Communication in reproductive health: intimate topics and challenging conversations.

The field of reproductive health encompasses diverse areas that touch on many of the core issues faced by humanity, including the ability to reproduce, the capacity to limit reproduction when it is not desired, and our nature as sexual beings. Communication about these issues, whether in the clinical setting or among friends, family, or in society at large, presents unique challenges due to the complex societal and personal contexts of these discussions. Communication on sexual and reproductive health topics is also important—and a challenge—across a wide range of medical practice, and an area in which physicians and other health professionals often need training. In this special issue of Patient Education and Counseling on communication about reproductive health, we present a variety of papers that address communication issues ranging from miscarriage to abortion to HIV/AIDS. A call for papers for this special issue was published in PEC in August 2009. We received 42 proposals and accepted 24 for publication. Papers are presented in six general categories: sexuality, contraception, abortion, infertility and assisted reproduction, pregnancy and childbearing, and HIV/AIDS. They represent work performed across four continents and include randomized controlled trials, observational studies, qualitative research, and literature reviews. Together, the papers in this special issue draw attention to the importance and value of appropriate counseling and effective communication in this challenging area. Despite the diversity of topics, this special issue reflects a consensus that client-centered approaches are both right in principle and promising in practice. Specifically what client-centered counseling should look like is not yet clear, however. Many of these papers address that question. They either assess specific approaches or gather information that would inform client-centered communication strategies. A number of studies test ways to support or structure counseling in hopes of overcoming providers’ and clients’ reluctance to raise and discuss these issues. As should be expected, some approaches yield demonstrable effects; others do not.