A public health movement in Oregon — where doctors query every woman of reproductive age — could make women and families healthier across the nation.

It’s called One Key Question, and asks these women: “Would you like to become pregnant in the next year?”

According to an article published in Slate, the Oregon Foundation for Reproductive Health believes this question “triggers a doctor-patient discussion that will keep women healthier, help eliminate health disparities and save taxpayer dollars.” Public Health Newswire spoke to the Ms. Foundation for Women’s Julie Kay and OFRH’s Michele Stranger Hunter to explain how, and how public health advocates can bring the question into more doctors’ offices.  

The concept of One Key Question is simple — to ensure that more pregnancies are wanted, planned and as healthy as possible. How can these 10 words make such an impact?

Julie Kay is the senior strategist, advocacy and policy, for the Ms. Foundation for Women. Photo by Julie Kay

This straightforward, non-judgmental question brings pregnancy intention screening and preventive reproductive health directly in to primary care. It opens the door to providing either preconception, prenatal or contraceptive care in a novel fashion that goes beyond simply asking if she is pregnant or using contraception. By asking a woman what she wants, not simply what steps she is taking at the moment, One Key Question is a conversation starter, not a checklist. It can initiate a genuine conversation that empowers a woman to plan her health care needs in support of her goals for herself and her family.

The best procedures are those most simple in design and function. OFRH tested many variations of asking about prenatal care and pregnancy prevention before determining this “iPhone of a question” to be the most effective.

What response have you gotten from doctors who have asked OKQ? How have patients responded?

We all know that doctors are busier than ever today, and frankly, many were initially concerned about opening up a Pandora’s Box by asking One Key Question. What the clinicians implementing One Key Question have found, however, is that the majority of women have a clear opinion about whether or not they would like to become pregnant in the next year. The question then very efficiently addresses reproductive health care needs.

In contrast, when a woman answers “maybe” or even “I don’t know,” One Key Question helps organize the larger conversation with her health care provider. For undecided women, One Key Question often effectively identifies urgent health needs that may otherwise go undetected — such as depression, violence in the home or substance abuse — and leads to negative pregnancy outcomes. OFRH works closely with doctors to provide ongoing support to those implementing One Key Question into their practices and has set up a clearinghouse that collects and distributes implementation experience from a wide range of practice settings, sharing solutions to common implementation barriers and operational templates of clinic flow, electronic health records, and educational materials to maintain support and track implementation.

The feedback we have gotten from patients has been enormously positive. Women say that it’s a relief to be able to talk about their reproductive health needs in a primary care setting rather than through a separate appointment with a specialist. This more streamlined approach can be invaluable for low income women, women of color and those in rural communities, in particular, who have decreased access to reproductive health care.

In a Slate column, you said that One Key Question will both eliminate health disparities and save taxpayer dollars. How are you measuring its impact?

Michele Stranger Hunter is the executive director of the Oregon Foundation for Reproductive Health.

We are in a moment in this country where nationally, health care providers, politicians and the general public are all very aware of the need to dramatically improve access to preventive health care without increasing costs. Pregnancy, childbearing and antenatal care are some of the most vital and the most expensive health care interventions, with the potential for lifelong positive or negative effects. Pregnancy outcomes are closely related to maternal child health disparities and low-income women of color experience the most compromised health before conception and disproportionately high instances of low birth weight and preterm babies, maternal mortality and other related outcomes.

One Key Question plays an indispensable role by identifying medical needs – not simply contraceptive use – at the time when treatment is straightforward and cost effective, ideally before conception even occurs.

To measure its impact, we are pleased to be partnering with researchers nationwide to collect implementation data on three major indicators: first, whether there has been an increase in contraceptive care as a result of One Key Question; second, whether there has been an increase in the number of women choosing to use more effective contraceptive methods; and third, whether there has been an increase in consumption of folic acid and prenatal vitamins, prime indicators that a woman was counseled about preconception and prenatal care.

OFRH is very aware of the need to establish reliable systems for measuring the impact of One Key Question as it is implemented in sites nationwide. Individual providers using One Key Question are asked to gather data and OFRH is developing a system to track early prenatal care and birth outcomes to see if there is correlation in a specific site. County public health data could also be relevant and we hope to gather that in the future.

Ultimately, because One Key Question encourages women to obtain preconception care, we expect we’ll see a drop-off in public health care costs as earlier identification and management of conditions such as diabetes and hypertension improve pregnancy, delivery and post-natal care and lower long-term costs for all women, but particularly for those with decreased access to specialized care.

APHA is one of 30 professional organizations that support One Key Question. What are your next steps to bring this question into more health care conversations?

We are thrilled that the APHA membership is able to learn about One Key Question and appreciate that APHA is a leader in recognizing reproductive health as a key part of public health. We would like to have a dozen new sites launching One Key Question next year – it would be great to have a One Key Question doctor, or a “public health provider of the month” to feature. OFRH welcomes inquiries and feedback from APHA membership and is developing an advisory group to advise on public health implications and other aspects of our One Key Question implementation.

Other exciting ways that we are exploring to spread the word about One Key Question include partnering with the National Association of Nurse Practitioners to convene organizations committed to public health and primary care and reaching out to health care professionals, policymakers and funders to implement One Key Question in additional sites nationwide. Of course we’ll continue to gather and disseminate the data on implementation and to support medical providers interested in launching One Key Question in their practice. We’re also designing a public campaign that asks women to make their primary care provider aware of their reproductive health needs and not just expect this from an OBGYN.

Has your doctor asked if you would like to become pregnant in the next year? If not, ask your doctor why.

Unintended pregnancy is a decades-old community health problem. Enough is enough. We have the experience and expertise to change the outcomes; now let’s change the system!

Patients and providers can learn more about reproductive health at One Key Question online, including a one-page brochure.