Would you like to become pregnant in the next year? Those 10 little words, uttered by a primary care doctor, may lower Oregon’s unplanned-pregnancy rate (currently approaching 50 percent), help moms deliver healthier babies, and stir up a sea change in women’s health care throughout the nation. 

After touring hospitals and clinics across the state in 2009, Michele Stranger Hunter was shocked to find that most primary care docs never talk about family planning with patients. “I was like, What?!” says the executive director of the Oregon Foundation for Reproductive Health and NARAL Pro-Choice Oregon. “I didn’t handle the news very well.”

So she and her colleagues began crafting a direct, nonjudgmental question that every doctor could use, designed specifically to spur conversations about reproductive health between primary care physicians and patients. (Poor women and women in rural areas often lack access to ob-gyns or family planning clinics, where the question would be more likely to come up naturally.) “It supports women who want to be pregnant, and those who don’t,” Stranger Hunter explains. “It’s common sense. Just ask the woman what she wants, and provide services based on her response.” 

A few years after this initial insight, the medical community is abuzz with Stranger Hunter’s One Key Question project. “This is the first new idea I’ve heard in preconception health ... ever,” says Deborah Allen, director of Boston’s Bureau of Child, Adolescent, and Family Health. Allen’s department is currently rolling out OKQ among families involved in the city’s Healthy Start program, as well as mounting a massive education campaign built around the initiative. 

In Oregon, 15 clinics and provider networks use the program. The feedback from Healthy Start and WIC providers in Southern Oregon is that the wording, which shifts the focus from long-term planning to immediate desires, strikes a chord with patients who have little control over their lives due to poverty or abuse. So far, providers in 14 other states have adopted the strategy.