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Pregnancy impacts almost every aspect of a women’s life and that of her family. Pregnancy timing and circumstances affect not only a prospective mother’s health, but also the wellbeing of her children.

While nearly half of women in the US will experience an unintended pregnancy in their lifetime, many health care workers do not ask about a woman’s desire to become pregnant.

Cascade Pacific Action Alliance (CPAA) hosted a One Key Question training on June 4th to teach health care works to ask their patients: “Would you like to become pregnant in the next year?” and have counseling and resources ready for responses from clients who respond one of four ways: they do want to become pregnant, do not want to become pregnant, don’t know, or are unsure about what they want to do.

Throughout the full-day training, trainers from Power to Decide modeled how to talk to clients about their pregnancy intentions using the One Key Question model.

While rates of unintended pregnancy remain around 22% in Washington State, many women, when asked if they want to become pregnant in the next year, respond that they are uncertain or don’t know. This presents a challenge for health care workers, who are often on a tight schedule and do not want to push clients to make a difficult decision about their bodies before they are ready.

“It’s important to sit with that uncertainty and be okay with it,” said one of the Power to Decide trainers for the event. While uncertainty is common, armed with the right training, health care works can help clients think through that uncertainty.

Participants shared how challenging it can be to keep their own biases from guiding women’s decisions about birth control and pregnancy. Community health workers, whose work relies on a trusting relationship with their clients, said their clients often directly ask them “what do you think I should do?” when asked about contraceptive needs.

The One Key Question model encourages health care providers, from primary care providers to social workers, to talk with women about different types of birth control, how much time to wait before becoming pregnant again, encourage women to talk to their partners about birth control, and how to adopt healthy behaviors for a healthy pregnancy.

The training gave providers tools to talk a patient through these decisions by conducting role-playing exercises, handing out contraceptive counseling materials, and facilitating peer to peer learning where participants shared what works for them and how to talk with clients facing difficult situations. Participants brainstormed how to embed One Key Question into their intake or electronic health records systems and ensure that there are standard ways providers and health care workers address client needs.

The training also included national data illustrating how reproductive health outcomes vary based on income and race. Despite an overall decline in unintended pregnancy, rates remain high for low income women and women of color. Furthermore, Black and American Indian/Alaska Native babies are two times more likely than white babies to die before the age of 1. Black women are three to four times more likely to experience a pregnancy-related death than white women.

Stark racial disparities helped health care workers in clinical and non-clinical setting see the importance of ensuring everyone they work with has access to timely and high quality care. The training empowered physicians, social workers, community health workers, nurses, and home visitors to feel more comfortable helping families identify goals around if or when they want to become pregnant. Whether a client wants one child or five, or to be pregnant in three years or next month, providers were encouraged to help clients achieve their reproductive goals in the most safe and healthy way possible.

Over 50 health care workers attended the training from 15 different organizations. Organizations included home visiting programs, hospital systems, health department, state agencies, Federally Qualified Health Centers, and community-based organizations. The diverse mix of health care workers and organizations allowed attendees to understand how different parts of the healthcare system can align to provide quality care for families.

Please contact Caroline Sedano with any questions: