Background <p>Pregnancy intention is not routinely asked about in most primary care settings, leading to missed opportunities for timely discussions about contraception or preconception care. This study evaluated a Scottish adaptation of the One Key Question^® (OKQ^®) screening tool, designed to prompt conversations about pregnancy desire with women of reproductive age.</p> Methods <p>The pilot was implemented in two GP practices in Scotland. All women aged 16 and over with the capacity to become pregnant were eligible to be asked the question, regardless of the reason for their visit. Information, services, or referrals were then offered based on their response. Quantitative and qualitative methods were used to evaluate acceptability from the perspective of patients and healthcare professionals (HCPs) over a 3-month period.</p> Results <p>Fifty-six women were asked the pregnancy intention question from October to December 2024. Thirty-eight (68%) provided feedback. Most found the conversation easy (92%) and felt listened to and supported (94%). Six HCPs were interviewed at the end of the pilot; they described the tool as a useful prompt, with contraception the most common outcome. However, some reported uncertainty about when it was appropriate to ask.</p> Conclusion <p>This pilot suggests that using a standardised pregnancy intention question may be a simple and acceptable way to initiate reproductive health conversations in routine care. The findings also highlight the need for flexible and sensitive use depending on patient context.</p>