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Models Addressing Preconception Health

Preconception health emphasizes the importance of engaging in healthy behaviors prior to pregnancy, as it sets the stage for a healthy pregnancy and a healthy recovery after delivery. Forty-five percent of pregnancies in the U.S. are mistimed or unintended, and unintended pregnancies occur more often in communities with less income and less formal education. Rural women are over-represented in this group, which suggests a relationship between risk of unintended pregnancy and rurality.

Pregnancy can be unpredictable, so it is difficult to determine at what point clinical visits should address preconception health. It is therefore recommended that healthcare providers deliver comprehensive education at all preventive care appointments with all patients of childbearing age. Topics addressed may include include nutrition, social connectedness, contraception, and other healthy behaviors. Evidence suggests that preconception education interventions may improve nutrition and physical activity, increase consumption of folic acid, reduce the risk of birth defects, reduce smoking pre-pregnancy, and reduce binge drinking. There is also evidence that increasing access to long-acting reversible contraceptives reduces unintended pregnancy and reduces teen pregnancy. Healthcare providers should pay particular attention to patients from communities that might benefit most from preconception care, including non-Hispanic Black women, uninsured women, and those residing in Southern states.

Examples of Preconception Health Programs

  • The National Preconception Health and Health Care initiative is a private-public partnership. The initiative established a national goal for women and men of reproductive age to achieve optimal health so they and their future children are healthy. Women of childbearing age will ideally make necessary changes to unhealthy behaviors and habits, such as achieving a healthy weight, eating healthfully, quitting smoking, and increasing physical activity, prior to conception. The initiative acknowledges that behavior change takes time.
  • Interventions such as CHOICES have improved the use of contraception and reduced pre-conception alcohol consumption in some minority populations, such as American Indians.
  • Every Woman California, an initiative of Preconception Health Council of California, has partnered with Covered California to work with individuals, healthcare providers, and communities to improve the health of women of reproductive age. The program encourages making reproductive life plans and offers education to community groups on how to provide healthy environments to raise healthy children. Covered California, the statewide health insurance marketplace, offers preconception health promotion visits without copays.

Program Clearinghouse Examples

Considerations for Implementation

Women in rural communities face multiple barriers to accessing preconception care, including contraception. Geography and transportation are majors barrier for rural women, as they may result in long travel times to clinics or provider offices, which may make it difficult to access care. Telehealth and home-delivery of pharmaceuticals may address geographic and transportation barriers. Other barriers include:

  • The high cost of birth control and provider visits, especially for women with low incomes or inadequate insurance coverage
  • Indecisiveness about planning for pregnancy
  • Lack of knowledge about contraception options available
  • Fear or stigma around seeking contraception or medical advice

Resources to Learn More

Long-Acting Reversible Contraception (LARC)
Website
Information on activities and initiatives related to increasing access to LARCs, including state-by-state guidance on Medicaid reimbursement for postpartum LARCs.
Organization(s): The American College of Obstetricians and Gynecologists (ACOG)

Preconception and Interconception Care: The Role of the Home Visitor – A Critical Look at the Current Literature and Recommendations for Programs
Document
Highlights the importance of preconception care (PC) and interconception care (IC) for improving pregnancy outcomes and discusses the evidence supporting the integration of home visitors (HV) in providing PC and IC. Offers guidance and recommendations for HVs addressing preconception health.
Author(s): Alio, A.
Organization(s): University of Rochester Medical Center, New York State Maternal & Infant Health Center of Excellence
Date: 6/2017

Preconception Resource Guide
Tutorial/Training
Developed as a reference tool for primary care providers caring for women who may become pregnant or are at risk of becoming pregnant, and for women who prefer not to become pregnant.
Organization(s): National Preconception Health and Health Care Initiative, University of North Carolina at Chapel Hill