Thank you for providing the Journal’s readership with a focused issue (November 2012) honoring World Prematurity Day and directing attention to novel efforts to reduce the incidence of preterm birth. As stated in the Framework and accompanying editorial, there are exciting opportunities ahead. Mapping the human Gestome may lead to the identification of effective preterm birth preventative strategies. However, the potential of this approach, or any other, to truly affect the rate of preterm birth will be unrealized unless it is accompanied by a comprehensive approach to improve family planning services. This is particularly true when discussing a global approach to preventing preterm birth because so many women still lack access to high quality contraception and safe abortion care.

Primary and secondary prevention efforts to reduce the rate of preterm birth depend on effective utilization of family-planning services to reduce unintended pregnancies. A successful and cost-effective primary prevention strategy is to focus family-planning efforts on providing highly effective contraception (methods with typical use failure rates of 1% or less per year) to women at high risk of unintended pregnancy. This strategy has proven effective in reducing population level rates of unintended pregnancy and could have a powerful influence on preventing preterm birth. For example, in a population in which half of all pregnancies are unintended, universal access to highly effective contraception could reduce all births including preterm births by one quarter, an enormous effect. This approach could certainly reduce the more than 500 preterm births (spontaneous and indicated) that occur each year to women in Utah who conceive within 12 months of their last delivery.

Secondary prevention efforts will require improved family-planning care for women identified as having the highest risk of preterm birth. Because a history of preterm birth is the most effective marker for future preterm birth risk, it is paramount to provide these high-risk women with the most effective methods of contraception. Optimizing the interpregnancy interval and reducing unintended pregnancies in this group will reduce recurrent preterm births. If new approaches effectively identify women at high risk for first preterm birth, then it would be sensible to apply this approach to those women as well.

Exciting opportunities lay ahead to reduce preterm birth. By improving access to high-quality family planning care, a low-tech approach, we will have an immediate and significant impact while we pursue novel preterm birth prevention strategies.