Commentary: Investing in women's preconception care is investing in our future
Every day, Jennifer McClure, a family nurse practitioner at Christiana Care Health System, sees women of all ages and for all kinds of medical issues. There is one question she asks every young woman during her appointment: "Do you want to become pregnant in the next year?"
If the answer is yes, Jennifer provides preconception care. If the answer is no, that opens the door to a different conversation, including which birth control method might be right for her. This simple, yet respectful counseling gives women control of their reproductive health and overall well-being.
A key part of advancing health outcomes for women and children is to work with women to plan and space their pregnancies. In the U.S., nearly 50% of all pregnancies are unplanned—6% higher than the global average and a shockingly high number for the nation with some of the best healthcare in the world.
Unplanned pregnancies can be detrimental to the health of mother and child. Women who had not planned to become pregnant can struggle with delayed prenatal care and postpartum depression. Unplanned babies are more likely to be born preterm and have lower birth rates, which can affect the rest of their lives.
A key to reducing the number of unplanned pregnancies is to reduce barriers that prevent women from accessing the full range of contraception options. These barriers can include providers not trained in all contraception options, high costs and lack of local availability.
The opportunity is great. Lowering the rate of unplanned pregnancy improves economic and health outcomes for women. Healthier mothers and children can lead to increased education and employment opportunities for women and their families.
Addressing unplanned pregnancies also has significant potential to reduce the burden on our healthcare system. The rate of unintended pregnancy for low-income women is five times the rate among wealthier women. The costs on our healthcare system to care for unintended pregnancies are immense–$21 billion each year in public costs alone.
Ensuring that women can plan when and if they want to become pregnant can help break the cycle of economic inequality.
Delaware, where Christiana Care is based, for years has had one of the highest rates of unintended pregnancies in the U.S. To ensure same-day access to the full range of contraception through every door of the healthcare system, Upstream USA, a national not-for-profit founded in 2014 to expand economic opportunity and mobility by reducing unplanned pregnancy, created a public-private partnership with the state of Delaware. Across the state, including at Christiana Care, healthcare providers can now offer women more convenient access to birth control—and not just in the offices of OB-GYNs.
The full range of contraception is offered as part of annual screenings for all women of childbearing age, and in hospitals immediately after a woman has given birth. Physicians, nurse practitioners and nurse midwives learn how to place and remove long-acting contraception. Support staff learn patient-centered counseling techniques to educate women about all of their birth control options.
Early results indicate that we are well on our way to reducing Delaware's high unintended pregnancy rate.
The starting point is integrating access to contraception into primary care and training a range of providers and staff to be a part of the solution. This approach can be replicated nationally—and is gaining momentum with recent expansions to Massachusetts and Washington state. We need more large healthcare systems to support access to these vital services.
By empowering women to decide when and if they want to become pregnant, we are giving them the keys to health and future success.
Imagine a nation with the highest rate of healthy women and babies in the world. That is a nation with women and communities ready to achieve their full potential. It can be ours.
Dr. Janice E. Nevin is president and CEO of Christiana Care Health System in Wilmington, Del. Mark Edwards is co-founder of Upstream USA, based in Oakland, Calif.
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