title: One Key Question®: First Things First in Reproductive Health.
abstract: 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.
authors.affiliation: Child, Adolescent and Family Health, Boston Public Health Commission, 1010 Massachusetts Ave #2, Boston, MA, 02118, USA. dallen@bphc.org.
authors.forename: Deborah
authors.identifier: 0000-0002-6825-0503
authors.initials: D
authors.lastname: Allen
authors.affiliation: Oregon Foundation for Reproductive Health, P.O. Box 40472, Portland, OR, 97240, USA.
authors.forename: Michele Stranger
authors.initials: MS
authors.lastname: Hunter
authors.affiliation: Department of Health Policy and Management, Jacobs Institute of Women's Health Services, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC, 20052, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Wood
authors.affiliation: Department of Health, Educational Administration, and Movement Studies, Central Washington University, 400 E University Way, Ellensburg, WA, 98926, USA.
authors.forename: Tishra
authors.initials: T
authors.lastname: Beeson
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D033182:Intention; D016742:Preconception Care / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods / Q000639:trends; D011320:Primary Health Care / Q000379:methods; D016730:Program Development; D060728:Reproductive Health / Q000592:standards / Q000639:trends*; D014930:Women / Q000523:psychology*
keywords: Family planning; One Key Question©; Preconceptional health; Well woman care