topics relating to sexual and reproductive health within clinical settings. Female respondents were more likely to consider the terminology in the context of women’s health generally.
“So, family planning I think of women’s health, I think of screening, I think of contraception information and so it can be ranging from giving out the condom to young people to testing for STDs to kind of a place to go from the whole like it’s your health issue.” FP11 - Female, Age 21, Black, Degree qualification, has no child, would like in future.
“I think of, like, doctors’ surgeries and that kind of thing, like, doctors asking that kind of question, like how you’re managing your fertility, in quite a medical sense rather than a more casual sense. I usually think contraception though.” FP12 - Female, Age 21, White, Degree qualification, has no child, unsure about having children in future.
“I think of family planning clinic. Offering contraception, sexually transmitted disease advice things like that.” HCP3, Consultant, White, no child, did not meet partner until later in life.
Why does contraception or pregnancy prevention come to your mind when thinking about the term family planning?
Following on from the responses on what family planning meant, we probed further to understand the reason why family planning was viewed almost exclusively in terms of contraception. Most respondents were unable to clarify the reason why family planning was viewed in the context of pregnancy prevention but there were some suggestions, especially amongst healthcare professionals, that it is related to the use of the term within clinical contexts. Another key theme which emerged as a reason for this connection was the focus of sexual and reproductive health school education being primarily on pregnancy prevention.
One of the key reasons provided for viewing family planning in terms of pregnancy prevention is the way it is used in clinical settings. For example, ‘family planning clinics’ are healthcare centres where patients would go to receive contraceptive services. These include clinics where patients are provided with condoms, placed on the pill, have contraceptive devices fitted or where abortion services are provided.
“Contraception that’s the first thing that comes to mind. I have [a] medical background. I think always in terms of medicine that you know Family Planning Clinic is where people go to get their contraception or to have coils changed or to be started on the pill, after their pill maintenance, you know, having their blood pressure checked and for prescriptions.” HCP1 - Doctor, Female, Age 33, has two children, does not want more.
“I think of a Family planning clinic. Offering contraception, sexually transmitted disease advice things like that. Americans have Planned Parenthood, which I get the impression is the same kind of thing. It’s just the general culture of talk about family planning is that it’s about [pregnancy] prevention” HCP3 - General Practitioner, Female, Age 45, has no child, would like in future.
There were also ubiquitous themes regarding school education and the focus on pregnancy prevention, when family planning discussions came up as part of sexual and reproductive health education.
“I remember at school it was all about not having a baby - there was nothing on planning for the future. I know you don’t want to have teenage pregnancies but when it comes to wanting to have a baby, I think it gives you a false understanding of how easy it is to have a baby because for some people it really isn’t. So, it’s really about understanding whole fertility and contraception at an earlier stage I think”. FP2 - Female, Age 32, White, Degree qualification, has one child, would like more.
“We didn’t learn a lot on fertility as a whole. It was based on the fear factor. We were told not to get pregnant, not to have sex. Basically, avoid pregnancy at all costs.” HCP2 - Nurse, Female, Age 30, has no child, unsure about having children.
“Thinking of family planning terminologies in school, there was quite a lot about contraception.” HCP3 - General Practitioner, Female, Age 45, has no child, would like in future.
“I don't think that we got any good foundation on fertility, the knowledge was far more sketchy and scant.” HCP4- Consultant, Male, Age 45, has three children, does not want more.
Introducing “family building” – what does this term mean to you?
When the term “family building” was introduced to respondents, they were able to view the terminology in the context of wanting to have children.
I think it [family building] involves looking to the future. Creating a family within a relationship. MP5, male, Age 38, white, vocational qualification, has two children, does not want more.
When I think of family building, I think of sitting down, having a talk with your significant other and just thinking about having a baby or furthering the relationship that way, that's what I think. MP2, male, Age 27, Asian, Degree, no children, would like in future.
Some respondents provided further reflection on the general perception of what family planning means, welcomed the new definition and reiterated the importance of representing needs for those wanting pregnancy prevention as well as pregnancy planning.
“Honestly, I’m now not sure why I usually think of contraception. It [family planning] Should be about planning your whole reproduction, it’s not just about contraception. Family building makes me think of that. Yes, the whole discussion should be holistic to include having and taking a break from having children.” FP1. Female, Age 36, Asian, Degree and above, has two children, would like more.
“Yeah [family building] I’d think trying to have a baby or children in future. I guess that's what family planning ought to mean if you look at it holistically.” HCP2 - Nurse, Female, Age 30, has no child, unsure about having children.
“…Your definition makes perfect sense. I guess family building is what we’ve missed from family planning.” HCP3 - General Practitioner, Female, Age 45, has no child, would like in future.
How do you think use of these terms can be improved to help people achieve desired fertility intentions?
Finally, interview respondents were asked to provide their views on improvement opportunities. In their responses were recurring themes regarding improving school and general healthcare education, planting ‘the seed’ young in terms of early but age-appropriate education, having more balanced views on pregnancy prevention, pregnancy planning and reproductive life planning in lay terms.
“Yes, it should be a combination of both: talk about contraception and talk about planning for a baby. Discussions between couples. One person in the marriage or the relationship might want to start a family and then the other doesn't. Having that discussion as to what's important to both parties and there should be a forum for that.” HCP8 - General Practitioner, Female, Age 36, has no child, would like in future.
Yes, it should involve sitting down having a talk with your significant other [planning] and just thinking about having a baby or furthering the relationship that way, that's what I think. MP2
“It’s best to give the education [so] that they [students] can make the choices they want, rather than say ‘I wish I knew that 10 years ago’.” FP11 - Female, Age 21, Black, Degree qualification, has no child, would like in future.
“I think you should plant the seed when someone’s younger and then later on it should be there for them to get at the time when they want it, ‘cause everyone’s gonna want it at different times, aren’t they?” HCP5 - Nurse, Female, Age 24, has no child, would like in future.