Preconception Care in Publicly Funded U.S. Clinics That Provide Family Planning Services

Abstract

Introduction Federal recommendations for providing quality family planning services were published in 2014 and included preconception care (PCC). This paper aims to describe the prevalence of PCC delivery among publicly funded clinics, prior to the recommendations. Methods Prevalence of providing occasional or frequent PCC in the last 3 months and having written protocols for recommended PCC screenings were estimated in 2015 using survey data collected from a nationally representative sample of publicly funded clinic administrators (2013–2014, N=1,615). Analyses included examination of differential distributions of outcomes by clinic characteristics (p<0.05) and multivariable regression. Results Prevalence of occasional or frequent PCC delivery was 81% for women and 38% for men. The percentage of clinics with written protocols for specific PCC screenings ranged from 74% to 88% (women) and 66% to 83% (men). Prevalence of having written protocols for all PCC screenings was 29% for women and 22% for men. Characteristics negatively associated with having written protocols for all PCC screenings for women and men (respectively) were as follows: not receiving Title X funding (adjusted prevalence ratio [APR]=0.6, 95% CI=0.50, 0.76; APR=0.6, 95% CI=0.47, 0.77) and being a community health center (APR=0.5, 95% CI=0.37, 0.72; APR=0.5, 95% CI=0.30, 0.67); health department (APR=0.7, 95% CI=0.61, 0.87; APR=0.6, 95% CI=0.49, 0.76); or hospital/other (APR=0.6, 95% CI=0.50, 0.79; APR=0.6, 95% CI=0.43, 0.75) (versus Planned Parenthood). Conclusions Provision of PCC appears to differ by clinic characteristics and by interpretation of the phrase “preconception care,” suggesting opportunities for education and improvement.

Prevention of noncommunicable diseases by interventions in the preconception period: A FIGO position paper for action by healthcare practitioners

“…This means that in many cases, the onus for preconception care is on healthcare practitioners who see women in their routine practice, for reasons other than pregnancy planning. Elements of preconception care can occur whenever a healthcare practitioner meets a woman of childbearing age and this would include offering support for pregnancy planning or contraception counselling, and addressing nutrition and weight management 22,24,25 …”

Availability of Services Related to Achieving Pregnancy in U.S. Publicly Funded Family Planning Clinics

“…Conversely, we found that recommendations for routine screening of pregnancy intentions (i.e., reproductive life plan assessment), preconception health care (for men), and screening for risk factors for infertility and adverse pregnancy outcomes (i.e., STD and body mass index screening for men) were more likely in Title X compared with non-Title Xfunded clinics. Previous studies using these data have also shown enhanced preconception care service delivery in Title X-funded clinics (Robbins et al, 2016), which was attributed to institutional support from the Office of Population Affairs to Title X grantees to promote preconception care and training in reproductive life plan assessment. Although we adjusted for some differences between the two clinic categories, the differences we found in services provided by Title X funding status may also reflect the unique needs of the clients attending each type of clinic.…”

“…Although previous analyses of these study data have examined several of the preconception care services included in our analysis (Robbins et al, 2016(Robbins et al, , 2017, we were specifically interested in identifying the full set of services that may offer opportunities to prevent infertility and/or enhance fertility in family planning settings serving persons with low incomes. In particular, we found that a high proportion of publicly funded clinics reported that they provided basic infertility services for women (66%), whereas a lower proportion reported this for men (45%).…”

“…Surveys could be completed on paper or online, and several follow-up reminders were sent. Details of the study's survey methodology have been previously published (Carter et al, 2016;Robbins et al, 2016;Robbins, Gavin, Carter, & Moskosky, 2017).…”

China’s community-based strategy of universal preconception care in rural areas at a population level using a novel risk classification system for stratifying couples´ preconception health status

“…Preconception care (PCC) is defined as interventions that aim to identify and, when possible, modify the biomedical, behavioral, and social risks to optimize woman’s health before pregnancy with the aim of improving pregnancy outcomes [1]; In 2014, Centers for Disease Control and Prevention (CDC) and the Office of Population Affairs published clinical recommendations, “Providing Quality Family Planning Services” (QFP), and recognized PCC as a critical component of health care for women of reproductive age [2]. …”