Preconception Health Toolkit

Toolkit/Guide
Preconception Health Title X Family Planning Program
Last Reviewed
Source
RHNTC

Welcome to the Toolkit

Preconception and interconception health services aim to identify and modify biomedical, behavioral, and social risks to an individual’s health or future pregnancy outcomes through prevention and management. These services promote the health of individuals of reproductive age before conception (preconception health services) or between births (interconception health services), which helps to reduce pregnancy-related adverse outcomes, such as maternal morbidity and mortality, low birth weight, preterm birth, and infant mortality.1 Preconception health services benefit all individuals of reproductive age, regardless of whether they are planning a pregnancy.2

This toolkit provides a series of steps and supportive resources that Title X family planning projects can use to review and strengthen the quality of preconception health services. Family planning agencies can use this toolkit to improve preconception health knowledge, attitudes, and practices; strengthen preconception health services to support clients in attaining and maintaining optimal health; integrate contextual and environmental factors into preconception health services; and reduce disparities in maternal and pregnancy outcomes.

Image of healthcare provider with patient smiling

Use this toolkit as a guide to review and strengthen the quality of preconception health services.

The toolkit proposes five steps to enhance Title X agencies' preconception health services and activities:

  1. Assess your agency’s preconception health services
  2. Expand opportunities to engage staff in preconception health interventions
  3. Routinely conduct high-quality preconception health assessments
  4. Strengthen the quality and responsiveness of preconception health services
  5. Collaborate with community partners to improve preconception health

Preconception and interconception health services are essential components of family planning services. Family planning agencies can improve outcomes in clients of reproductive age by implementing preconception health evidence-based guidelines and recommendations. As an initial step, family planning agencies should assess the preconception health services they provide and identify gaps between current and recommended practice. Using this analysis, family planning agencies can then conduct quality improvement over time.

Action Steps Supportive Resources

Review current preconception health evidence-based guidelines and recommendations.

QFP at a Glance

National Preconception Health and Health Care Initiative Practice Bulletin, 2020

Assess the extent to which preconception health policies and protocols reflect evidence-based guidelines and recommendations.

Provision of Family Planning and Related Services Sample Policy Template

Family Planning Program Policy and Procedures Preconception Health Screening and Counseling

Track preconception health measures over time to identify opportunities to expand preconception health services and make other related improvements.

Quality Improvement Plan

Preconception Health Services Performance Tracking Sheet

Include preconception health messaging informed by community members with diverse reproductive intentions and goals in Community Participation, Education, and Project Promotion (CPEP) plans.

Community Participation, Education, and Project Promotion Plan Template

The conditions in which we are born, grow, live, work, and age—also referred to as social determinants of health—impact preconception and interconception health. To address pervasive health inequities, social determinants of health must inform strategies for improving sexual and reproductive health. Family planning agencies should continue providing opportunities for clinicians and staff to analyze the root causes of maternal morbidity and mortality and give them resources and training to act to reduce racial inequities. This foundation will give staff both the motivation and skills to make changes.

Action Steps Supportive Resources

Train staff, as needed, on the root causes of reproductive and sexual health inequities and ongoing harms experienced by communities of color.

Innovating Education in Reproductive Health. Structures & Self: Advancing Equity and Justice

Think Cultural Health. Culturally Competent Nursing Care: A Cornerstone of Caring

Train staff, as needed, on shared decision making and client-centered care.

Putting the QFP into Practice Series Toolkit

Principles for Providing Quality Counseling

Train staff, as needed, on the foundations of preconception care and counseling.

Determining Your Client’s Need for Services and Discussing Reproductive Goals eLearning

Before, Between, and Beyond Pregnancy Website

Family planning agencies should incorporate life course theory into their preconception health assessments. Life course theory describes how contextual and environmental factors inform individuals’ health across their lifetimes and shape health and disease patterns across populations and communities. Before counseling a client about healthy behaviors, providers should routinely assess the client’s context and environment.

Action Steps Supportive Resources

Assess all clients’ reproductive goals.

Client-Centered Reproductive Goals & Counseling Flow Chart

Assess risk factors for adverse health and adverse pregnancy outcomes before conception.

Preconception Counseling Checklist

Preconception Health Resource Index

Assess and address social needs to support each client’s ability to engage in healthy behaviors.

PRAPARE: Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences Screening Tool

Optimize clinic flow to efficiently collect clients’ preconception health assessment data.

Clinic Flow Assessment

Using Data to Increase Clinic Efficiency: A Quality Improvement Guide

Unique factors affect each client’s preconception and interconception health. Family planning agencies should provide preconception health education, counseling, care, and referrals that align with evidence-based guidelines and take into account the goals, risks, social needs, and contextual and environmental factors gathered during a client’s preconception health assessment.

Action Steps Supportive Resources

Provide clients with risk reduction strategies that reflect their preconception health assessment and evidence-based guidelines and recommendations.

Provide clinical and non-clinical resources and referrals to support clients in reaching their general and reproductive health goals.

Establishing and Providing Effective Referrals for Clients: A Toolkit for Family Planning Providers

Gather client satisfaction data and use results to enhance preconception health services.

Patient Experience Improvement Toolkit

Although improving the quality of preconception and interception health services in the clinical setting is important, it is insufficient for reducing maternal morbidity and mortality at scale. Local and national agencies must work together to address social determinants of health, which drive health inequities within communities of color and increase their burden of poor health outcomes.3,4 Engaging in diverse collaborative community partnerships can help family planning agencies identify additional opportunities for improving maternal health outcomes.

Action Steps Supportive Resources

Work with community partners to identify root causes of inequities in maternal morbidity and mortality.

Build relationships with community partners that work toward improving health conditions for individuals of reproductive age.

Stakeholder Mapping

System Support Mapping

Collaborate with community partners to implement strategies that can address underlying causes of inequities in maternal morbidity and mortality.

Integrate culturally appropriate wellness and healthy living messaging into community education and outreach activities.

Collaborate across sectors (for example, health care, education, housing, law enforcement) to expand opportunities to advance health equity.

Value Proposition Template

 

  1. Gavin, L., Moskosky. S., Marion, C., Curtis, K., Glass, E., Godfrey, E.,...Zapata, L. (2014). Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs. Morbidity and Mortality Weekly Report, 63(4). Retrieved from https://www.cdc.gov/mmwr/pdf/rr/rr6304.pdf
  2. Ibid.
  3. Centers for Disease Control and Prevention. (2021, April 9). Working Together to Reduce Black Maternal Mortality. https://www.cdc.gov/healthequity/features/maternal-mortality/index.html
  4. Centers for Disease Control and Prevention. (2021, April 12). Racism and Health. https://www.cdc.gov/healthequity/racism-disparities/index.html