Tag Archives: position statements

Male Sexual and Reproductive Health: The Role of Womenʼs Health Nurse Practitioners

The National Association of Nurse Practitioners in Women’s Health (NPWH) affirms the right of all individuals to quality, evidence-based sexual and reproductive health (SRH) care that is non-judgmental, respectful, and culturally appropriate. SRH is an important component in individuals’ overall physical, emotional, and social well-being. SRH encompasses sexuality, sexual relationships, and all matters related to the function and processes of the reproductive system.1 The SRH of one individual often intertwines with that of another individual or individuals.

Sexual and reproductive healthcare includes health promotion, disease prevention, and identification and treatment of disease. As such, SRH care addresses issues such as sexuality, reproductive life planning, fertility, contraception, preconception health, all pregnancy options, reproductive assistance options, sexually transmitted infections (STIs)/HIV infection, SRH-related vaccinations (e.g., HPV vaccination), sexual dysfunction, reproductive health-related illnesses such as breast and cervical cancers, and violence within relationships.2,3

NPWH asserts that women’s health nurse practitioners (WHNPs) have a uniquely strong educational foundation to provide SRH care for all individuals, inclusive of all gender identities and sexual orientations. The specific purpose of this position statement is to support the role of WHNPs in the provision of SRH care for males. Providing quality SRH care to males not only helps them preserve and promote their own health but also helps optimize SRH outcomes in females. Of note, throughout this position statement, we use the terms male, female, man, and woman to denote both cisgender and transgender individuals.

The role and the competencies of WHNPs are not setting specific. However, the environment in which WHNPs practice may or may not include opportunities for direct interaction with males as patients. WHNPs who provide healthcare in settings that include male and female patients (e.g., family practice offices, family planning clinics, school- and college-based health centers, reproductive endocrinology/fertility centers) can reach males who might not otherwise receive SRH care. WHNPs who provide care in settings where males are generally not seen as patients (e.g., Ob/Gyn offices/clinics) may still have opportunities to reach male partners for a coordinated approach to SRH.


Providing SRH care for males requires attention to removing barriers and innovation to engage them in a variety of settings. Males, as they move into adolescence and young adulthood (and exit pediatric care), are less likely than their female counterparts to seek preventive healthcare that can include SRH services.4,5 In fact, a large proportion of young men do not know where to access SRH care.4,6,7 Even when adolescent or young adult males are seen in a healthcare setting, many healthcare providers (HCPs) do not address SRH.4,8-10 Recent studies indicate that if discussion about SRH with male patients does occur, it is often limited to how to decrease STI risk, and that although males are willing to discuss SRH-related issues, they prefer that the HCP initiate the discussion.7,9

Guidance for HCPs regarding the content and provision of SRH for males is often combined with recommendations for female SRH care. In 2014, the U.S. Office of Population Affairs (OPA) and the CDC developed and published recommendations for providing quality family planning and related preventive health services that include both female and male SRH services.2 Family planning services, as defined in this document, include reproductive life planning, contraception, preconception health, pregnancy testing and counseling, basic infertility services, and STI screening and treatment. Other important SRH care components include screening for reproductive cancers, providing appropriate immunizations, and providing or referring for prenatal and abortion care as needed.3 The audience for these recommendations extends beyond providers at sites dedicated to family planning services to providers in all primary care settings.

To support HCPs in providing male SRH services, the Male Training Center for Family Planning and Reproductive Health (MTC) elaborated on the OPA/CDC document with the publication of Preventive Male Sexual and Reproductive Health Care: Recommendations for Clinical Practice.11 The MTC document provides recommendations for eight health history components, three physical examination components, and six laboratory tests, as well as seven recommendations for counseling based on identification of risk.11 Box 1 outlines the MTC’s recommendations for SRH services for males. HCPs can find additional guidance regarding male SRH care through multiple organizations’ publications—and links to these publications—provided in Box 2.

male sexual reproductive health box1

Box 2. Sample resources for male sexual and reproductive health

The WHNP role in providing SRH care for males is not new. For more than two decades, the NPWH WHNP Guidelines for Practice and Education have included curriculum content on evaluation and management of common SRH problems in males. Likewise, the National Certification Corporation’s WHNP certification exam has included male SRH content for more than two decades. Current NPWH WHNP Guidelines for Practice and Education include comprehensive curriculum content for male SRH addressing all of the MTC recommendations (Box 3).12 The WHNP certification exam includes male SRH issues outlined to include sexuality/sexual dysfunction, contraception, infertility, and STIs.13 WHNPs educationally prepared to provide assessment and management of common male SRH concerns are qualified to provide this care in the variety of clinical settings where they work.

male sexual reproductive health box3

Implications for WHNP practice

WHNPs provide SRH care for males directly (or indirectly) as primary care providers or as specialty care providers in areas such as reproductive endocrinology/fertility and breast health.

  • WHNPs who provide healthcare solely for females can give their patients information on male SRH to share with their male partners. The goal is to support male SRH that enhances the health of female patients and optimizes family planning, pregnancy outcomes, and the physical and emotional health of relationships.
  • WHNPs who provide healthcare solely for females may consider incorporating male SRH care in a couple’s approach in the clinical setting. Again, the goal is to support male SRH, which enhances the health of female patients and optimizes family planning, pregnancy outcomes, and the physical and emotional health of relationships.
  • WHNPs providing care in settings where males are routinely seen (e.g., family practice offices, family planning clinics, school- and college-based health centers, reproductive endocrinology/fertility centers) have opportunities to provide direct male SRH care in such settings. The goal expands beyond enhancing the health of female patients to enhancing the SRH of males.
  • WHNPs are educationally prepared to provide SRH care for individuals inclusive of all gender identities and sexual orientations. WHNPs provide SRH care based on the individual needs of each patient.


NPWH recommends that WHNPs do the following:

  • Engage in learning opportunities to maintain, update, and/or expand knowledge and skills that enable them to provide and promote SRH care for all individuals and couples within the context of their clinical setting.
  • Include provision of SRH care for individuals inclusive of all gender identities in collaborative practice agreements in states where such written agreements are required.
  • Establish referral resources for SRH concerns to meet the needs of patients and partners.

NPWH will provide leadership to ensure that:

  • Faculty of WHNP programs have resources to continue to provide up-to-date, evidence-based male SRH content in the curriculum.
  • Continuing education programs and resources are available for WHNPs to maintain, update, and/or expand their knowledge and skills with regard to male SRH care.
  • WHNPs have SRH informational resources to share with both male and female patients.
  • WHNPs’ scope of practice regulations do not restrict them from providing male SRH care within the parameters of their education and competency.


  1. World Health Organization. Defining Sexual Health: Report of a Technical Consultation on Sexual Health, 28-31 January 2002. Geneva, Switzerland: WHO Press, 2006. www.who.int/reproductivehealth/publications/sexual_health/defining_sexual_health.pdf.
  2. Gavin L, Moskosky S, Carter M, et al. Providing quality family planning services: recommendations of CDC and the U.S. Office of Population Affairs. MMWR Recomm Rep. 2014;63(RR04):1-54.
  3. United Nations Population Fund. Sexual and Reproductive Health. 2016. unfpa.org/sexual-reproductive-health
  4. Chabot M, Lewis C, de Bocanegra H, Darney P. Correlates of receiving reproductive health care services among U.S. men aged 15 to 44 years. Am J Mens Health. 2011;5(4):358-366.
  5. Bersamin M, Fisher DA, Marcell AV, Finan LJ. Defi cits in young men’s knowledge about accessing sexual and reproductive health services. J Am Coll Health. 2017;65(8):579-584.
  6.  Bersamin M, Fisher DA, Marcell AV, Finan LJ. Reproductive health services: barriers to use among college students. J Community Health. 2017;42(1):155-159.
  7. Tyler C, Warner L, Gavin L, Barfield W. Receipt of reproductive health services among sexually experienced persons aged 15-19 years—National Survey of Family Growth, United States, 2006-2010. MMWR Suppl. 2014;63(2):89-98.
  8. Choiriyyah I, Sonenstein FL, Astone NM, et al. Men aged 15-44 in need of preconception care. Matern Child Health J. 2015;19(11):2358-2365.
  9. Same RV, Bell DL, Rosenthal SL, Marcell AV. Sexual and reproductive health care: adolescent and adult men’s willingness to talk and preferred approach. Am J Prev Med. 2014;47(2):175-181.
  10.  Warner JN, Frey KA. The well-man visit: addressing a man’s health to optimize pregnancy outcomes. J Am Board Fam Med. 2013;26(2):196-202.
  11. Marcel AV, Male Training Center for Family Planning and Reproductive Health. Preventive Male Sexual and Reproductive Health Care: Recommendations for Clinical Practice. 2014. maletrainingcenter.org/wp-content/uploads/2014/09/MTC_White_Paper_2014_V2.pdf
  12. NPWH/AWHONN. Women’s Health Nurse Practitioner: Guidelines For Practice and Education. 7th ed. Washington DC: NPWH/AWHONN; 2014.
  13. National Certifi cation Corporation. 2018 Candidate Guide Women’s Health Nurse Practitioner. Chicago, IL: National Certifi cation Corporation; 2018.

Position Statement: Cervical Cancer Screening

The National Association of Nurse Practitioners in Women’s Health (NPWH) supports a concerted effort to continue to improve cervical cancer screening rates and timely, appropriate follow-up and treatment when screening results are abnormal. The goal is to reduce cervical cancer incidence, morbidity, and mortality. NPWH supports ongoing research to ensure that screening guidelines are based on the best evidence available. Furthermore, NPWH supports policies at the local, state, and federal levels that ensure access to cervical cancer screening services and follow-up as needed. Continue reading »

Healthcare for Transgender and Gender Non-Conforming Individuals

The National Association of Nurse Practitioners in Women’s Health (NPWH) affirms each individual’s right to quality, evidence-based sexual and reproductive healthcare and encourages each individual to strive for a healthy self-concept of sexuality and gender identity. Although NPWH has historically focused on the care of cisgender women, we recognize the importance of providing quality sexual and reproductive healthcare to all individuals, regardless of gender identity. Table 1 provides gender identity-related terminology and definitions.1  Continue reading »

Human Sex Trafficking

The National Association of Nurse Practitioners in Women’s Health (NPWH) recognizes the critical role of women’s health nurse practitioners (WHNPs) and other nurse practitioners (NPs) who provide healthcare for adolescent and adult females in terms of identifying, assessing, and responding to the needs of trafficked female individuals. Adolescent and young adult females comprise the majority of trafficked persons in the United States and globally, most specifically as victims of sex trafficking. NPs must be well prepared to identify, assess, and provide care for these individuals and have access to the resources to do so.

Many trafficked persons are seen in healthcare settings, yet they remain unidentified.2 Healthcare providers (HCPs) either are not aware of or do not respond to signs, when present, that a patient may be a victim of sex trafficking. A validated screening tool is not yet available. However, NPs can draw from existing evidence in related areas—especially intimate partner violence, sexual assault, homeless and runaway youth, child abuse and neglect, and individuals experiencing trauma in general—for clinical guidance. In addition, NPs can consider practice recommendations from colleagues in social service, advocacy, healthcare, and law enforcement who have expertise in human trafficking identification and intervention.

NPWH supports a comprehensive, coordinated, multidisciplinary approach to meet sex-trafficked individuals’ complex needs and help them address the challenges they face. To that end, NPWH supports research initiatives to develop a validated screening tool to better identify patients who are victims of sex trafficking, as well as to better understand the most effective manner in which to meet their emergency, short-term, and long-term healthcare needs.

Legislation and regulatory policies should focus on eliminating the demand for trafficked individuals in the first place, and on targeting persons and agencies that condone human trafficking. NPWH supports the development of legislation, regulatory policies, and advocacy efforts that protect the safety, rights, dignity, and cultural values of trafficked individuals.

NPWH will provide leadership and collaborate with other organizations and agencies to deliver NP education, develop policies, and conduct or support research in a concerted effort to increase knowledge and provide resources for NPs to identify, assess, and respond to the needs of trafficked female individuals.


In 2000, the U.S. Trafficking Victims Protection Act (TVPA) updated post-Civil War slavery statutes to further guarantee freedom from slavery and involuntary servitude.3 For this purpose, sex trafficking was defined as the recruitment, harboring, transportation, provision, or obtaining of a person, through force, fraud, or coercion, for the purpose of commercial sex act.3 Severe forms of trafficking in persons was defined as sex trafficking in which the person induced to perform such act has not attained 18 years of age or sex trafficking for the purpose of subjection to involuntary services, servitude, peonage, debt bondage, or slavery.3 The TVPA was re-authorized most recently in 2013.4 Today, the terms modern slavery, trafficking in persons, and human trafficking are used as umbrella terms meeting the TVPA definition.

Accurate statistics for the incidence and prevalence of human trafficking are elusive because of the clandestine nature of the crime and trafficked individuals’ reluctance to identify themselves. Worldwide, it is estimated that 20.9 million persons are victims of trafficking and that among this group, 4.5 million (22%) are victims of forced sexual exploitation.5 Within the U.S., trafficked individuals may be transported across borders from other countries or they may already reside here. Data from a Bureau of Justice Statistics report for January 2008 through June 2010 identified 527 confirmed victims of trafficking, with 80% of these cases being classified as sex trafficking, 10% as labor trafficking, and 10% as undetermined.1 Eighty-three percent of the sex-trafficked individuals in this report were U.S. citizens, with 94% of them being female. The commercial sexual exploitation of minors comprised 64% of the cases. Of note, these data reflect only reported and investigated cases; the numbers may greatly under-represent the true extent of the problem. In 2015, the National Human Trafficking Resource Center (NHTRC) hotline received 21,957 calls across all states, with 4,314 calls reporting sex trafficking.6 

Females at high risk for being victims of sex trafficking include those who are young, live in extreme poverty, have limited education and work opportunities, engage in drug use, and/or have a history of instability or abuse in their families of origin. They may be more vulnerable if they have mental or physical disabilities. Adolescent females who are runaways and/or homeless are particularly vulnerable.2,7

Trafficked individuals face numerous barriers to disclosing their situation to HCPs. They may fear harm to themselves, family members, or friends; fear deportation if not legally in the U.S.; have language barriers; distrust authority figures; feel they do not have any options; be ashamed of their situation and the stigma they believe it carries; or have a criminal record. Traffickers may use monitoring devices to track these individuals’ every move to deter them from seeking help. In addition, some trafficked individuals may not under-stand the concept of coercion or that they are victims of an illegal activity.2

Patients who have been trafficked are at high risk for long-term physical and mental health con-sequences related to inflicted trauma and depriva-tion of their basic needs for survival. Health conse-quences may include unintended pregnancies; sexually transmitted infections (STIs), including HIV; poor dentition compounding malnutrition; depression; post-traumatic stress disorder (PTSD); and suicidal ideation. Commonly reported physi-cal symptoms include fatigue, headaches, back pain, and weight loss.8

Implications for women’s healthcare and WHNP practice

WHNPs and other NPs who provide women’s healthcare should be aware of indicators that raise suspicion that an individual presenting to a healthcare setting may be in an exploitative circumstance. Warning signs identified by anti-trafficking experts include:

Hypervigilant, fearful, or submissive demeanor; evidence of being controlled;

Provision of vague answers to questions or a script-like recitation of her history;

Delay between the onset of an injury or illness and the seeking of healthcare, in context with other indicators;

Discrepancies between an individual’s explained cause and the clinical presentation of her injuries;

Accompaniment by another person who answers questions for the individual and refuses to leave her alone during the visit;

Inability to produce identification documents;

Signs of physical abuse (e.g., cigarette burns, bruising), sexual abuse, medical neglect, torture, depression, PTSD, and/or alcohol or substance use disorder;

Tattoos or other markings indicating a claim of ownership by another;

Recurrent STIs;

Trauma to her genitals or rectum; and/or

History of repetitive abortions or miscarriages.2,7,9,10

WHNPs are particularly qualified through their educational preparation to recognize and provide needed healthcare services and referrals for adolescent and adult females who are victims of sexual, physical, and/or emotional abuse. Trauma-informed care for these patients places an emphasis on helping the individual feel safe and reclaim control of her life and decisions. Goals of a trauma-informed approach in care are to avoid re-traumatization, to emphasize the patient’s strengths and resilience, to support development of healthy short- and long-term coping mechanisms, and to promote healing and recovery.2

No official guidelines are available regarding the most effective manner in which to provide for the emergency, short-term, and long-term healthcare needs of trafficked patients. However, expert opinion supports these approaches:

Foster trust and relationship building, which includes an assurance of confidentiality.

Ensure privacy prior to discussing potential trafficking with the patient.

Recognize potential danger to the patient and/or her family members if she reports the crime.

Incorporate safety planning for both the patient and staff.

Use a trauma-informed approach in assessment and treatment.

Provide care for any immediate needs (e.g., treat STIs, diagnose a pregnancy).

Provide culturally appropriate services.

Mitigate language barriers; provide a professional interpreter when needed.

Establish a list of local resources for collaboration that provides wraparound services for the individual.

Contact the NHTRC hotline at 1-888-373-7888 for guidance on the next steps and referrals if needed.2,7,11

The NHTRC provides detailed information for HCPs concerning identification, assessment, and response to the needs of patients who have been trafficked.


WHNPs and other NPs who provide healthcare for adolescent and adult females should:

Be familiar with and educate staff about warning signs indicating that a patient may be a victim of sex trafficking;

Establish a plan in the healthcare setting for safety of both the patient and staff;

Establish partnerships with local social service providers, mental health providers, religious leaders, legal advocates, and law enforcement representatives for comprehensive services;

Serve as change agents in their communities through mentoring programs for at-risk youth, advocacy for policy changes to aid recovery of trafficked individuals, and engagement in activities that will promote greater cultural awareness of gender inequalities; and

Assess their own learning needs with regard to the unique and complex needs of trafficked individuals and seek continuing education as appropriate.

NPWH will provide leadership and resources to ensure that:

Educational programs for NP students with a population focus that includes adolescent and adult females impart evidence-based knowledge and skill building for the development of competencies to identify trafficked individuals and provide healthcare and appropriate referrals for them; and

Continuing education programs are available for NPs to obtain evidence-based knowledge and competencies to identify and provide healthcare and appropriate referrals for trafficked individuals.


1. Banks D, Kyckelhahn T. Characteristics of Suspected Human Trafficking Incidents, 2008-2010. Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 2011. 

2. Alpert EJ, Ahn R, Albright E, et al. Human Trafficking: Guidebook on Identification, Assessment, and Response in the Health Care Setting. Waltham, MA: MGH Human Trafficking Initiative, Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, and Committee on Violence Intervention and Preven-tion, Massachusetts Medical Society; 2014.

3. 106th U.S. Congress. Victims of Trafficking and Violence Protection Act of 2000, Public Law 106-386. 2000. 

4. U.S. Department of State. U.S. Laws on Trafficking in Persons. 2016. 

5. International Labor Organization. ILO 2012 Global Estimate of Forced Labor: Executive Summary. 2012. 

6. National Human Trafficking Resource Center. 2015 NHTRC Annual Report. 2016. 

7. Clawson H, Dutch N, Solomon A, Grace L. Human Trafficking Into and Within the United States: A Review of the Literature. U.S. Department of Health and Human Services, Office of the Assistant Secretary of Planning and Evaluation; 2009. 

8. World Health Organization. Understanding and Addressing Violence Against Women: Human Trafficking. 2012. 

9. Baldwin SB, Eisenman DP, Sayles JN, et al. Identification of human sex trafficking victims in health care settings. Health Hum Rights. 2011;13(1):36-49. 

10. National Human Trafficking Resource Center. Identifying Victims of Human Trafficking: What to Look for in a Healthcare Setting. 2016. 

11. Dovydaitis T. Human trafficking: the role of the health care provider. J Midwifery Womens Health. 2010;55(5):462-467. 

Prevention of Alcohol-Exposed Pregnancies

The National Association of Nurse Practitioners in Women’s Health (NPWH) supports women’s health nurse practitioners (WHNPs) and other nurse practitioners (NPs) who provide healthcare for reproductive-aged women in the use of evidence-based strategies to prevent alcohol-exposed pregnancies (AEP). Use of these strategies should extend to alcohol screening at least yearly for all adolescent and adult patients. In addition, all sexually active, reproductive-aged women who could become pregnant and who drink alcohol should be counseled about the potentially deleterious effects of alcohol on a developing fetus. They should be advised to use effective contraception to prevent pregnancy or to stop drinking alcohol. Women who are trying to get pregnant should be advised to abstain from drinking alcohol. Pregnant women should be screened for alcohol use at their initial prenatal visit and during each trimester thereafter.1 For those who screen positive for risky alcohol use, NPs should provide a brief behavioral intervention, refer them to specialty services as needed, and plan appropriate follow-up.

Furthermore, NPWH recognizes that early and regular prenatal care for women with alcohol dependence is essential in order to encourage healthy behaviors and provide support and early treatment referrals to reduce risks of harm. Laws that require reporting of alcohol/substance abuse during pregnancy as potential child abuse or ne glect may deter women with alcohol dependence from seeking prenatal care.2,3 Therefore, NPWH opposes policies that require reporting or criminalization of alcohol/substance abuse during pregnancy and supports repeal of existing laws with such mandates. NPWH will provide leadership and collaborate with other organizations and agencies to deliver education and skills training for NPs, develop policies, and conduct and/or support research in a concerted effort to prevent AEP.


Prenatal alcohol exposure is the No. 1 preventable cause of birth defects and intellectual and developmental disabilities in children. Alcohol, a known teratogen, readily crosses the placenta and persists in amniotic fluid after a woman’s serum alcohol level metabolizes to zero. Toxicity is dose related, with the greatest risk to the fetus in the first trimester.With regard to preventing fetal alcohol spectrum disorders (FASD) and other adverse pregnancy and birth outcomes associated with prenatal alcohol exposure, there is no known safe amount of alcohol use at any time during pregnancy

FASD is an umbrella term describing a range of possible effects that include physical, intellectual, behavioral, and learning disabilities and language delays, with lifelong implications for individuals prenatally exposed to alcohol.5 FASD are completely preventable if alcohol is not consumed during pregnancy. But many pregnant women do drink alcohol; the estimated prevalence of FASD in first-grade students in the United States is 2%-5%.The lifetime cost of caring for an infant with fetal alcohol syndrome, a single disorder within the FASD continuum, is approximately $2 million.In addition to FASD, alcohol use during pregnancy is associated with increased risks for spontaneous abortion, intrauterine growth restriction, stillbirth, preterm birth, and sudden infant death syndrome.8

In 2005, the U.S. Surgeon General advised that pregnant women not drink any alcohol, pregnant women who have already consumed alcohol stop doing so, and women considering becoming pregnant abstain from drinking alcohol.9 Despite this recommendation, the number of women who drink alcohol while pregnant has not decreased significantly.10 Ten percent of pregnant women report drinking some amount of alcohol in the past month and 3.1% report binge drinking.10

The fact that about one-half of all pregnancies are unplanned poses a particular challenge to the prevention of AEP. Approximately 3.3 million reproductive-aged women report drinking alcohol in the past month and having sex without using contraception.11 An additional challenge is that only 1 in 6 U.S. adults reports ever having talked with a healthcare professional about their drinking.11 Therefore, many adults may be unaware of the potential risks of alcohol use to their own health or to the health of a developing fetus.

Implications for women’s healthcare and WHNP practice

Strong evidence suggests that alcohol screening and brief intervention (SBI) is effective in reducing risky alcohol use among women of childbearing age.12,13 Leading U.S. healthcare organizations and agencies, including the U.S. Preventive Services Task Force,14 the CDC,11 and the American College of Obstetricians and Gynecologists,15 recommend that alcohol SBI be implemented at least yearly for all adults in primary care settings. Likewise, all pregnant women should be screened at the first prenatal visit and once during each trimester thereafter.

Alcohol SBI involves using a validated screening tool to identify a woman’s drinking patterns, whether her alcohol consumption is creating a health risk for herself or others, and whether she has symptoms of dependency. If at-risk drinking is identified, the NP engages the woman in a brief motivation-enhancing intervention to reduce drinking. The main goal of alcohol SBI is to motivate patients to be aware of their alcohol consumption patterns, understand the associated risks and options for reducing or eliminating the risk, and make their own decisions. Referral to specialty care for further assessment and treatment is made if a woman is unable to moderate risky alcohol use on her own. The CDC’s Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices provides guidance for incorporating universal alcohol SBI within clinical practice.This guide includes information on the use of a variety of screening tools validated for use with adults, including pregnant women.

WHNPs and other NPs who provide healthcare for reproductive-aged women have a responsibility to provide clear, fact-based information regarding risks associated with drinking any amount of alcohol during pregnancy. Furthermore, they have the responsibility to identify women with at-risk drinking habits and provide counseling and referrals for treatment as appropriate.


WHNPs and other NPs who provide healthcare for reproductive-aged women should:

Adopt a non-judgmental respectful approach when broaching the topic of alcohol use.

Counsel each reproductive-aged woman in their care that there is no safe amount of alcohol consumption during pregnancy and provide fact-based information regarding risks.

Provide alcohol screening with a validated screening tool annually and during each trimester of pregnancy.

Provide an evidence-based brief intervention when at-risk alcohol use is identified.

Advise all pregnant women who drink alcohol  to stop doing so.

Advise all women planning a pregnancy who drink alcohol to stop doing so.

Advise all sexually active women who drink alcohol and could become pregnant to use effective contraception to prevent pregnancy or to stop drinking.

Recognize that not all women are able to stop using alcohol without support.

Refer women for additional services if they cannot stop drinking on their own. Know which services are available in the community.

Provide follow-up as needed to monitor women’s drinking, provide encouragement and support, and, if necessary, refer for specialized help.

Be aware of state reporting laws for alcohol/substance abuse in pregnancy and advocate for retraction of legislation that exposes pregnant women with alcohol dependence to criminal or civil penalties.

NPWH will provide leadership and resources to ensure that:

Educational programs for NP students with a population focus that includes reproductive-aged women impart evidence-based knowledge and skill building for the development of competencies to conduct effective alcohol SBI to prevent or address alcohol use during pregnancy.

CE programs are available for NPs to obtain evidence-based knowledge and competencies to conduct effective alcohol SBI to prevent or address alcohol use during pregnancy.


1. Nocon J. Chapter 15: Substance use disorders. In Mattison DR, ed. Clinical Pharmacology During PregnancyAmsterdam: Academic Press, an Imprint of Elsevier; 2013.

2. ACOG. Committee on Health Care for Underserved Women. Committee opinion no. 473: Substance abuse reporting and pregnancy: the role of the obstetriciangynecologist. Obstet Gynecol. 2011;117(1):200-201. Reaffirmed 2014.

3. Guttmacher Institute. Substance Abuse During Pregnancy. Washington, DC: Author; 2014.

4. Mattison DR, ed. Clinical Pharmacology During Pregnancy. Amsterdam: Academic Press, an Imprint of Elsevier; 2013.

5. Sokel RJ, Delaney-Black V, Nordstrom B. Fetal alcohol spectrum disorder. JAMA. 2003;290(22):2996-2999.

6. May PA, Baete A, Russo J, et al. Prevalence and characteristics of fetal alcohol spectrum disorders. Pediatrics. 2014;134(5):855-866.

7. CDC. Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use: A Step-by-Step Guide for Primary Care Practices. Atlanta, GA: CDC National Center on Birth Defects and Developmental Disabilities; 2014.

8. Bailey BA, Sokol RJ. Prenatal alcohol exposure and miscarriage, stillbirth, preterm delivery, and sudden infant death syndrome. Alcohol Res Health. 2011;34(1):86-91.

9. U.S. Department of Health and Human Services. U.S. Surgeon General Releases Advisory on Alcohol Use in Pregnancy. Washington, DC: US Department of Health and Human Services; 2005.

10. Tan CH, Denny CH, Cheal NE, et al. Alcohol use and binge drinking among women of childbearing age – United States, 2011-2013. MMWR Morb Mortal Wkly Rep. 2015;64(37):1042-1046.

11. Green PP, McKnight-Eily LR, Tan CH, et al. Vital signs: alcohol-exposed pregnancies—United States, 2011-2013. MMWR Morb Mortal Wkly Rep. 2016; 65(4):91-97.

12. Bertholet N, Daeppen JB, Wietlisbach V, et al. Reduction in alcohol consumption by brief alcohol intervention in primary care: systematic review and metaanalysis. Arch Intern Med. 2005;165(9):986-995.

13. Jonas DE, Garbutt JC, Amick HR, et al. Behavioral counseling after screening for alcohol misuse in primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2012;157(9):645-654.

14. Moyer VA; Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;159(3):210-218.

15. ACOG. Committee on Health Care for Underserved Women. Committee opinion no. 496: At-risk drinking and alcohol dependence: obstetric and gynecologic implications. Obstet Gynecol. 2011;118(2 pt 1):383-388. Reaffirmed 2013.

Approved by the NPWH Board of Directors: August 2016

The Doctor of Nursing Practice for Women’s Health Nurse Practitioners

The National Association of Nurse Practitioners in Women’s Health (NPWH) supports a pragmatic approach for the continuing evolution to the Doctor of Nursing Practice (DNP) degree as entry level for women’s health nurse practitioners (WHNPs). During the transition, study of the impact of DNP education on quality, access, and cost of healthcare should be ongoing. Policies must be in place to ensure that currently practicing WHNPs are not disenfranchised from practice in any way. Furthermore, NPWH advocates for concerted strategies to maintain an adequate number of highly qualified WHNPs to meet the healthcare needs for individuals and communities.


In October 2004, the American Association of Colleges of Nursing (AACN) published a position paper with the recommendation to transition the entry-level degree for advanced practice registered nurses (APRNs) from the master’s degree to the DNP by the year 2015.The AACN position paper outlined several trends to support the need for a practice doctorate for advanced nursing practice. These trends included continuing expansion of scientific knowledge, technology and informatics advances, increasing complexity of healthcare systems, the need for improved patient outcomes, and the need for parity with other healthcare professionals.

The Institute of Medicine (IOM) 2011 report, The Future of Nursing: Leading Change, Advancing Care, recognized that more would be expected of the APRN as the healthcare system grows in complexity, scientific knowledge continues to expand, and technology advances.2 APRNs would need competence in aspects of healthcare that require additional coursework and aligned clinical experiences. Further, the IOM report recognized the importance of DNP-prepared APRNs as clinical scholars who translate research and positively affect individual and population health outcomes at organizational and systems levels.

Based on the AACN’s Essentials of Doctoral Education for Advanced Nursing Practice, DNP curricula go beyond that of master’s programs.3 DNP programs prepare APRNs as leaders in evidence- based practice, quality improvement, systems thinking, and clinical scholarship. DNP curricula provide critical learning in the areas of informatics and technology, healthcare policy and advocacy, population health, and inter-professional collaboration to improve healthcare.

In 2015, the National Organization of Nurse Practitioner Faculties (NONPF) reaffirmed a commitment to advancing the DNP degree as entry level for the NP role.4 Further, NONPF recommended that all NP programs provide a postbaccalaureate to DNP with a seamless, integrated curriculum that prepares graduates with NP core competencies,population-focused  competencies,and competencies of the DNP Essentials.3

Significance to women’s healthcare and WHNP practice

NPWH affirms that master’s and certificate programs have fully prepared WHNPs with the competencies required to provide safe, quality healthcare for women. NPWH also recognizes the growing complexity of healthcare environments and the continuously expanding body of scientific knowledge regarding women’s health and healthcare needs. DNP education provides WHNPs with advanced competencies significant to providing women’s healthcare and enhancing NP practice.

Women benefit when WHNPs are prepared with the highest level of scientific knowledge and the ability to translate that knowledge quickly and effectively into practice. Proficiency in leading quality improvement strategies that create and sustain positive change at organizational and policy levels leads to improved health outcomes. Advanced preparation in the inter-professional dimension of healthcare enables WHNPs to facilitate collaborative team functioning. DNP-prepared WHNPs provide a critical interface between practice, research, and policy, with a focus on women’s health.

NPWH also recognizes challenges that must be addressed regarding the move to the DNP as entry level for WHNP practice. The DNP degree will require longer educational programs that add to educational costs. Longer educational programs may also slow the number of WHNPs prepared to meet national healthcare shortages. Financial gain for the WHNP prepared at the DNP level is not guaranteed.

NPWH recommendations

DNP education must include availability for preparation in the WHNP population focus.

• The DNP curriculum for the WHNP population focus must incorporate the WHNP Guidelines for Practice and Education.7

NPWH and other APRN organizations must collaborate to address the challenges presented in making the transition to the DNP as entry into practice for APRNs in an informed and equitable manner.

NPWH and other APRN organizations must participate in and support research to study the impact of DNP education on quality, access, and cost of healthcare.

NPWH will continue to advocate at organizational and legislative levels to ensure that policies and regulations support the practice of all WHNPs. NPWH will support only those policies and regulations for NP practice, education, and reimbursement that do not disenfranchise WHNPs without DNP degrees.


1. American Association of Colleges of Nursing. AACN Position Statement on the Practice Doctorate in Nursing. October 2004.

2. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011.

3. American Association of Colleges of Nursing. The Essentials of Doctoral Education for Advanced Nursing Practice. 2006.

4. National Organization of Nurse Practitioner Faculties. The Doctorate of Nursing Practice NP Preparation: NONPF Perspective. 2015.

5. National Organization of Nurse Practitioner Faculties. Nurse Practitioner Core Competencies. 2012.

6. Population Focused Competencies Task Force. Population-Focused Nurse Practitioner Competencies2013.

7. National Association of Nurse Practitioners in Women’s Health. Women’s Health Nurse Practitioner: Guidelines for Practice and Education. 7th ed. 2014.

Editor-in-chief‘s message

Dear Colleagues,

I am excited to now serve as Publication Coordinator for NPWH along with my continuing role as Editor-in-Chief of the journal. In the role of Publication Coordinator, I work with the Board of Directors (BOD), our Chief Executive Officer (CEO) Gay Johnson, and our staff to expand the benefits NPWH brings to its members. It is my pleasure to share with you some of the activities with which I am engaged.

One of the responsibilities of my new role is to coordinate the development of position statements for NPWH. Position statements provide an explanation, justification, or recommendation for a course of action that reflects the organization’s stance regarding a specific issue or concern. Position statements can be used to facilitate development and advocacy for health policies, direct educational activities, promote evidence-based practice, support research, and/or encourage collaboration with other agencies and organizations. In keeping with the mission of NPWH, position statements for the organization always advocate for women’s health and the practice of WHNPs and other nurse practitioners who provide women’s healthcare.

With input from the membership, the NPWH BOD and professional staff are charged with identifying priority issues and concerns. The process for writing position statements is inclusive, and requires active involvement of NPWH members—from identifying issues, to participating as a writing group member, to reviewing and providing feedback on drafts.

We have collaborated with Sigma Theta Tau International Honor Society of Nursing to establish collections in both the “Nursing Organizations—Events” and the “Nursing Organizations—Resource Papers” communities on the Virginia Henderson Global Nursing e-Repository. The NPWH events collection will enable our conference research and innovative clinical project poster and podium presenters to have abstracts posted in the e-Repository, making their work available to nurses around the globe. The resource papers collection will provide another avenue for NPWH to reach nurses and other constituents with our position statements, guidelines, and other important documents to promote women’s health. Watch for our entries in both of these collections later this summer.

We have been hard at work on the online NPWH Certification Review Course for WHNPs and are pleased to let you know that it will be available early this summer. The course will have 21 modules covering the topics outlined in the NCC WHNP certification examination guide, with review questions at the end of each module. Continuing education credit will be provided.

I am looking forward to continuing to work enthusiastically with the NPWH BOD, our CEO, our staff, and our members to support our organization’s mission and goals.

Beth Kelsey, EdD, APRN, WHNP-BC