Community-based model aims to address lifelong reproductive needs

Using a wide range of data on contraception and preconception care, researchers in the United Kingdom developed a community-based model that holistically addresses women’s reproductive health care and needs throughout their lives.

The model “will bridge the gap between contraception and antenatal services, providing services in a way that better meets women’s needs as they move through their reproductive life course, in line with the ambitions of the recent Women’s Health Strategy,” Jennifer Hall, MBChB, PhD, MSc, MFPH, FHEA, lead author of the study, said in a press release.

Healio spoke with Hall, who is a clinical associate professor and a National Institute for Health and Care Research advanced fellow at the University College London Elizabeth Garrett Anderson Institute for Women’s Health, to learn more about the model.

Healio: How do contraceptive and preconception care typically work now?

Hall: There is no routine preconception care in primary care in the U.K. Some women with existing conditions, such as diabetes or epilepsy, may receive preconception health advice as part of secondary care. Contraception is freely available in primary care through general practice and through sexual and reproductive health clinics in the community.

Healio: What shortcomings in care need to be addressed?

Hall: We would like everyone to be able to have access to advice about how to prepare for pregnancy, but this doesn’t have to be through formal health care. While different health professionals — general practitioners, practice nurses, health visitors, sexual and reproductive health doctors, etc — can provide this information directly, other options include signposting people to relevant sources or digital tools to enable people to access information themselves. Schools, social media and other national actions, such as flour fortification, all also play important roles in improving preconception health.

For contraception, changes to how these services are commissioned over the last decade has resulted in a persistent lack of funds and subsequent reduction in services. This means that it can often be quite hard to access these services, especially for the long-acting reversable contraceptives that are most effective at preventing pregnancy, with many general practitioners no longer providing these services and community services having long waits. This needs urgent action.

Women currently have to go to different places to access different services; it would be better if reproductive health care were provided more holistically. Women’s hubs, which would offer this, are currently being trialed in a number of areas, and this model is something that would be relevant to them.

Healio: How did you develop your community-based model?

Hall: We developed the model using a number of different sources of evidence: a literature review on ways of providing preconception care in the community; new analyses of data on women’s preferences on how, where and who could ask them about pregnancy preferences; and exploring case studies of existing practice from across England. In line with the WHO recommendations to leverage existing programs and explore innovative channels to improve preconception care, we did not restrict our model to health care, but considered schools, social media, digital health and other society-wide aspects of raising the awareness of the importance of preconception health.

Healio: How does the model work?

Hall: This is a high-level model that can be adapted to use at the level of the individual, for service design and for policy. The model is centered round assessing people’s preference — whether that is to avoid pregnancy or to become pregnant — and providing care accordingly. This is not something that is currently routinely done. Given that there is more evidence, and long experience, with providing contraception services, we focus on detailing the steps involved in a preconception journey. This means identification of any risks — for example, overweight, smoking, preexisting medical condition — education on how to address these and, if required, intervention.

Healio: How generalizable is the model to different communities and countries?

Hall: While based mainly on evidence from high-income countries and developed with the U.K. in mind, we believe that the high-level nature of this model enables it to be considered for implementation in other settings, with appropriate consideration of the context.

Healio: Is there anything else you would like to add?

Hall: The most important thing about the model is that it is based around assessing people’s preferences and supporting them to achieve their reproductive goals, or to develop them if this is something that they haven’t really thought about before. So, it isn’t about getting everyone on contraception, or assuming that everyone of reproductive age should want to have children. But by encouraging people — starting from school, employing digital health and working with society through social media — to think about whether or when to have children, we can help them achieve their goals, reducing unplanned pregnancies and improving preconception health at the same time.

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Reproductive & Maternal Health Resource Center