City University of New York School of Public Health (CUNY SPH) researcher Dr. Heidi Jones, was recently awarded a planning grant from the Society of Family Planning to study using a reproductive justice framework to integrate reproductive health services and primary care in New York. In recent years, the public health community has recommended the inclusion of reproductive intention screening into primary care settings, such as through the use of the “One Key Question” (OKQ). Including pregnancy intention questions into primary care could improve pre-conception care for women who desire pregnancy as well as contraceptive choices for women who do not. However, the OKQ protocol guides providers to promote long acting reversible contraceptives (LARCs), rather than the full array of contraceptive options. At the same time, successes in reducing unintended pregnancies by increasing use of LARCs have led to a widespread call to increase access to these methods. Proposed metrics to measure the impact of integration of fertility intention questions into primary care, as well as metrics for quality of family planning services, also include measures of LARC uptake.
The promotion for increased LARC access, coupled with LARC uptake evaluation metrics has a two-fold consequence. It endorses LARCs during contraceptive counseling while de-emphasizing efforts to integrate reproductive health services into primary care. While expansion of access to LARCs has the potential to reduce unplanned pregnancies, the history of similar previous efforts is fraught with human rights abuses denying women’s autonomy over their own fertility. These abuses have been especially prevalent among poor women and women of color. This is a critical socio-historical moment.
The goal of this project will be to establish a common research and policy agenda for integration of reproductive health services into primary care in New York following reproductive justice principles. Participants will include reproductive justice activists and organizations, women’s health and communities of color advocates, primary care health facility networks, professional family medicine, and obstetric and gynecologist provider organizations, public and private health insurance agencies, and the New York City and State health departments.