Maternal and Child Health Journal

, Volume 21, Issue 3, pp 387–392 | Cite as

One Key Question®: First Things First in Reproductive Health

  • Deborah AllenEmail author
  • Michele Stranger Hunter
  • Susan Wood
  • Tishra Beeson


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.


One Key Question© Preconceptional health Family planning Well woman care 



The authors acknowledge Janelle Wylie for assistance with manuscript preparation.


  1. Alexander, G. R., & Kotelchuck, M. (2001). Assessing the role and effectiveness of prenatal care: History, challenges, and directions for future research. Public Health Reports, 116(4), 306–316.CrossRefPubMedPubMedCentralGoogle Scholar
  2. American College of Obstetricians and Gynecologists. (2015). Committee opinion no. 642 summary: Increasing access to contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstetrics & Gynecology, 126(4), e44–48.CrossRefGoogle Scholar
  3. American Congress of Obstetricians and Gynecologists (ACOG). (2005). The importance of preconception care in the continuum of women’s health care. Retrieved from
  4. Ballantyne, J. W. (1901). A plea for a pro-maternity hospital. British Medical Journal, 1(2101), 813–814.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Bello, J. K., Rao, G., & Stulberg, D. B. (2015). Trends in contraceptive and preconception care in United States ambulatory practices. Family Medicine, 47(4), 264–271.PubMedGoogle Scholar
  6. Besculides, M., & Laraque, F. (2005). Racial and ethnic disparities in perinatal mortality: Applying the perinatal periods of risk model to identify areas for intervention. Journal of the National Medical Association, 97(8), 1128–1132.PubMedPubMedCentralGoogle Scholar
  7. Borrero, S., Nikolajski, C., Steinberg, J. R., Freedman, L., Akers, A. Y., Ibrahim, S., & Schwarz, E. B. (2015). “It just happens”: A qualitative study exploring low-income women’s perspectives on pregnancy intention and planning. Contraception, 91(2), 150–156.CrossRefPubMedGoogle Scholar
  8. Boston Public Health Commission. (2015). Boston health equity goals mid-point report. Retrieved from
  9. Centers for Disease Control and Prevention. (2014). Medical conditions. Retrieved from
  10. Centers for Disease Control and Prevention. (2016). PRAMStat system. Retrieved from
  11. Collins, J. W., Rankin, K. M., & David, R. J. (2011). Low birth weight across generations: The effect of economic environment. Maternal and Child Health Journal, 15(4), 438–445.CrossRefPubMedGoogle Scholar
  12. Dehlendorf, C., Fox, E., Sobel, L., & Borrero, S. (2016). Patient-centered contraceptive counseling: Evidence to inform practice. Current Obstetrics and Gynecology Reports, 5(1), 55–63.CrossRefGoogle Scholar
  13. Demont-Heinrich, C., Hawkes, A., Ghosh, T., Beam, R., & Vogt, R. (2013). Risk of very low birth weight based on perinatal periods of risk. Public Health Nursing, 31(3), 234–242.CrossRefPubMedGoogle Scholar
  14. Handler, A., & Johnson, K. (2016). A call to revisit the prenatal period as a focus for action within the reproductive and perinatal care continuum. Maternal and Child Health Journal, 20(11), 2217–2227.CrossRefPubMedGoogle Scholar
  15. 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
  16. Hudson, D. L., Neighbors, H. W., Geronimus, A. T., & Jason, J. S. (2016). Racial discrimination, John Henryism, and depression among African Americans. The Journal of Black Psychology, 42(3), 221–243.CrossRefPubMedGoogle Scholar
  17. MacDorman, M. F., Declercq, E., Cabral, H., & Morton, C. (2016). Is the United States maternal mortality rate increasing? Disentangling trends from measurement issues. Obstetrics and Gynecology, 128(3), 447–455.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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
  19. Oregon Health Authority. (2014). Effective contraceptive use among women at risk of unintended pregnancy guidance document. Retrieved from
  20. Patient-Centered Primary Care Collaborative. (2015). Defining the medical home. Retrieved from
  21. Ranji, U., & Salganico, A. (2011). Women’s health care chartbook: key findings from the Kaiser women’s health survey. Retrieved from
  22. Tindall, E.J. (2009). Ravenswood: Bringing behavioralists into an FQHC. National Council Magazine, 18, 37–38.Google Scholar
  23. Verbiest, S., Malin, C. K., Drummonds, M., & Kotelchuck, M. (2016). Catalyzing a reproductive health and social justice movement. Maternal and Child Health Journal, 20(4), 741–748.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 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

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Child, Adolescent and Family HealthBoston Public Health CommissionBostonUSA
  2. 2.Oregon Foundation for Reproductive HealthPortlandUSA
  3. 3.Department of Health Policy and Management, Jacobs Institute of Women’s Health Services, Milken Institute School of Public HealthGeorge Washington UniversityWashingtonUSA
  4. 4.Department of Health, Educational Administration, and Movement StudiesCentral Washington UniversityEllensburgUSA

Personalised recommendations