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
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.
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
- 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
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)
and Interconception Care: The Role of the Home Visitor – A Critical Look at the Current Literature and
Recommendations for Programs
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
Preconception Resource Guide
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