Monday, October 3, 2016

Including women’s partners in preconception care

- Jennifer Middleton, MD, MPH

The September 15 issue of AFP reviews the new AAFP position paper recommending the discussion of preconception care at every visit for women of reproductive age. Along with asking female patients about their reproductive plans, the authors encourage us to work with them to optimize their health in case of unplanned pregnancy. Appropriately, the paper includes an often forgotten individual in determining maternal and infant well-being: the father and/or pregnant woman’s partner. The health of these potential fathers, along with the lifestyle habits of both male and same-sex female partners, are also important determinants of pregnancy outcomes

It can be challenging to remember to include preconception care during already busy visits, but the biggest challenge may be just getting these partners to our offices in the first place. Men visit physicians far less often than women, even when visits for OB care are excluded. Low income and uninsured men are even less likely to see physicians, and men of all income and insurance statuses do not routinely receive much counseling about mental health, sexual health, or violence and safety when they do come into the office. Including mental health assessment and counseling is especially important given that fathers can also experience perinatal depression, which can have consequences for both their partners and their children. Even more than their older counterparts, male adolescents may find accessing care for their sexual health especially stressful and intimidating. Discomfort regarding care-seeking affects same-sex female partners as well. Lesbian women access health care far less frequently than heterosexual women despite having comparatively higher rates of chronic disease, tobacco use, and heavy drinking. Ensuring access to welcoming care is an important first step in providing preconception care for the partners of women of child-bearing age, be they male or female.

Making our offices safe places for everyone is, then, a critical first step. Once they are there, incorporating preconception care into our everyday practice will likely require a team approach. Pre-visit planning may be one way of systematizing this care. There’s a Family Practice Management Topic Collection on Care Team & Staffing if you’re interested in other possible approaches. You can also read more about common psychosocial issues in men here, and there's an AFP By Topic on the Care of Special Populations that includes a subsection on Gay, Lesbian, Bisexual, and Transgendered Persons.

How is your office addressing preconception care?