Preventive care helps patients and providers catch potential health concerns early and intervene to lessen the risk of severe problems developing later. Patents can improve their current and future health by understanding risk factors for chronic diseases, cancer, and other health issues and knowing what actions can be taken to mitigate these risks. This is especially important regarding prenatal, postpartum, and maternal health, where early intervention can save the lives of both mothers and their babies.
Women’s Preventive Services Initiative (WPSI), a federal program supported by Health Resources and Services Administration (HRSA) through the U.S. Department of Health and Human Services (HHS), helps women be proactive about their health. The program offers a variety of tools and resources for both providers and consumers to improve health outcomes through preventive action.
Goals of WPSI are to identify and recommend evidence-based updates to HRSA-supported Women’s Preventive Services Guidelines, raise awareness of the guidelines, and increase clinician adoption and utilization of the guidelines. In a recent HRSA webinar, Diana Ramos, MD, MPH, FACOG, and Susan Kendig, JD, WHNP-BC, FAANP, presented an overview of how these recommendations are developed through WPSI and how the program educates women on the opportunities they have to be proactive about their health.
“Prevention is critically important to improving long life and health, and oftentimes that is especially true for reproductive age women,” Dr. Ramos said. “If you start as an adolescent, the lifelong health really impacts not only the life of the person that’s pregnant, but that of the children, the offspring, so it’s across the life course from adolescents all the way to postmenopausal ages.”
One of the tools WPSI offers is the well-woman chart (available in English and Spanish), which is categorized into subsets including general health, infectious disease, cancer, pregnancy, and postpartum. Each subset includes information about the health concerns women face throughout their lifespan and what screenings and services they should receive, and when, to improve their health.
It is important to note, WPSI recommendations apply primarily to cisgendered women, but can be relevant and applicable to individuals who are transgender, nonbinary, or otherwise gender expansive, founded on the principles of promoting equitable sex and gender-based care. WPSI recommends access to and the provision of respectful, gender-affirming, high quality, and safe health care.
“In my opinion, one of the crowning jewels of WPSI is the well-woman chart,” Kendig said. “The purpose of the well-woman chart and visit is really to ensure the delivery and coordination of recommended preventive services across the lifespan. This can be a single visit or it can be a series of visits.”
According to Kendig, there is a common misconception surrounding well-woman visits, and that they are often regarded as a one-time annual visit to receive a pelvic exam or Pap smear. While these are important, they do not nearly cover the range of preventive screenings and exams available to help women identify signs of concern early on. Instead, women should become familiar with the services appropriate for their age, health status, and risk factors, identified through the well-woman chart, which may require several appointments to complete.
“It’s important to understand what a well-woman visit is, because I think most of us think of that as, ‘Oh, I go once a year, it’s a one and done,’ and that’s not true,” she continued. “The well-woman preventive visit isn’t just that annual exam. It includes free pregnancy care, prenatal care, postpartum care, as well as inter-pregnancy visits.”
Under the Affordable Care Act (ACA), over 150 million people with private insurance – including 58 million women and 37 million children – are eligible to receive preventive services without cost-sharing. States participating in the ACA’s Medicaid expansion program, including Missouri, are required to provide the same level of preventive services for the expansion populations as private plans.
For Missourians participating in MO HealthNet (Missouri Medicaid), preventive services that are available for no cost include:
- Smoking cessation.
- Diabetes prevention program.
- Healthy children and youth program.
- Maternal and infant care management.
- Obesity services.
- Health homes.
- Oral health.
Because many chronic health issues co-occur, it’s crucial to take preventive action to stay ahead of your health. This is especially important for pregnant and postpartum women who are facing high rates of maternal morbidity and mortality in Missouri as preventive care can catch signs of trouble early and prepare you and your child for a healthy pregnancy and birth.
WPSI’s Development Process
WPSI undergoes a multistep process for developing recommendations to the Women’s Preventive Services Guidelines supported by HRSA. This process includes:
- Step 1: Topic review and selection.
- Step 2: Evidence reviews.
- Step 3: Convene experts.
- Step 4: Recommendation development.
- Step 5: Public comment.
- Step 6: Final approval and submission to HRSA.
- Step 7: Routine review.
- Step 8: Dissemination of the guidelines.
After a topic is selected, there is a strict and thorough review of the data and evidence surrounding the topic at hand to justify whether a recommendation or service can help prevent this issue/disease or play an impactful role regarding prevention.
“After that, experts are convened, and this is where the formation of the WPSI comes into play,” Dr. Ramos said. Experts include various representatives from many organizations and departments, including internal medicine, pediatrics, obstetrics and gynecology, crisis nurse practitioners, and more.
Recommendations are created by reviewing the existing clinical recommendations for a health issue and then tailoring these recommendations to fill in the gaps that currently exist. Current literature may identify health concerns and the relevant risk factors for women, but often do not take recommendations the extra step to effectively help women implement lifestyle changes.
For example, clinical recommendations for obesity in women state that women ages 40-60 years with normal or overweight BMI should maintain their weight and limit any weight gain. WPSI includes implementation considerations such as individualizing counseling based on women’s specific assessments and lifestyles, providing supportive interventions for women who are overweight or struggling with diet and exercise, and offering positive reinforcement and validation for women keeping up with optimal habits.
“We know that obesity is escalating in the United States, and it’s estimated that by 2030 nearly half of the population of the U.S. will be obese, and women are especially affected,” Kendig said. “There are no recommendations for preventive obesity elsewhere in normal weight or overweight women — this filled that gap.”
Once recommendations are developed, they are published for public comment. Members of the public can provide their input and experiences, and comments are then reviewed and approved by HRSA. The recommendations then undergo another intensive, routine review before dissemination.
Clinical summary tables provide the rationale for the recommendation, the recommendation itself, the implications for clinical practice, risk assessment, and more, along with links to tools that may provide additional information.
Through the well-woman chart and other WPSI resources, women can identify what preventive care they should be receiving based on their age, health status, and risk factors. These same resources also help providers stay on top of their patients’ health and help catch potential problems before it’s too late.
“I think getting this information into the hands of not only consumers, but clinicians, is exceptionally important,” Kendig said. “I like to take the well-woman chart wherever I go. . . I have taken it to my own healthcare providers, and handed it to them, so that if they didn’t know what kind of care I was supposed to be getting, they would have that in hand.”
Other resources WPSI offers for providers include:
- A coding guide that provides information about Medicare and Medicaid as preventive services in nonexpansion states may not be covered.
- A telehealth FAQ sheet that discusses how preventive services can be available via telehealth, which was especially important during the pandemic.
- The “How I Practice” video series, created by clinicians for clinicians, to discuss women’s preventive health topics and how to implement WPSI recommendations into everyday practice.
- WPSI social media toolkit.
Room to Improve
Though WPSI offers invaluable tools for preventing negative health outcomes, there is still room for improvement. The recommendations are generalized and apply to the average woman with average risk. Specialized and unique health problems, comorbidities, or health concerns and risk factors that apply to specific populations may need additional support to effectively mitigate risks and further issues.
For example, according to Dr. Ramos, women of color are disproportionately experiencing more precancerous lesions, which can be caught early and treated if they are screened early enough, which WPSI tools like the well-woman chart assist with. However, if social determinants of health and the women’s environment play a role in their risk for these lesions and certain cancers, WPSI tools may not effectively capture those additional risk factors beyond age and gender.
“I think that one of the key messages is tailoring the recommendation, particularly those counseling recommendations, in a way that meets the individual’s and the community’s needs, so that it is meaningful for them, and that is something that we struggle with,” Kendig said. “You’ll see that most of our research recommendations are saying we need to know more about how this applies to different populations, so that we can assure that people are not only getting these services, but they are getting the best services for their particular situation.”
Though WPSI has room to grow in the remainder of its cooperative agreement awarded through 2026, the well-woman chart and other tools are readily available to help women initiate conversations about preventive health and the proactive steps they can take to mitigate risks of disease, cancer, and pregnancy/birth complications.
“Ideally, if patients can educate themselves, they can empower themselves as to what should be covered during that well-woman exam for their specific age, then the services can be rendered,” Dr. Ramos said. “We’re trying to — through forms like this — inform providers and inform consumers of what is available and what can be provided.”
“This is the type of care that women deserve to help them stay as healthy as possible, so be creative in how you utilize and access the wellness chart,” Kendig added. “Give it to your family members, your neighbors, your friends, so that the message is spread far and wide and, most importantly, people have access to the care they need.”
Maternal Health Support in Missouri
Local support is available to help pregnant and birthing people in Missouri get connected to health care and social services, including utilizing the preventive services covered by MO HealthNet. Altruism Media, Inc. (AMI) is proud to offer The Maternal and Infant Health Project, or The MaIH Project, which connects birthing people to a doula and community health worker (CHW) team who can provide hands-on support and referrals to care and other resources.
Through The MaIH Project, patients are assessed for any support they may need, including assistance with social determinants of health such as transportation to health care appointments, utility assistance, enrollment in Medicaid, WIC, and other services. A doula and CHW team do the heavy lifting to connect clients to support, free of cost, as well as follow up to make sure clients have what they need to have a safe, healthy, and positive perinatal journey from pregnancy through at least one year postpartum.
To learn more and get connected to support, call or text 844.860.0111 or visit https://altruism-media.org/the-maih-project/.