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We live in a world quite different from the one our mothers and grandmothers grew up in. Today, many young women are raised to take care of themselves, pursue their education, and land jobs that are meaningful to them. This means women tend to have children much later in life than they used to.

But our biology hasn’t changed. A woman’s ability to get pregnant still peaks between 18 and 25, when so many people are just getting started in their lives. From there fertility declines, especially once women reach their mid-30s. So by the time some women are ready to start a family, they might face fertility challenges and other age-related health problems.

That’s why I encourage my younger patients to think about whether and when they want to have children, and to talk with me about their plans. That way, I can help them plan a healthy pregnancy—no matter their age—or prevent pregnancy, if that’s what they want. We call this reproductive life planning.

A simple question

I’m a big fan of asking this question: “Are you planning to have a child in the next year?” If your ob-gyn doesn’t ask you this, you should feel comfortable bringing up the topic.

If your answer to this question is “yes,” then you and your ob-gyn can talk about taking steps to improve your health before you get pregnant. For example, if you have diabetes, we can make sure your blood sugar is in a good range. Blood pressure on the high side? We can work to get that under control too. You also can start taking prenatal vitamins to reduce the risks of birth defects during pregnancy. These are all important parts of prepregnancy care.

If your answer is “no, I don’t want to have a child in the next year” and you are having sex, the next question is, “What are you doing to not get pregnant?” Then you and your ob-gyn can review options for birth control.

If you know you want to get pregnant later in life—just not in the next year—we may talk about how age affects fertility and pregnancy. It’s your choice when you want to get pregnant, but it always helps to understand what to expect.

If you are not sure whether you want to have a child in the coming year, or you are okay either way, please know that’s a very common response. Your ob-gyn can continue to advise you on birth control and prepregnancy care—whatever best suits your needs and goals. Together, you can revisit your reproductive life plan at your next routine care visit, or even sooner if you wish.

Reproductive life planning is about both preventing unintended pregnancies and helping women have healthy pregnancies when they’re ready. It’s something you should discuss with your health care team throughout your reproductive years.

Different goals, different plans

There are many forms of birth control, and the choice is both personal and practical. Your ob-gyn can help you decide on a method that fits your life plans.

If you’re 20 and you want to start having children around 30, then you may be a good candidate for long-acting birth control, such as an IUD (intrauterine device). Once inserted, an IUD can be used for several years, depending on the type.

If you’re planning to get pregnant within the next few years, then you may prefer a birth control method that you can stop on your own. Birth control pills can be a good option here.

Or if you’re ready to start trying to get pregnant, we can talk about prepregnancy care and how to increase your chances of having a baby. Again, our conversation may vary based on your age. If you’re 35 or older, we can talk about genetic testing and what to do if you have a hard time getting pregnant.

If you’ve recently given birth, we can talk about what’s next for your family. You may already know you want another child. Maybe you’re certain this was your last baby. If you are unsure, that’s okay too. Your ob-gyn can help you choose the birth control method that is best for you right now, keeping in mind that it is best to space your pregnancies apart by at least 18 months. This time frame allows your body time to recover between pregnancies and improves the chances of having a good pregnancy outcome the next time.

Keep talking with your ob-gyn about your plans throughout your reproductive years. Some women stop being concerned about pregnancy in their 40s, assuming their chances are low. In fact, it is possible to get pregnant until you reach menopause (marked by 12 straight months without a menstrual period). So if you aren’t there yet and are having sex, and you don’t want to get pregnant, you need a plan.

Your partner in planning

Whether to have a child, and when, is a big decision. Your age, career, financial stability, relationship with a partner, and general health all may come into play. The point is, you can be as proactive with your reproductive health as you are with other aspects of your life, like school and work.

Think about what you want, and talk with your ob-gyn. Like all ob-gyns, I’m here to support you if you want to have children and if you do not. Your health, and the health of any baby you may choose to have, is my top priority.

Published: December 2021

Last reviewed: December 2021

Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

About the Author
Dr. Kimberly Gregory.
Dr. Kimberly D. Gregory

Dr. Gregory is an obstetrician–gynecologist and maternal–fetal medicine specialist at Cedars-Sinai in Los Angeles. She serves as vice chair of Women’s Healthcare Quality and Performance Improvement, division director and fellowship director in the division of Maternal Fetal Medicine, and professor in the department of Obstetrics and Gynecology. She is the Helping Hand of Los Angeles Miriam Jacobs Chair in Maternal Fetal Medicine. She is a fellow of the American College of Obstetricians and Gynecologists (ACOG) and a member of ACOG’s Women’s Preventive Services Initiative.