Background: Early and continuous prenatal care has long been considered the standard for optimizing positive birth outcomes. Yet infant mortality, low birth weight and preterm deliveries are still high in the United States. This inconsistency has led experts to reconsider the role of prenatal care by itself. Recently, public health and maternal-fetal experts are now recommending that prevention practices include early entrance into prenatal care, but also begin before prenatal care, in the preconception and interconception periods. Preconception care has been identified as a way to improve birth outcomes, by moving away from care centered on the intervals of pregnancy to that of providing high levels of care throughout a woman's life. In 2011, although an increasing number (72%) of pregnant women in the state of Washington entered prenatal care within the first trimester, disparities continue to exist in access to early prenatal care by age group, Medicaid status, and race/ethnicity. Also, while early prenatal care is improving overall, preterm birth and low birth weight have not declined in Washington since 2006. Preterm birth and low birth weight have remained at about 10% and 6% respectively, (Washington Vital Statistics 2009-2011). Preconception care could help close this gap. Despite the importance of preconception/interconception care, the state of Washington does not maintain consistent surveillance of preconception care access. The development of indicators of preconception care is a critical factor in developing long-term surveillance of progress toward implementation of preconception care. Methods: This report develops indicators to measure need for access to preconception care using data from the 2009-2011 Pregnancy Risk Assessment Monitoring Survey (PRAMS). Pre-pregnancy health seeking and risk behaviors were used to develop surveillance indicators for preconception care. In addition, a Preconception Health Index was created using variables known to contribute to preconception health. Results: This index shows only 7% of Washington women are in the highest level of preconception health, per the index. The Preconception Health Index also shows disparities across race/ethnicity, age, and Medicaid status. Conclusions: Interventions to increase women's access to care include removing financial obstacles and promoting culturally competent care.