Community approaches to women's health: Delivering preconception care in a community health center model

Preconception care has been recognized as an important set of interventions necessary to improve pregnancy outcomes and the overall health of women of childbearing age. Traditionally underserved populations such as the low income, uninsured, racial and ethnic minorities, homeless, and migrant farmworkers have less access to a usual source of primary care and therefore are more at risk for adverse health outcomes. The national network of Community Health Centers was created to break down compounding barriers to care that leads to poor health. Health centers are a vital source of care for low-income women. Almost 60% of health center patients are women, about half of whom are women of childbearing age. In addition, health centers provide care for > 17% of low-income births in the United States. Most health centers offer their patients preconception services, such as HIV/AIDS screening and treatment, weight management, nutrition counseling, and smoking cessation programs, in addition to comprehensive primary care services. Three quarters of health centers provide mental health services and half provide substance abuse treatment services onsite; the rest provide these services in partnership with other providers. Health centers also participate in a number of community-based programs focused on improving women's health and providing preconception care services. As policymakers and public health planners consider options for enhancing the utilization of preconception care, they must also consider options for expanding access to health centers nationwide.