Understanding women's needs: Patient engagement in novel family planning in Emergency Departments

The exclusion of women's and girls' perspectives in health programmes and products has been a deeply concerning issue. Women are at greater risk of misdiagnosis, improper treatment and complications in common medical situations, yet their voices often go unheard in these situations. So much so, that clinical guidelines recommend simply 'listening to women'.

This issue is particularly concerning in family planning. Research by the World Health Organization (WHO) found that the objective measures of quality of care in providing sexual and reproductive health services are not always consistent with the client’s perspective of quality.

Further research by RAND found that family planning programmes pay insufficient attention to client needs and quality of care and tend to ignore other aspects of women's reproductive health care. By disregarding women’s input and experiences, these programmes and products often fail to address crucial aspects such as access to comprehensive information about contraception, contraceptive options tailored to diverse needs, and support for reproductive health decisions.

Many health systems are considering providing family planning services in novel ways, where meaningful engagement with women in programme design is paramount. One such example of exploring new strategies to increase access to family planning is hospital Emergency Departments (EDs).

"The ED offers a unique platform for changing the narrative of women's access to reproductive care. The single greatest risk to a woman's livelihood is an unexpected pregnancy. And in this case, each conversation matters," said Jennifer L. White MD, FACEP, Director of Clinical Operations at the Jefferson Health Emergency Department.

In many underserved communities, women have limited access to regular gynaecological care, resulting in EDs becoming the location for critical life-planning decisions, due to their accessibility and reach, urgency of care, opportunity for education, and screening for reproductive health concerns.

According to the WHO, approximately 214 million women in developing countries have an unmet need for modern contraception, leading to 25 million unsafe abortions and 810 preventable maternal deaths each year. In the US alone, approximately 20 million women of childbearing age seek care in EDs annually – and there are around 6,000 EDs in the United States alone.

However, most EDs do not adequately address recurring medical issues related to unwanted pregnancies. Providing interventions in the ED has proven to be a successful strategy in addressing previous health emergencies (e.g., flu pandemic vaccinations, opioid screening, and providing albuterol inhalers to patients to take home after an ED visit).

EDs offer great potential for reaching women worldwide with family planning information and services, which can ultimately help reduce unintended pregnancies and improve reproductive and sexual health outcomes on a global scale. However, prioritizing the desires and needs of women and girls is indispensable in designing any initiative to advance family planning in the ED, and that starts by listening to them.

Patient engagement involves actively listening to the voices of women who are part of the potential patient population, taking their viewpoints into utmost consideration in the development of a family planning programme. Rather than merely observing women, this approach asks women directly about their wants, needs, and concerns about such a programme. It embodies a bottom-up, collaborative methodology for programme development, shifting away from the conventional top-down approach.

Engaging women and girls ensures that the interventions offered fit the specific geographical, cultural, socio-economic, and other pertinent dynamics within the prospective patient population. This creates a meaningful partnership with women in the construction of a family planning programme, enabling it to cater to the entirety of their needs and aspirations. However, many health systems grapple with engaging women effectively in family planning. Diverse needs and barriers, such as gender biases and limited access, require innovative, tailored approaches. Many health systems simply don’t know where to start.

"Tailoring family planning programs to align with cultural and socio-economic needs is essential, requiring a profound understanding of the community's dynamics," said Dr Mandeep Singh, Maternal and Fetal Medicine Consultant at Burjeel Medical City in Abu Dhabi.

The White Ribbon Alliance has created a Facilitator's Guide for meaningful patient engagement to inform the design of any potential Family Planning in the ED effort, geared toward health systems interested in this approach. This guide helps conduct productive Focus Group Discussions with women and girls, ensuring their voices and needs are heard and considered in the planning process. It offers practical tips and a structured framework for effective facilitation.

The guide is designed to be used by anyone interested in exploring or introducing Family Planning in the ED, including but not limited to ED doctors, hospital administrators, health researchers, women’s health leaders, and others. It’s essential for health systems to first understand women’s reactions to the possibility of getting FP information or services in the ED before developing and scaling associated solutions. Health systems should approach the initiative with an open mind, acknowledging that the ED might not align with the preferences of women and girls they care for. Finding a suitable solution will require careful consideration of the specific context, and the design should be tailored accordingly.

The guide provides clear objectives, participant selection criteria, and efficient recruitment strategies. It offers a structured discussion guide to explore comfort with birth control, ED experiences, and preferences for FP services. Skilled facilitators and assistants play key roles in fostering an inclusive environment.

The Listening to Mothers programme, conducted by Childbirth Connection (now part of the National Partnership for Women and Families) in the United States, provides a good example. This initiative involves surveying mothers about their childbirth experiences and preferences. The collected data informs maternity care improvements, helping tailor healthcare services to better meet women's needs and preferences, leading to more patient-centred care. This approach has led to improved maternity care practices, reduced disparities, informed policy changes, enhanced patient satisfaction, and increased informed decision-making, making care more patient-centred and responsive.

While designing a successful family planning programme for the ED starts with engaging prospective patients themselves, it also involves other considerations such as prioritizing provider staff education and readiness, ensuring continuity of care beyond the ED, utilizing digital solutions for enhanced access, especially in underserved regions, among other factors.

Educating healthcare professionals equips them to provide comprehensive services, while addressing barriers and establishing connections with community providers ensures ongoing care. Leveraging technology expands outreach, offering vital reproductive health information and resources. Engaging women early on helps inform all aspects of programme design and ensures the suitability and practicality of the support systems built around the solution.

“Healthcare—especially family planning programmes—will be stronger if we make listening to women standard practice,” said Kimberly Whipkey, Advocacy and Communications Manager, White Ribbon Alliance.

Effective patient engagement, where every woman and girls feel heard and valued, builds trust between providers and patients and contributes to programmes and services that women are more likely to use. It enhances credibility within communities, addresses health inequities, empowers women, and fosters a compassionate healthcare landscape.