A preconception visit is designed to reduce the risk of adverse health outcomes based on modifiable risk factors. It is used to optimize health and provide individualized education. Any patient with reproductive potential is a candidate for pre pregnancy counseling, regardless of relationship status, gender identity, or sexual orientation.
Black women are at higher risk for pregnancy related deaths and complications when compared to their white peers. They also have higher pre pregnancy rates of chronic health conditions (ie. diabetes, hypertension, and kidney disease) and are at higher risk for unplanned pregnancies. Although black maternal mortality continues to gain attention, solutions have not been readily identified. Additionally, some of the top theories behind black maternal mortality relate to implicit bias of providers and systemic racism/discrimination. This has led to growing fear, distrust, and even near hopelessness among black women with unmet fertility desires. Many are asking if there is anything that can be done to decrease their risks.
I propose that intentional and frequent use of the preconception visit may be a small step in the right direction. The preconception visit helps identify patient specific issues including non-clinical and social needs. It provides an opportunity for optimization of the chronic health conditions that more commonly affect black women, as well as an opportunity to discuss reliable contraception to help time pregnancies in allowance for that optimization to occur.
Equally as important, is the early opportunity for patients to identify and partner with a health care provider that is committed to high-quality, culturally-sensitive, evidence-based care. I recommend that you explicitly ask your provider their stance on black maternal mortality. If their answer is unsatisfactory or if they ignore it altogether, you have effectively identified another modifiable risk factor. 𝐌𝐨𝐝𝐢𝐟𝐲 𝐚𝐜𝐜𝐨𝐫𝐝𝐢𝐧𝐠𝐥𝐲.
Bottom line: Optimize health prior to pregnancy to decrease risks of adverse outcomes. Pick your obstetrical provider (and birthing location) like your life depends on it, because it just might.
