A direct and patient-centered approach to people’s contraceptive needs

New research highlights the need for a more specific and patient-centered question to connect people with contraceptive care.

Over the last two decades, primary health care services have put more focus on addressing patients’ reproductive health needs. This focus was motivated in part by an idea that providers were failing to identify people who needed contraceptive services, as well as a desire to expand counseling to support healthy pregnancies.

One commonly used screening tool is One Key Question (OKQ), developed in 2011 to incentivize screening for reproductive health care needs in primary care. OKQ consists of asking patients, “Would you like to become pregnant in the next year?” There is a sequence of recommended steps for providers to follow depending on the answer.

One goal of implementing OKQ has been prevention of unintended pregnancy by increasing contraceptive use among people who answer “no.” However, it’s unclear whether what people say about their desire for pregnancy in a year’s time reflects their needs for pregnancy prevention services at the time of the visit.

New research from the Person-Centered Reproductive Health Program looked at the relationship between answers to OKQ and response to a question about current interest in preventing pregnancy.

  • Of the people who said that they wanted to become pregnant in the next year, 30% reported that they wanted to prevent pregnancy now.
  • Of the people who indicated ambivalence in response to OKQ, 44% answered that they wanted to prevent pregnancy now and 13% were unsure.

For some people, whether they want to become pregnant in a year may not align with whether they want pregnancy prevention now. These findings have implications for the use of OKQ as a screening tool in clinical care. Researchers found a sizeable minority of people who reported wanting to prevent pregnancy now and wanting to become pregnant within a year. People may want to delay pregnancy for at least a short period of time, indicating that OKQ may not adequately capture people’s contraceptive needs.

More than half of people who were ambivalent about the desire to become pregnant reported wanting pregnancy prevention now. Under current guidelines, people who report ambivalence in response to OKQ should be counseled to investigate their needs further, however whether or how providers due that can be inconsistent.

Using pregnancy intention to assess current contraceptive needs is indirect and complex. A more patient-centered approach may be to ask the patient directly about their contraceptive needs.