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 Title X: Promoting Preconception Health through Family Planning

By Clare Coleman
President and CEO, National Family Planning & Reproductive Health Association (NFPRHA)

Public health researchers and analysts familiar with the Title X program recognize it as the nation’s only dedicated source of federal funding for family planning services. However, few know that in addition to the vital contraceptive and other sexual health services available in Title X-funded health centers, many women access a wide range of health services – commonly referred to as preconception care – designed to reduce and address risk factors known to affect future pregnancies. The Office of Population Affairs, the agency responsible for administering the Title X program, recognizing the natural fit between the public health goals of preventing unintended pregnancy and promoting healthy pregnancies, has made preconception care one of the Title X program priorities.

Many of the services traditionally provided in a Title X-funded health center help women and their families prepare physically and mentally for a pregnancy. Women often visit a family planning health center seeking a routine pelvic exam, contraceptive services, screening for STDs or pregnancy tests. Access to contraceptive services, including both a birth control method and counseling, helps women prevent a range of pregnancy-related health complications. In addition to these traditional services, Title X programs have integrated cost-effective and efficient strategies to their list of available health services to address preconception care, including education and counseling to address diabetes, obesity, smoking cessation and other health risks. In addition, family planning programs help women with "reproductive life planning," asking a series of questions to assess specific risk factors that might impact a future pregnancy.

The California Family Health Council (CFHC), for example, uses a series of screening questions to determine whether a woman is trying to become pregnant, but makes a specific effort to discuss behaviors that would affect the woman’s health regardless of whether she intends on becoming pregnant. Research that CFHC conducted among women who received preconception counseling found that the vast majority of women, whether or not they were planning on becoming pregnant, expressed a desire to change at least one health behavior such as obesity, smoking or alcohol use, exercise, or healthy eating after receiving the preconception counseling.

For many women, a Title X-funded family planning system is their first entry point into the health care system. On average, these patients are young, between the ages of 20-29, and cycle on and off health insurance coverage. Most of the women who seek health care at a Title X-funded family planning provider make less than $10,890 a year and, as a result, face many of the social and public health challenges traditionally associated with being a poor or low-income individual in our country. Like most young women, they seek very few health services in addition to their reproductive health services and many of them have not had a thought, much less a conversation, about their "reproductive life plan."

Promoting preconception health services in the family planning setting makes good sense. For more than 40 years, the Title X program has enabled women to make the best decisions about their sexual and reproductive health. By well integrating preconception care into the Title X system, the Title X network continues to grow its capacity to meet the health care needs of the women in its communities. Women, men and families depend on their family planning provider to deliver the message that a healthy future is possible for them and for their children and, subsequently, provide the care to make that possibility a reality.