Sign In
Boston Public Health Commission Home

For Providers


Doctor talking to patientIn 2012, the Oregon Foundation for Reproductive Health (OFRH) created the One Key Question® initiative (OKQ) to address high rates of unintended pregnancy, low rates of preconceptional health care, and inadequate awareness among women of options in relation to contraception. One Key Question® provides tools providers can use to screen women about pregnancy intent and then guide them to appropriate follow-up care. The process starts with a simple Question®: “Would you like to become pregnant in the next year?”

This conversational, encouraging approach allows women to consider their families and their futures, and serves as one step of many in ensuring that all pregnancies are wanted, planned, and as healthy as possible. Based on the success of the OFRH’s program, the Boston Public Health Commission (BPHC) welcomes the One Key Question® campaign as a way for Boston providers and patients to better prepare women in facilitating their own reproductive health needs.

Women who reply to One Key Question® with “No”, “I’m not sure” or “I’m fine either way” can be referred to family planning counselors for discussion about contraceptive options that are tailored to their needs. Some women who take this path may prefer contraceptives that are permanent, such as tubal ligation, or long-term, reversible options, such as IUDs. Women who indicate that they are uncertain or fine either way can be referred both to preconception care and offered short-term contraceptive methods, such as birth control pills; women who indicate that they definitely want a baby should be immediately engaged in a well-woman/before-the-baby preventative care to ensure the healthiest pregnancy possible.
We encourage primary care providers who see women of reproductive age to adopt One Key Question® as a standard part of care. For additional support in helping your practice succeed with healthy family planning, please visit our Resources page. (link)

Why Now?
Recent analysis indicates that almost half of all pregnancies nationwide are unintentional. Unfortunately, research shows that an unplanned pregnancy can lead to worse outcomes for mother and infant, with increased rates of stress, financial hardship and domestic violence.
But there’s hope: research from the Centers for Disease Control (CDC) shows that preconception care, which includes the identification and management of chronic medical conditions, nutritional counseling, assistance with and education about smoking cessation and other forms of lifestyle and behavioral modification, as well as support around environmental circumstances, can increase the likelihood of a healthy pregnancy.

One Key Question® also addresses the following issues:

Essential Need
Women of reproductive age need access to accurate information, services and necessary referrals. Women who do not wish to become pregnant need appropriate contraceptive and preventive care. Women who proactively wish to become pregnant or are comfortable with the possibility of pregnancy need targeted primary and preventive care. Perinatal Periods of Risk (PPOR) analysis of Boston’s health data indicates that women’s health leading up to and early in pregnancy is a central factor in the health of their babies, reinforcing the case for care prior to conception.

Beneficial for the Mother, Child and Family
Pregnancies should be wanted, planned, and as healthy as possible. Contraception is a core preventative measure both to ensure that pregnancy occurs only when a woman is ready and to prevent transmission of infection from unprotected sex. Unintended pregnancy can be stressful for the family, increasing financial difficulties and derailing educational and career opportunities. Unintended pregnancy can impose health burdens when it occurs too close to a previous pregnancy or in the presence of untreated or poorly managed chronic disease. These can cause risks to the mother’s health and also place the infant in harm’s way while jeopardizing the overall family wellbeing.

Beneficial for Society
Women’s ability to control fertility through contraception was a major health breakthrough of the twentieth century reducing maternal and infant mortality and improving family wellbeing overall. This advance paved the way for women’s increasing roles as active members of their social and economic communities. When the full range of reproductive services are not available to women, adverse health consequences impair social wellbeing and lead to increase costs for health care, education, and social services. Unplanned pregnancy places a particular burden on lower income families, who are less likely to have jobs that offer paid sick leave and other benefits related to healthy childbearing. By increasing communication between clinician and patient, One Key Question® offers an opportunity to improve health equity and better care for women of all socioeconomic statuses, especially those who do not have the financial option of an ill-timed birth.

Boston Public Health Commission
1010 Massachusetts Ave, 6th Floor, Boston, MA 02118.
Phone:(617) 534-5395 Email: