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ONE KEY QUESTION® Initiative
Integrating Reproductive Care into Primary Care Settings
Most women know what it is like to have
concerns about an unintended
pregnancy. They may not know what
their contraceptive options really are
and how to access or make use of them.
Sometimes women have health risks
they didn't fully realize before
pregnancy. Often, women just don't
know what is harmful during pregnancy
and what they should do to stay healthy.
Whether women want to conceive or
avoid pregnancy, we need to start
asking One Key Question® to ensure
more pregnancies are wanted, planned,
and as healthy as possible.
Many primary care providers do not routinely
talk to women about contraception, emergency
contraception, and the importance of making
sure they are in their best health before a
wanted pregnancy. Women need reliable
information, services and referrals in order to
have optimal health, planned pregnancies, and
the best possible birth outcomes.
There is ONE KEY QUESTION(R) that
primary care providers should ask all
women of reproductive age: “Would you
like to become pregnant in the next year?”
If the woman answers “yes”, her primary care
provider can talk to her about the best ways to
increase the chances that she will have a
healthy pregnancy and a healthy infant, such as
taking folic acid and making sure any health
problems are treated. If she answers “no”, her
Almost half of all pregnancies in Oregon are
primary care provider can make
unintended and 53% of deliveries
sure she is using effective
in 2010 were paid for by
The average US woman desires contraception that she is satisfied
Medicaid. Women with unintended
2 children and is fertile for
with to prevent unintended
pregnancies are more likely to
about
35
years.
That
means
pregnancy. She can also be
seek an abortion. If they carry the
informed of the importance of
she
will
spend
about
30
years
pregnancy to term, they have a
emergency contraception as a
trying
to
prevent
pregnancy.
lower chance of a healthy
back-up method.
pregnancy, higher risks of birth
complications, and their infants
are more likely to be born prematurely or with
birth defects. Additionally, the emotional and
economic stress on the family may increase with
an unintended pregnancy and the stress on
society increases in the form of increased social
services and health care costs.
The average US woman desires 2 children and is
fertile for about 35 years. That means she will
spend about 30 years trying to prevent
pregnancy. In that sense, preventing
unintended pregnancy is similar to other health
issues that need ongoing attention from the
woman’s primary health care provider.
Oregon Foundation for Reproductive Health
Contact: Michele Stranger Hunter, Executive Director, 503-223-4510
By asking this ONE KEY QUESTION®,
“Would you like to become pregnant in the
next year?” and following up on the
answer, health care providers can provide
the best preventive services to Oregon
women and ensure that all pregnancies are
wanted, planned, and as healthy as
possible.
How unintended pregnancies hurt Oregon
mothers
Many women have health problems such as high
blood pressure and diabetes which need
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ONE KEY QUESTION® Initiative
Integrating Reproductive Care into Primary Care Settings
treatment and/or stabilization before they
become pregnant to maximize the chances for a
healthy pregnancy. When pregnancy is not
planned, and preconception health care is less
thorough than it should be, the women’s health
and the pregnancy are jeopardized. Diabetes
and high blood pressure can spiral out of
control. The woman may need extra health care
during her pregnancy and have higher risks of
complications. She may be more likely to need a
C-section or other procedures.
Prevention is common sense. Ensuring that
women are as healthy as possible before
pregnancy will help increase the chances of
healthier pregnancies and healthier
infants.
who are low-income. Each pregnancy that was
avoided in the program saved the public
approximately $6,557 in medical, welfare, and
other social service costs for a woman and child
from conception to age two and saved $14,111
from conception to age 5. By reducing public
health and welfare expenditures resulting from
unintended pregnancies, every dollar spent on
Family PACT saved the tax payers $4.30 from
conception to age two and $9.25 from
conception to age five.
Researchers in Oregon estimated that if a
similar program were in place here, Oregon
could prevent 90% of unintended pregnancies
and save $75.5 million per year.
How unintended pregnancies hurt infants
Children of unintended pregnancies have an
Effective reproductive health care can
increased risk of poor health outcomes. This is
enable women to avoid many unintended
partly due to women having uncontrolled health
pregnancies, have healthier children and
problems, taking medications that aren’t safe
protect their overall health. An investment
during pregnancy, or using alcohol, tobacco or
in reproductive health care is returned
street drugs because they don’t realize they are
many times over in improved health
pregnant. The baby is more likely to b
outcomes that result in cost savings in
e born prematurely and to be very
health care and in
underweight. Unintended
society, and a
pregnancies also increase the
decreased reliance on
Researchers in Oregon estimated that
chances that the baby could die in
limited public services.
®
if the ONE KEY QUESTION program
its first year.
were in place here, Oregon could
prevent 90% of unintended pregnancies
and save $75.5 million per year.
Costs of unintended
pregnancy
The negative consequences of
unintended pregnancies affect not only the
children and
families of these pregnancies, but also society
as a whole through the increasing costs of
health, education, and social services. One
example of the potential for cost savings from
prevention of unintended pregnancy is evident
in California’s family planning program, which
provides contraception and reproductive health
services to women and men of reproductive age
Oregon Foundation for Reproductive Health
Contact: Michele Stranger Hunter, Executive Director, 503-223-4510
Preventing unintended
pregnancy
Many women who
delivered a baby in the
past 3 months stated that they and their
partners were not doing anything to prevent
pregnancy when they became pregnant. Those
that wanted to avoid pregnancy gave reasons
indicating that they lacked comprehensive
contraception advice from a clinician: they
thought they couldn’t get pregnant at that time,
they had side effects from the birth control they
were using (and presumably stopped using it),
they couldn’t access contraceptive services, or
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ONE KEY QUESTION® Initiative
Integrating Reproductive Care into Primary Care Settings
they were in disagreement with their partner
about the type of birth control to use.
If a woman wants to become pregnant, it is very
important for her to have preconception care.
The purpose of preconception care is to provide
information, screenings, and needed
interventions for women who are trying to
conceive so that they have the healthiest
pregnancy possible, and the best outcome for
their infants. Preconception care is about
preventive health services for our most
vulnerable population – newborn infants.
Primary care providers can help women
consistently use a satisfactory contraceptive
method by asking women routinely about their
pregnancy intentions and their current use of
contraception. Providers can also assist women
who need to switch methods until they find the
one best suited to them, which usually changes
over time. Contraceptive counseling needs to be
an ongoing discussion in primary care in order
While many primary care providers offer
to meet women’s
prenatal care, fewer than half routinely
reproductive health
provide preconception care – care before
Contraceptive counseling
needs most effectively.
the woman is pregnant to help her control
health problems, quit smoking, take folic
needs to be an ongoing
Emergency Contraception
acid, and make better diet choices. Many of
discussion in primary care in
(EC) is an important part
these clinicians know that folic acid
order to meet women’s
of a comprehensive
supplementation is important, but only
reproductive health needs
approach to prevention
50% know that half of pregnancies are
most effectively.
of unintended
unplanned (which means women need to
pregnancies, and should
take folic acid before they get pregnant)
be offered to most women as a backup method.
and less than half know the correct dosage of
Emergency Contraception (also called the
folic acid supplementation.
morning-after pill) involves taking a high dose of
contraceptive hormones within 3 to 5 days of
Taking folic acid before conceiving and during
unprotected intercourse in order to prevent
the first weeks of pregnancy can reduce certain
pregnancy. It has no effect if a woman is
birth defects, such as spina bifida. Most women
already pregnant, and does not cause an
do not know this, but research shows many
abortion.
women would begin taking folic acid or prenatal
vitamins (which contain the right amount of folic
Emergency Contraception is still often mistaken
acid) if their primary care provider
for the abortion pill (RU 486) which terminates
recommended it. Oregon data from 2010 shows
existing pregnancies, but the two are very
that 50% of Oregon women did not take a
different. If Emergency Contraception were used
prenatal vitamin or multivitamin in the month
after all contraceptive failures, it is
before they became pregnant.
estimated that 50% of unintended pregnancies
would be prevented. Unfortunately, only 3-4%
Limited time during health care visits is an
of women report that a health care provider had
important issue, and may be one reason why
discussed Emergency Contraception with them
preconception care isn’t routinely offered. Using
in the past year, even if they had seen a
other members of the health care team, such as
gynecologist for a pelvic exam.
medical assistants, nurses and health educators
can ease the pressure on the primary care
Helping women to be in the best health
provider. Using social marketing strategies
possible before a desired pregnancy
within the clinic setting may also help ensure
Oregon Foundation for Reproductive Health
Contact: Michele Stranger Hunter, Executive Director, 503-223-4510
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ONE KEY QUESTION® Initiative
Integrating Reproductive Care into Primary Care Settings
patients receive necessary information without
relying exclusively on the provider to deliver it.
We need your help
Here’s what you can do!
By asking the ONE KEY QUESTION(R)
“Would you like to become pregnant in the
next year?”, primary care providers in
Oregon can help women prevent
unintended pregnancies and be in the best
health possible if they do want to become
pregnant. This will lead to healthier
women, healthier infants and healthier
families.
1. Talk to your friends, neighbors, and coworkers about
the importance of making sure everyone has
access to contraception and preconception care. Give
them information on ONE KEY
QUESTION(R) . Look online at our website,
www.onekeyquestion.org or connect with us through
facebook or twitter: OregonRH.
2. Talk to your representatives in the legislature about
making sure that all preventive services are provided in
The ONE KEY QUESTION(R) should be part
primary care, including prevention of unintended
of health care reform in Oregon
pregnancies and good preconception care. Give them
As Oregon attempts to redesign its health care
information about the ONE KEY QUESTION(R)
system, policy makers are looking for
Initiative.
ways to achieve the “triple
3. Donate to the Oregon Foundation
aim”: improving the health of
for Reproductive Health, the sponsor
Oregonians, delivering higher
Bring pregnancy intention into the
of the ONE KEY QUESTION(R)
quality care and reducing costs.
conversation with your primary
Initiative to help us make Oregon a
The ONE KEY QUESTION(R)
healthier place for families.
care clinician:
initiative does all 3 of these
4. Talk to your primary care clinician.
“Would you like to become
things. Extensive research
Does he or she routinely provide
pregnant this year?”
shows that prevention of health
reproductive health to women?
problems is better for people
Would he or she be willing to ask
and less expensive than waiting until problems
women ONE KEY QUESTION(R)?
happen and then treating them. This is also
common sense.
Endorsements
We need to make it easier for everyone to have
the best prevention services possible when they
see their primary care provider. Half of all
pregnancies in Oregon are unintended and the
taxpayers (through Medicaid) pay for 53% of all
deliveries, even though only 15% of those
women were on OHP when they conceived.
Unintended pregnancy is one of the major
reasons why women and families fall into
poverty. It is critical that we include prevention
of unintended pregnancy and provision of
preconception care in the routine package of
primary care services.
Oregon Foundation for Reproductive Health
Contact: Michele Stranger Hunter, Executive Director, 503-223-4510
The ONE KEY QUESTION(R) Initiative has
been endorsed by 24 professional
organizations, including:
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Nurse Practitioners of Oregon
Oregon Nurses Association
Oregon Academy of Family Physicians
Oregon Medical Association
Oregon Primary Care Association
Oregon Public Health Association
African American Health Coalition
Office of Rural Health
Northwest Portland Area Indian Health Board
Oregon Obstetricians and Gynecologists
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