Family Planning Programs – An Opportunity to Integrate Preconception Health Services into Primary Health Care

A life-course approach to enhancing maternal and child health by improving parental health prior to conception is gaining international interest. Healthcare providers and researchers are seeking effective ways to increase women’s and men’s access to preconception care, especially through primary care. At the same time, preconception health includes conversations about pregnancy planning (or avoidance), which is a part of FP services. Unfortunately, “family planning” has the same meaning as “contraception” for many people at the moment, which is too simplistic because there are multiple aspects of preconception health and well-being. Expanding the understanding of preconception health as inclusive of FP and primary care has the potential to increase access to this important care while respecting sexual and reproductive rights, according to a couple’s reproductive plans. Respecting the sexual and reproductive rights of the population requires that FP programs be focused not only on contraception but, equally, on preconception care.

Health behaviours in 131,182 UK women planning pregnancy

Background A woman’s health at the time of conception lays the foundation for a healthy pregnancy and the lifelong health of her child. We investigated the health behaviours of UK women planning pregnancy. Methods We analysed survey data from the ‘Planning for Pregnancy’ online tool (Tommy’s, UK). We described all women planning pregnancy and compared the frequency of non-adherence to preconception recommendations in women who had already stopped contraception (active planners) and those who had not (non-active planners). Results One hundred thirty-one thousand one hundred eighty-two women from across the UK were included, of whom 64.8% were actively planning pregnancy. Of the whole cohort, twenty percent were smokers and less than one third took folic acid supplements (31.5%). Forty two percent engaged in less than the recommended 150 min of weekly physical activity and only 53.3% consumed five portions of fruit or vegetables 4 days a week. Smokers were 1.87 times more likely to be active planners than non-smokers (95% CI 1.79–1.94), and women who took folic acid were 7 times more likely to be active planners (95% CI 6.97–7.59) compared to women who did not. Smoking, drug use and lack of folic acid supplementation were common in younger women and those who were underweight. Conclusions This unique survey of UK women has identified poor adherence to preconception recommendations in those planning pregnancies and supports the need for a greater public health focus on preconception health. This study provides a contemporary basis from which to inform preconception health advice and a benchmark to measure changes over time.

A Network Analysis of Multiple Preconception Health Behaviors in Chinese Women

A healthy preconception lifestyle, consisting of multiple health behaviors, is crucial for preventing adverse health outcomes in mothers and offspring. Although inter-behavior relations may be leveraged to boost the effectiveness of lifestyle education and multiple health behavior changes, this has not been adequately explored in the existing literature. Adopting a network perspective, the present study conceptualized multiple health behaviors as a behavior network (i.e., behaviors as nodes, inter-behavior relations as edges) and utilized network analysis to investigate the patterns of interdependence of preconception health behaviors in a large sample of Chinese women. We used the data of a population-based cohort study in China to estimate the behavior network. An analytic sample included 41,127 Chinese women who were surveyed about their adoptions of multiple health behaviors during the preconception period. Network analysis revealed a relatively dense behavior network and visualized the network structure of multiple preconception health behaviors, suggesting that the behaviors were strongly interconnected. Subsequent centrality analysis identified three central behaviors (i.e., avoiding passive smoke, reducing psychosocial stress, and reducing alcohol) that had distinctively stronger connections to other behaviors within the network. This study demonstrated the applicability of the network model in multiple health behavior research. Our findings highlight the interdependence of preconception health behaviors and implicate the potential usefulness of targeting central behaviors in preconception lifestyle education.

Characterising and monitoring preconception health in England: a review of national population-level indicators and core data sources

Initiatives to optimise preconception health are emerging following growing recognition that this may improve the health and well-being of women and men of reproductive age and optimise health in their children. To inform and evaluate such initiatives, guidance is required on indicators that describe and monitor population-level preconception health. We searched relevant databases and websites (March 2021) to identify national and international preconception guidelines, recommendations and policy reports. These were reviewed to identify preconception indicators. Indicators were aligned with a measure describing the prevalence of the indicator as recorded in national population-based data sources in England. From 22 documents reviewed, we identified 66 indicators across 12 domains. Domains included wider (social/economic) determinants of health; health care; reproductive health and family planning; health behaviours; environmental exposures; cervical screening; immunisation and infections; mental health, physical health; medication and genetic risk. Sixty-five of the 66 indicators were reported in at least one national routine health data set, survey or cohort study. A measure of preconception health assessment and care was not identified in any current national data source. Perspectives from three (healthcare) professionals described how indicator assessment and monitoring may influence patient care and inform awareness campaign development. This review forms the foundation for developing a national surveillance system for preconception health in England. The identified indicators can be assessed using national data sources to determine the population’s preconception needs, improve patient care, inform and evaluate new campaigns and interventions and enhance accountability from responsible agencies to improve preconception health.