There is a tendency to think of women’s health as only the well woman visit, an “annual event, ” the time to be screened for breast and cervical cancers and to address their family planning needs, menopausal symptoms, and/or other gynecologic health problems and concerns. In reality the well woman visit is more than an annual event.

The preventive services provided during the well woman visit are one important aspect of women’s overall health care, and may be accomplished during one visit, or over several encounters.¹ The Women’s Preventive Services Initiative (WPSI), a federally supported collaborative program led by the American College of Obstetricians and Gynecologists to review and recommend updates to the current Women’s Preventive Services Guidelines², “recommends that women receive at least one preventive care visit per year beginning in adolescence and continuing across the lifespan to ensure that the recommended preventive services, including preconception and many services necessary for prenatal and interconception care, are obtained.” Depending on a woman’s age, health status and needs, and other risk factors, additional well-woman visits may be needed to obtain all necessary services.^3,4 To aid in understanding the recommended components of the well-woman visit, the WPSI developed a Well-Woman Chart that outlines preventive services for women as recommended by the WPSI, U.S. Preventive Services Task Force (USPSTF), and Bright Futures.⁵ Clinical guidelines included in the Well-Woman Chart are generally covered with no cost-sharing for most public and private insurance plans under the prevention service mandate of the Affordable Care Act.⁶

During this time of COVID-19, sheltering in place and seeking a new normal, women’s attention is turned to staying well. However, attention to scheduling that annual visit, or attending to preventive care outside of virus prevention strategies may be taking a back seat. Certainly, unless delaying in-person preventive services would be harmful to a patient’s health and safety, such services could be potentially deferred until after the COVID-19 response stabilizes. But other services enumerated in the well-woman chart, such as verbal screening and counseling recommendations can lend themselves well to a telehealth visit. For example, services such as mental health screenings, healthy diet and activity counseling, intimate partner violence screening and counseling regarding available resources, tobacco screening and counseling may be beneficial during this high stress time. Likewise, blood pressure screening, or preeclampsia screening for pregnant women if appropriate resources such as blood pressure cuffs are available, can provide additional touchpoints to monitor emerging risks. The WPSI has compiled a telehealth FAQ resource to support HCPs in continuing to provide critical women’s preventive services.⁷ During this time of uncertainty, innovative approaches to health care access can provide touchpoints for wellness.

Women’s Health Week serves as a reminder for woman and girls to make their health a priority. Beyond the well-woman visit, ongoing attention to underlying health conditions, such as cardiovascular disease, diabetes, and mental health concerns is critical to optimizing health outcomes. Likewise, supporting and maintaining healthy lifestyle habits – eating well, sleeping enough, managing stress, exercising regularly – is a daily experience. Indeed, for HCPs who care for women, as well as for the women themselves, women’s health is much more than just an annual event.

Importance of Preventive Services for Women

The well-woman visit (WWV), and recommended preventive services, are designed to make a difference by helping women identify their personal health risks, access healthcare appropriate to their own needs, and receive support in achieving their goal to be as healthy as possible. The WWV gives women a chance to partner with their HCP to do the following:

• Access recommended health screenings and assessments;
• Recognize and address emerging personal and/or family risk factors that may have a direct impact on their present and future health status;
• Attend to physical, emotional, behavioral, and environmental factors that affect health and well-being; and
• Identify personal health goals and the strategies to achieve these goals.

These key components of the WWV, and recommended preventive services, directly address the many factors affecting women’s reproductive, gynecologic, and sexual health; maternal–child health outcomes; and overall health status from menarche through older adulthood. Under the Affordable Care Act, basic women’s preventive healthcare is covered with no cost-sharing (e.g., co-payments, co-insurance, deductible costs) to the woman. The well-woman preventive care visit is defined as occurring “annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care….”⁴ In general, the WWV occurs once a year, although the U.S. Department of Health and Human Services recognizes that, depending on a woman’s health status, health needs, and other risk factors, several visits may be needed within a year to obtain all necessary recommended preventive services.⁴ The WPSI Well Woman Chart provides a roadmap to support HCPs in assuring that women have access to the care they deserve.⁵

Conclusion

A woman’s physical and emotional health is influenced by biologic, psychosocial, behavioral, and environmental factors. In addition, the impact of gender differences on the manifestations of chronic disease and mental illness cannot be overlooked. Although events such as Mother’s Day, Women’s Health Week, Breast Cancer Awareness Month, American Heart Month, and other awareness campaigns serve to remind us of the importance of attention to women’s health, they cannot be the sole driver of our focus. Like the components of the WWV, women’s health is addressed and improved in a variety of steps, over time. To improve women’s health, regardless of life stage, women’s issues must be a key consideration in every policy decision—education, economics, and, of course, healthcare. NPWH is proud to join with WPSI core partners ACOG, ACP and AAFP in working with this national coalition of 21 health professional organizations and patient representatives to develop, review, update, and disseminate evidence-based clinical recommendations for women’s preventive health care services in the United States.²

References

1. Conry J, Brown H. Well-Woman Task Force: Components of the Well-Woman Visit. Obstetrics & Gynecology 2015; 126: 697-701. https://journals.lww.com/greenjournal/Fulltext/2015/10000/Well_Woman_Task_Force__Components_of_the.2.aspx 2. Women’s Preventive Services Initiative. Recommendations for preventive services for women.
2. Women’s Preventive Services Initiative. (2018). Available at: https://www.womenspreventivehealth.org/.
3. Women’s Preventive Services Initiative. (2018). Well-woman Preventive Visits. Available at: https://www.womenspreventivehealth.org/recommendations/well-woman-preventive-visits/.
4. Health Resources Services Administration. (2019). Women’s Preventive Services Guidelines. Available at: https://www.hrsa.gov/womens-guidelines/index.html.
5. Women’s Preventive Services Initiative. (2018). Well Woman Chart: Recommendations for well woman care. Available at: https://www.womenspreventivehealth.org/recommendations/well-woman-preventive-visits/.
6. Phipps MG, Son S, Zahn C, OʼReilly N, Cantor A, Frost J, Gregory KD, Jones M, Kendig SM, Nelson HD, Pappas M, Qaseem A, Ramos D, Salganicoff A, Taylor G, Conry J. Womenʼs Preventive Services Initiative. (2019). Women’s Preventive Services Initiative Well-Woman Chart: A summary of preventive health recommendations for women. Obstetrics & Gynecology, 134 (3), 465-469.
7. Women’s Preventive Services Initiative. (2020). FAQ for Telehealth. Available at: https://www.womenspreventivehealth.org/implementation/telehealthfaq/faqs/.

Susan Kendig, JD, WHNP-BC, FAANP is a Women’s Health Integration Specialist with SSM Health – St. Mary’s Hospital in St. Louis, Missouri, and serves as Director of Policy, National Association of Nurse Practitioners in Women’s Health (NPWH). She has held numerous appointments to national policy efforts, including CMS Medicare Evidence Development & Coverage Advisory Committee and the National Quality Forum (NQF) Measures Application Partnership Medicaid Adult Workgroup and NQF’s Social Determinants of Health Data Integration Workgroup. In her home state of Missouri, she serves as Vice Chair of the Missouri Women’s Health Council and as a member of the St. Louis City Board of Health and Hospitals. Dr. Kendig represents NPWH on the Alliance for Innovation in Maternal Health national partners group and Executive Committee. She is a member of the Women’s Preventive Services Advisory Panel, which guides the HRSA funded collaborative interdisciplinary effort to develop, review, update and disseminate recommendations for women’s preventive health care services.