How Asking One Key Question Helps Moms and Healthcare Providers Prepare for Pregnancy

Posted September 13, 2016 by Josh Grant

Doctor Talking To Woman About Pregnancy
One question can make a huge difference for women's health and infant health outcomes.

This post is in support of Infant Mortality Awareness Month, a great opportunity for everyone from patients to healthcare providers to think about how they can contribute to better health outcomes for infants around the country. 

A healthy pregnancy starts before conception, but almost half of pregnancies in the U.S. are unplanned. This increases the risk of poor outcomes for both moms and babies. Planning can help women better prepare themselves for pregnancy, and it all starts with a single question from their doctors: Would you like to become pregnant in the next year? 

The One Key Question® (OKQ) initiative from the Oregon Foundation for Reproductive Health (OFRH) encourages healthcare providers to ask every woman this specific question because it changes the context of other health factors. 

“Information like weight, pre-existing conditions and medications from a well-woman visit means something different for patients who want to get pregnant and those who don’t,” says Michele Stranger Hunter, executive director of the OFRH. “Some health assessments need to be done with the knowledge of a woman’s pregnancy intentions to inform associated risks and potential treatments.” 

Stranger Hunter gave an example of a weight-loss plan. A provider who’s working with a woman who has obesity issues can explain how being overweight could affect her and her baby over the course of her pregnancy. It also allows the doctor to recommend the appropriate course of action to start reducing potential risks. Additionally, medications may change based on pregnancy intentions. Because some drugs are not safe for pregnant women, doctors need to be ready to prescribe other options. The key is that women armed with information can receive services and adjust their behaviors before they conceive to avoid complications. 
“Women often say, ‘I’ll stop doing that when I get pregnant,’ almost using their first prenatal visit as the point to change their health. The real health impact starts before then though; preconception care is really about women’s health before they become pregnant,” says Stranger Hunter. 

OKQ also offers women four optional answers; not the just the usual yes/no dichotomy but also “unsure” or “OK either way.” It recommends a combination of preconception and contraceptive care for women who are unsure of their pregnancy plans or if they feel “what happens, happens.” In these cases, providers can offer contraception options and check for pre-existing health conditions that could affect birth outcomes. The initiative wants women to feel empowered to say that they are not sure about pregnancy and that they don’t have to answer yes or no. 

Why One Year Matters
OKQ’s 12-month timeframe was chosen for three reasons. One is that healthcare providers need to understand when women would like to become pregnant so they can create adequate preconception health plans. This helps address risks such as chronic ailments that can complicate pregnancies and negatively affect birth outcomes. 
“Another reason is that women told us that a year made sense to them while thinking about pregnancy in terms of what they want to achieve in the near future,” says Stranger Hunter. “When pregnancy intention is discussed in open-ended terms, or even two, three or five years down the road, it gets a little fuzzy and it’s harder for women to decide or answer accurately.”

Stranger Hunter also noted that a year helps providers think about the appropriate forms of contraception to recommend to patients. Women who do not plan to conceive within 12 months can be educated about long-acting reversible contraception as part of their consultation. Meanwhile, patients who want to become pregnant in a few months can be given short-term options. 
Bringing Pregnancy Preparedness to Every Woman
In addition to engaging women who are unsure of their plans, OKQ wants women from every background, especially those in underserved areas, to have conversations about preconception health with their healthcare providers. A 2016 study showed that the 2011 rate of unintended pregnancy among women with incomes at or below the federal poverty level was five times higher than the rate of women at the highest income level. 

“There’s a cultural taboo around pregnancy planning while poor and some women think they can only plan if they are married or are financially stable. The whole concept of planning can mean something different depending on your context and seems to resonate more with white, middle class, educated women,” says Stranger Hunter. “But low-income women still want to have children or more children. We can empower them to say so and offer them services to support the healthiest pregnancy possible. Like all others, these women need to understand how their bodies and health can affect their pregnancy, so providers need to routinely talk to them about their health risks, behavioral health risks, and family planning.”

This is a goal shared by the Collaborative Improvement and Innovation Network to Reduce Infant Mortality (IM CoIIN). The combination of pre- and interconception health is one of the six strategic focus areas that some participating state teams are focused on improving, which would help more women achieve better health before, during, after and in-between pregnancies.

“Women in underserved areas who can’t access certain services might not know how their behaviors and health before and between pregnancies can affect their babies,” says Zhandra Levesque, MPH, Associate Project Director at NICHQ. “When healthcare providers understand how to open conversations about pregnancy planning and systems are designed to support every woman, then risks and negative health outcomes will be reduced for moms and babies.” 

Although it may be one question for healthcare providers to ask, the answer to it can change a great deal about how patients are treated. Ensuring that every woman has an opportunity to talk to her provider about her plans can help prevent unintended pregnancies and reduce health risks associated with conception.


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