One Key Question®: First Things First in Reproductive Health
Objectives Preconceptional health care is increasingly recognized as important to promotion of healthy birth outcomes. Preconceptional care offers an opportunity to influence pregnancy timing and intent and mother’s health status prior to conception, all predictors of individual outcomes and of inequality in birth outcomes based on race, ethnicity and class. Methods One Key Question, a promising practice developed in Oregon which is now attracting national interest, provides an entry point into preconceptional care by calling on providers to screen for pregnancy intent in well woman and chronic disease care for women of reproductive age. For women who choose not to become pregnant or are not definitive in their pregnancy intent, One Key Question provides an opportunity for provision of or referral to counseling and contraceptive care. Results Adoption of One Key Question and preconceptional care as standard practices will require important shifts in medical practice challenging the longstanding schism between well woman care generally and reproductive care in particular. Adoption will also require shifts in cultural norms which define the onset of pregnancy as the appropriate starting point for attention to infant health. Conclusions for Practice This commentary reviews the case for preconceptional care, presents the rationale for One Key Question as a strategy for linking primary care to preconceptional and/or contraceptive care for women, outlines what is entailed in implementation of One Key Question in a health care setting, and suggests ways to build community support for preconceptional health.
KeywordsOne Key Question© Preconceptional health Family planning Well woman care
- American Congress of Obstetricians and Gynecologists (ACOG). (2005). The importance of preconception care in the continuum of women’s health care. Retrieved from http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Importance-of-Preconception-Care-in-the-Continuum-of-Womens-Health-Care.
- Boston Public Health Commission. (2015). Boston health equity goals mid-point report. Retrieved from http://www.bphc.org/whatwedo/health-equity-social-justice/Documents/Boston%20Health%20Equity%20Goals%20Midpoint%20Report.pdf.
- Centers for Disease Control and Prevention. (2014). Medical conditions. Retrieved from https://www.cdc.gov/preconception/careforwomen/conditions.html.
- Centers for Disease Control and Prevention. (2016). PRAMStat system. Retrieved from http://www.cdc.gov/prams/pramstat/index.html.
- Hatcher, R. A. (2011). In J. Trussell, A. L. Nelson, W. Cates, & D. Kowal (Eds.), Contraceptive technology: Twentieth revised edition. New York, NY: Ardent Media.Google Scholar
- MacDorman, M. F., & Gregory, E.C.W. (2015). Fetal and perinatal mortality: United States, 2013. National Vital Statistics Report, 64(8), 1–24.Google Scholar
- Oregon Health Authority. (2014). Effective contraceptive use among women at risk of unintended pregnancy guidance document. Retrieved from https://www.oregon.gov/oha/analytics/CCOData/Effective%20Contraceptive%20Use%20Guidance%20Document.pdf.
- Patient-Centered Primary Care Collaborative. (2015). Defining the medical home. Retrieved from https://www.pcpcc.org/about/medical-home.
- Ranji, U., & Salganico, A. (2011). Women’s health care chartbook: key findings from the Kaiser women’s health survey. Retrieved from http://kff.org/womens-health-policy/report/womens-health-care-chartbook-key-findings-from/.
- Tindall, E.J. (2009). Ravenswood: Bringing behavioralists into an FQHC. National Council Magazine, 18, 37–38.Google Scholar
- Wood, S. F., Beeson, T., Goldberg, D. G., Mead, K. H., Shin, P., Abdul-Wakil, A., Rui, A., Sahgal, B., Shimony, M., Stevens, H., & Rosenbaum, S. (2015). Patient experiences with family planning in community health centers. Retrieved from https://publichealth.gwu.edu/sites/default/files/Geiger_Gibson_Family_Planning_Report_2015.pdf.