Using a reproductive justice framework to integrate reproductive health services and primary care in New York
Awarded 2015
Interdisciplinary Innovation (Phase 1) Grants
Heidi Jones, PhD, MPH
City University of 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. Furthermore, 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 in general, include measures of LARC uptake. This call for increased LARC access coupled with LARC uptake evaluation metrics threaten to incentivize LARCs during contraceptive counseling as well as de-emphasize efforts to strengthen pre-conception counseling during integration of reproductive health services into primary care. While expansion of access to LARCs has the potential to reduce unplanned pregnancies, the history of efforts targeting increased uptake of specific contraceptive methods in the US 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. We are at a critical socio-historical moment for thoughtful deliberation on approaches to integration of reproductive and primary care services from a reproductive justice perspective. This Society of Family Planning (SFP) grant will be used to synthesize findings from current formative research on integration of services using a modified Delphi method that will culminate in a two-day meeting with stakeholders from a wide range of sectors. The goals will be to establish a common research and policy agenda for integration of reproductive health services into primary care in New York and to develop a phase II project for funding consideration. The Delphi method uses a series of questionnaires to reach consensus from experts toward a common goal, in this case, guidelines for integrating reproductive health services into primary care that follow reproductive justice principles. Participants in this process 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. The proposed team represents a wide range of disciplines including social science, community organizing, community health education, health services research, epidemiology, obstetrics and gynecology, and health policy. Furthermore, the team brings established partnerships with many stakeholder organizations and will use this grant mechanism to forge new partnerships with sectors not yet represented.