🚨 Child project: the 6 words to say in consultation that no one dares to pronounce
🔍💡 Fertility & child project: HAS finally sets a framework to talk about it with everyone — women, men, people with disabilities — without judgment or panic. 🤝 A solid foundation to equip reception, information, and guidance on the ground. #healthpractices #SexualHealth
📌 This document provides a solid framework to dare to open the dialogue about the child project with anyone of childbearing age — including men, people with disabilities, and transgender people, who have long been absent from these discussions. It provides reliable arguments to inform about fertility without guilt or fear, and clear guidelines on when to refer in case of suspected infertility. Useful for building a reception, a poster, a time for exchange, or a sensitisation action grounded in evidence.
📜🔗LINK to the source
1️⃣ ANALYTICAL SUMMARY
A shift towards early, expanded, and non-gendered reproductive health
Birth rates and fertility intentions are regularly declining, the age at first child is increasing (29.1 years in 2023, +5.1 years since 1974) and unplanned pregnancies limit access to upstream care (p. 11-12, 22). The HAS therefore broadens the preconception logic: no longer waiting for the declared "pregnancy project", but raising awareness and informing all individuals of childbearing age, integrating mental health, vulnerability situations, disability, and trans pathways. The male partner, almost absent from perinatal strategies, is explicitly reintegrated as a full determinant (p. 12, 35).
A tool for dialogue, informing and guiding without harm
The document provides professionals with the means to open the conversation simply, adapt information to levels of literacy and communication, and choose language that induces neither anxiety nor stigma (p. 33-37). It specifies the content of the different consultation times according to the situation (no project, deferred project, active project, suspicion of infertility) and sets clear thresholds for the first-line exploration of infertility (p. 80-99, 126-131). The overall aim is to reduce missed opportunities while respecting the freedom to decide.
2️⃣ KEY POINTS OF THE DOCUMENT
1️⃣ The conceptual shift: from "preconception" to reproductive health throughout life. The recommendation no longer waits for the expression of a pregnancy project: it proposes to open a dialogue space with any person of childbearing age, regardless of their project (none, deferred, undecided, active). This is based on DOHaD/POHaD theories (developmental and paternal origins of health) (Introduction, p. 7; framework p. 15-19).
2️⃣ Health literacy as a prerequisite, not an option. The European HLS survey (2020-2021) shows that 44% of adults struggle to access, understand or use health information; 73% have difficulty navigating the system, 65% in judging the reliability of online information. The document lists concrete adaptations (FALC, pictograms, large print, braille, LSF, audio, extended time, accompanying) (p. 33-35).
3️⃣ An anti-stigmatisation language framework (IRHEC). Five principles: aim for reproductive autonomy, be inclusive (men and women), show empathy without blaming, offer a positive angle without exaggerating risks, accept that people change their minds. Messages should "enable decision-making, not prevent behaviour" (R1 to R5, p. 35-37).
4️⃣ Readable referral thresholds for infertility. Infertility = absence of pregnancy after 12 months of regular unprotected intercourse (6 months after 35 years in women). About 1 in 6 couples will experience involuntary infertility after one year; infertility affects ~17.5% of the global adult population, and a male factor contributes to ~45% of cases (p. 120-127).
5️⃣ Explicit attention to invisibilised groups. Dedicated sections position parenthood as a fundamental right for people with disabilities (with the major distinction between parental incompetence — contextual and reversible — and parental incapacity — structural), the support for trans individuals (preservation/reuse of gametes), and the identification of psychological, social vulnerabilities and violence (219,000 women/year victims of domestic violence) (p. 100-118, 22).
3️⃣ ACTION PATHWAYS FOR LOCAL ACTORS
1️⃣ Install call support in reception areas. Posters and brochures in the waiting room to indicate that the subject can be addressed and to initiate dialogue — ideally in easy-to-read language and translated (R1, p. 36). Refer to the public platform "My fertility" (Santé.fr).
2️⃣ Systematise a neutral opening question about the intention to conceive. Start from a general formulation ("Do you have a plan, or not, to have a child one day?") that includes those who do not want children, rather than presuming a plan (p. 69-77).
3️⃣ Adapt each piece of information to the level of literacy and communication. Allow time, offer a written reminder, check understanding, use pictograms/easy-to-read language/sign language as needed; never provide anxiety-inducing information without a positive reformulation (p. 33-37).
4️⃣ Address both men and women. Explicitly integrate the male partner into the messages (paternal age, tobacco, alcohol, diet, exposures) to rebalance a responsibility that is currently mostly borne by women (p. 35, 38-52).
5️⃣ Use orientation thresholds as a shared reference. Identify without delay a situation of infertility (12 months, or 6 months if the woman is ≥ 35 years / the man ≥ 45 years) and refer to a consultation dedicated to the couple and to each partner (R4-R6, p. 126-131).
6️⃣ Ensure support for specific populations. For disability: do not confuse incapacity and parental incompetence, mobilise Handigynéco/HandiConsult, guarantee access to EVARS sessions (p. 101-111). Identify and refer in cases of violence or psychological/social vulnerability (p. 99-100).
Identified unmet needs: recognition of diagnostic coordination time; extension of “My prevention assessment” and contraception/STI consultations beyond 26 years; development of preconception interviews dedicated to men; production of FALC/multilingual tools still insufficient (p. 9-10).
4️⃣ ADDITIONAL REFERENCES
- HAS — Sexual and reproductive health: Recommendations Part 1. Fertility and overall health (2026) — the operational version of the action messages that stem from this argument; essential for moving from evidence to practice. 👉 https://www.has-sante.fr/jcms/p_4154557/fr/sante-sexuelle-et-reproductive-recommandations-volet-1-fertilite-et-sante-globale
- HAS — Sexual and reproductive health: Recommendations Part 2. Infertility: first-line exploration (2026) — the concrete actions to be taken for exploration and referral in primary care. 👉 https://www.has-sante.fr/jcms/p_4154558/fr/sante-sexuelle-et-reproductive-recommandations-volet-2-infertilite-exploration-en-premiere-intention
- Public Health France — Report on perinatal health surveillance in France 2010-2019 (May 2024 edition, 164 p.) — the multi-source epidemiological database that documents the underlying territorial and social inequalities.
👉 https://www.santepubliquefrance.fr/docs/rapport-de-surveillance-de-la-sante-perinatale-en-france-2010-2019
5️⃣ FREQUENTLY ASKED QUESTIONS (FAQ)
1️⃣ Who is this approach specifically aimed at? At anyone of childbearing age, whether or not they have a child project — explicitly excluding adolescents, incarcerated individuals, and people living on the streets, who fall under adapted approaches (p. 8-9).
2️⃣ Is a declared "pregnancy project" necessary to address the topic? No. This is precisely the change: we open the dialogue upstream, even without an expressed project, during existing consultations (p. 63-77).
3️⃣ How to talk about fertility without causing fear or guilt? By following the 5 IRHEC principles: autonomy, inclusivity, empathy, positive angle, acceptance of changing one's mind. The goal is to illuminate a decision, not to dictate behaviour (p. 35-37).
4️⃣ What to do when faced with a person having difficulty understanding? Allow time, adapt materials (easy-to-read, pictograms, large print, braille, sign language, audio), offer a written reminder and the support of a loved one if desired (p. 33-35).
5️⃣ When should infertility be suspected and referred? After 12 months of unprotected intercourse without pregnancy — or 6 months if the woman is ≥ 35 years and/or the man ≥ 45 years. Immediate identification is recommended from age 40 (p. 126-131).
6️⃣ Does the assessment concern only the woman? No. The initial exploration is focused on the couple and on each partner; a male factor contributes to nearly half of the situations (p. 120-121, 134-159).
7️⃣ How to approach parenthood with a person with a disability? As a fundamental right. Distinguish parental incompetence (contextual, reversible, to be supported) and parental incapacity (structural, legally recognised), use appropriate materials and rely on expert systems (p. 101-111).
6️⃣ REWRITING IN EASY LANGUAGE
What is this document?
The HAS explains how to talk about the desire for a child with people.
It gives advice to health professionals.
What is changing
Before, we only talked about the baby when the person asked.
Now, we can talk about it earlier.
We talk about it with women and with men.
We also talk about it with disabled people.
Well informing
We need to provide clear information.
We need to use simple words.
We can use drawings or images.
We must not scare.
We must not judge the person.
Fertility
Fertility is the ability to have a baby.
With age, it can sometimes be more difficult to have a baby.
This is true for both women and men.
When to see a doctor?
Have you been trying to have a baby for 1 year?
The baby isn't coming?
Then talk to a doctor.
If the woman is 35 years old or older: talk about it after 6 months.
A right for all
Everyone has the right to have children.
This is also true for disabled people.
7️⃣ CROSS-SECTIONAL ANALYSIS — VALUES OF HEALTH PRACTICES
- Literacy: ✅ The document proposes concrete adaptations (easy-to-read, pictograms, sign language, braille, audio) for all levels of understanding (p. 33-35).
- Empowerment: ✅ The stated objective is to strengthen people's decision-making capacity, not to dictate behaviour (p. 36, R2-R5).
- Participation: 🟡 Co-construction of tools with the public is recommended (IRHEC principle), but is not well formalised as a mechanism (p. 35-36).
- Community health: 🟡 The collective dimension is evident through user associations and campaigns, but the focus remains on the individual care relationship (p. 9, 36).
- Ethics: ✅ Gender, cultural, and social biases are identified and addressed (language, stigma, distinction between incompetence/parental incapacity) (p. 35, 102).
- Human rights: ✅ Parenthood is established as a fundamental right, with reference to the Convention on the Rights of Persons with Disabilities (p. 102).
- Intersectorality: ✅ Partnerships recommended with occupational health, maternal and child health, sexual health centres, disability services, social services (p. 8-9).
- Partnership: 🟡 Many actors are mentioned, but few formalised collaboration models (outside existing systems like Handigynéco) (p. 9).
- Fight against discrimination : ✅ Gender discrimination, related to disability and trans identity explicitly identified; non-judgement and diversity set as requirements (p. 35, 112-118).
8️⃣ EVALUATION OF THE RELIABILITY OF THE RESOURCE
Scientific relevance : high in terms of sources (HAS, WHO, Ined, Insee, DREES, SPF, international learned societies) and the currency of the data (2023-2025). ⚠️ Major limitation acknowledged by the document itself : no recommendation can be graded A/B/C ; all rely on expert agreement (AE), due to insufficient studies on the effectiveness of interventions. To be stated honestly in any dissemination.
Operational relevance : strong for framing a discourse, a posture and orientation thresholds; more limited for turnkey action (the argument is not the practical sheet — see the “Recommendations” and associated summaries).
Internal inconsistencies noted (reported, not corrected) :
- Numerous unresolved EndNote reference calls of type {Author, year #number} scattered throughout the text (over 350 occurrences, e.g. {Barbuscia, 2024 #240}): editorial production artifact, without impact on the substance but visible.
- Date of the same reference variable : reference #63 (European Association of Urology) is cited sometimes as “2024”, sometimes as “2025” depending on the pages (p. 120 and following).
- Publication dates with dual reading : metadata " adopted on 11 June 2026 " vs HAS page indicating a " validation date 11 June 2025 " and a publication on 24 June 2025 — the publication schedule deserves verification if the date is cited precisely.
9️⃣ STRATEGIC HASHTAGS
#healthpractices #SexualAndReproductiveHealth #Fertility #HealthLiteracy #PreConception #Men'sHealth #ChildProject #HealthPromotion