“Would you like to become pregnant in the next year?”
It’s a simple enough question, and most women probably know exactly how to answer it. But their doctors aren’t asking them. Typically, primary care doctors simply ask their female patients whether or not they’re currently using birth control, and that’s the beginning and end of the conversation.
Michele Stranger Hunter, the executive director of the Oregon Foundation for Reproductive Health, thinks that nuance matters. In an interview with ThinkProgress, Hunter pointed out that if a doctor simply asked their female patient what she wants for her reproductive future, that could open up a larger conversation about how to best achieve that. For instance, if she doesn’t want to become pregnant, they could discuss her range of contraceptive options and make sure she’s using the best method for her lifestyle — as well as make sure she knows how to use it effectively. If she is thinking about having a baby within the next year, they could discuss how to prepare for that and come up with a plan for her pre-natal care.
“Women are going to doctors, but doctors aren’t talking to them about birth control,” Hunter told ThinkProgress. “No matter how many family planning clinics and Planned Parenthood clinics we have, we’re still not talking about this in primary care, and it’s a huge missed opportunity.”
Hunter has been working in reproductive health for over 40 years. She remembers what it was like to be in this field before Roe v. Wade legalized abortion, and she’s watched women’s health care slowly drift away from the rest of the medical community over the past several decades. Politicized fights over access to contraception and abortion — and, particularly, whenever those services collide with taxpayer dollars — have ensured that reproductive health isn’t integrated into the rest of medical practice. Now, primary care doctors aren’t necessarily required to provide the full range of women’s health services in their offices, so many of them don’t.
So perhaps it’s no surprise that those doctors aren’t necessarily initiating the right conversations with women about contraception. One recent study found that the vast majority of women are misinformed about their different birth control options, yet don’t receive counseling on the subject from their health care professional. One out of ten women say they have questions about contraception that they don’t feel comfortable asking their doctor.
That’s why, in partnership with a primary care provider, Hunter developed the “One Key Question” program. Essentially, she simply wants to encourage general practitioners to start asking women this question — whether or not they want to become pregnant during the next year — during each annual check-up. The initiative was first piloted at a community health center in Oregon, and it’s since spread to several public health county clinics in the state. The Oregon Medical Association now endorses it.
And the goal is to spread it even further. Hunter’s group has received a grant from the Ms. Foundation for Women to keep working on One Key Question. The project is funded under the Ms. Foundation’s current initiative to integrate women’s reproductive health into basic health care. Especially over the past several years, as federally-funded family planning clinics and abortion providers have been under attack from anti-choice Republicans across the country, there’s been a renewed push to protect women’s health care by incorporating it back into general practice.
“Our current project is trying to make sure women’s health isn’t left out in the implementation of the Affordable Care Act,” Ellen Liu, the director of the Ms. Foundation’s women’s health program, told ThinkProgress. Liu pointed out that contraceptive counseling is an important part of a holistic approach to women’s health. “We chose Oregon because we want to fund innovative pilot programs that can be replicated across the country. One Key Question is so simple, and it’s just brilliant.”
Hunter is quick to note that although One Key Question is an incredibly effective method of helping prevent unintended pregnancy, it’s not just for women who don’t want to have a baby. It’s not necessarily framed around abortion rights, and it doesn’t have to be in conflict with abortion opponents (at least, as long as they aren’t also opposed to birth control).
“We’re here to support women whether she wants to be pregnant or whether she doesn’t want to be pregnant,” Hunter explained. She pointed out that the United States still has high rates of pre-term births and infant mortality rates, and some of those issues could be improved if women more effectively spaced their pregnancies and received better pre-natal care.
When ThinkProgress asked her if One Key Question could be implemented in a red state — somewhere that’s quite a different environment from Oregon, the only state left in the entire country that hasn’t imposed a single restriction on abortion — Hunter replied, “Absolutely.”
“It’s so rooted in common sense. Our goal is to have a great proportion of pregnancies that are planned, wanted, and as healthy as possible. Who’s going to fight that?” she pointed out. “I don’t care how red your state is. If you’re really talking about health pregnancies, healthy women, healthy babies — it’s very hard for people to be against that.”