Exploring social and public healthcare professionals' experiences providing pregnancy intentions and contraceptive counseling in the Netherlands.

backgroundUnintended pregnancy (UP) is highly prevalent among individuals with multiple social and/or (mental) health challenges. Despite this, pregnancy intentions and contraceptive options are rarely addressed in routine social and public healthcare. To bridge this gap, the Dutch Not Pregnant Now program integrates person-centered counseling on pregnancy intentions and contraceptive options into a variety of social and preventive public health services that people already access, such as social care, mental health and youth care, and public health programs. Since professionals providing these services play a central role in implementation in practice, their experiences and competencies are relevant for understanding feasibility and impact, and to guide further development and implementation of routine counseling on these topics in the Netherlands and beyond.

objectivesThe aim of this study is to explore social and public healthcare professionals' self-rated ability to deliver counseling on pregnancy intentions and contraceptive options within the context of the Dutch Not Pregnant Now program. Specifically, we aim to identify both strengths and areas for improvement by examining how professionals' reported skills, attitudes, and structural barriers relate to their self-perceived counseling capacity, representing core elements and practical requirements for delivering the counseling within their own work setting and during regular client visits, rather than as a separate activity. STUDY

designA practice-based, cross-sectional study was conducted using 131 self-reported questionnaires completed by trained professionals providing Not Pregnant Now counseling in social and public healthcare. The survey addressed reported responsibility for discussing pregnancy intentions and contraceptive options during regular care visits, skills in motivational interviewing, competence in contraceptive option counseling, client screening practices, and time constraints. Quantitative data were analyzed using ordinary least squares (OLS) regression to explore factors affecting self-rated counseling ability. Open-ended responses were thematically analyzed to provide additional insights and contextualize the findings within practice.

resultsSocial and public healthcare professionals who reported stronger skills in motivational interviewing-particularly in identifying the right moment to initiate the conversation, demonstrating empathy, and applying effective techniques-felt significantly more capable of delivering counseling on pregnancy intentions and contraceptive options during regular care visits. Competence in discussing contraceptive options further enhanced this perceived ability. In contrast, no significant effects were observed for (the lack of) perceived responsibility for providing such counseling, client screening skills, or time constraints. Open-ended responses highlighted the importance of building rapport with clients and creating a nonjudgmental environment to successfully embed counseling into routine care.

conclusionsStrengthening and sustaining professionals' motivational interviewing and contraceptive option counseling skills enhances their confidence and ability to integrate pregnancy intentions and contraceptive option counseling into practice. Embedding these discussions as a normalized component of routine social and public healthcare-services that people already turn to for support-may contribute to more comprehensive, preventive, and person-centered care, supporting unintended pregnancy prevention. The findings highlight the importance of ongoing training, skill development, and normalization of option counseling, not only in the Netherlands but also for other countries seeking to implement this often-overlooked aspect of care within their social and public health systems.