Updated: Feb 16
A new WHO report shows that preconception care has a positive impact on maternal and child health outcomes (1). Addressed primarily at health professionals responsible for developing national and local health policies, the report provides a foundation for implementing a package of promotive, preventive and curative health interventions shown to have been effective in improving maternal and child health. A wide range of sectors and stakeholders needs to be engaged to ensure universal access to preconception care. The report also guides non-health sectors, foundations and civil society organizations to collaborate with, and support, public health policy-makers to maximize gains for maternal and child health through preconception care.
What is preconception care, and what is its aim?
Preconception care is the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs. It aims at improving their health status, and reducing behaviours and individual and environmental factors that contribute to poor maternal and child health outcomes. Its ultimate aim is to improve maternal and child health, in both the short and long term.
Opportunities to prevent and control diseases occur at multiple stages of life; strong public health programmes that use a life-course perspective from infancy through childhood and adolescence to adulthood are needed. Preconception care contributes to these efforts. Even if preconception care aims primarily at improving maternal and child health, it brings health benefits to the adolescents, women and men, irrespective of their plans to become parents.
4 out of 10 women report that their pregnancies are unplanned (2). As a result, essential health interventions provided once a woman and her partner decide to have a child will be too late in 40% of pregnancies. Maternal undernutrition and iron-deficiency anaemia increase the risk of maternal death, accounting for at least 20% of maternal mortality worldwide (1).
In 2010, 58 000 newborn babies died from neonatal tetanus (3).
Female genital mutilation increases the risk of neonatal death (including stillbirths) by 15% to 55% (4).
Perinatal deaths are 50% higher among children born to mothers under 20 years of age compared to mothers aged 20–29 years (1).
Up to 35% of pregnancies among women with untreated gonococcal infections result in low birth weight infants and premature deliveries, and up to 10% result in perinatal death (1).
In the absence of interventions, rates of HIV transmission from mother to child are between 15 and 45% (1).
Violence against girls and women results in adverse physical, psychological and reproductive consequences, as well as increased risk for premature delivery and low-birth-weight infants (5).
Women with epilepsy are at increased risk of having babies with congenital anomalies (both epilepsy and the medications given for its control may have adverse effects on the baby) (1).
Estimates indicate that eliminating smoking before or during pregnancy could avoid 5–7% of preterm- related deaths and 23–24% of cases of sudden infant death syndrome (1).
Preconception care can make a difference
What is the package of preconception care interventions?
Examples of evidence-based interventions
Screening for anaemia and diabetes
Supplementing iron and folic acid
Information, education and counselling
Monitoring nutritional status
Supplementing energy- and nutrient-dense food
Management of diabetes, including counselling people with diabetes mellitus
Iodization of salt
Screening of women and girls for tobacco use (smoking and smokeless tobacco) at all clinical visits using “5 As” (ask, advise, assess, assist, arrange)
Providing brief tobacco cessation advice, pharmacotherapy (including nicotine replacement therapy, if available) and intensive behavioural counselling services
Screening of all non-smokers (men and women) and advising about harm of second-hand smoke and harmful effects on pregnant women and unborn children
Taking a thorough family history to identify risk factors for genetic conditions
Carrier screening and testing
Appropriate treatment of genetic conditions
Community-wide or national screening among populations at high risk
Providing guidance and information on environmental hazards and prevention
Protecting from unnecessary radiation exposure in occupational, environmental and medical settings
Avoiding unnecessary pesticide use/providing alternatives to pesticides
Protecting from lead exposure
Informing women of childbearing age about levels of methyl mercury in fish
Promoting use of improved stoves and cleaner liquid/gaseous fuels
Creating awareness and understanding of fertility and infertility and their preventable and unpreventable causes
Defusing stigmatization of infertility and assumption of fate
Screening and diagnosis of couples following 6–12 months of attempting pregnancy, and management of underlying causes of infertility/sub-fertility, including past STIs
Counselling for individuals/couples diagnosed with unpreventable causes of infertility/sub-fertility
Health promotion to prevent dating violence
Providing age-appropriate comprehensive sexuality education that addresses gender equality, human rights, and sexual relations
Combining and linking economic empowerment, gender equality and community mobilization activities
Recognizing signs of violence against women
Providing health care services (including post-rape care), referral and psychosocial support to victims of violence
Changing individual and social norms regarding drinking, screening and counselling of people who are problem drinkers, and treating people who have alcohol use disorders
Keeping girls in school
Influencing cultural norms that support early marriage and coerced sex
Providing age-appropriate comprehensive sexuality education
Providing contraceptives and building community support for preventing early pregnancy and contraceptive provision to adolescents
Empowering girls to resist coerced sex
Engaging men and boys to critically assess norms and practices regarding gender-based violence and coerced sex
Educating women and couples about the dangers to the baby and mother of short birth intervals
Providing age-appropriate comprehensive sexuality education and services
Promoting safe sex practices through individual, group and community-level behavioural interventions
Promoting condom use for dual protection against STIs and unwanted pregnancies
Ensuring increased access to condoms
Screening for STIs
Increasing access to treatment and other relevant health services
Promoting safe sex practices and dual method for birth control (with condoms) and STI control
Provider-initiated HIV counselling and testing, including male partner testing
Providing antiretroviral therapy for prevention and pre-exposure prophylaxis
Providing male circumcision
Providing antiretroviral prophylaxis for women not eligible for, or not on, antiretroviral therapy to prevent mother-to-child transmission
Determining eligibility for lifelong antiretroviral therapy
Assessing psychosocial problems
Providing educational and psychosocial counselling before and during pregnancy
Counselling, treating and managing depression in women planning pregnancy and other women of childbearing age
Strengthening community networks and promoting women’s empowerment
Improving access to education for women of childbearing age
Reducing economic insecurity of women of childbearing age
Screening for substance use
Providing brief interventions and treatment when needed
Treating substance use disorders, including pharmacological and psychological interventions
Providing family planning assistance for families with substance use disorders (including postpartum and between pregnancies)
Establishing prevention programmes to reduce substance use in adolescents
Vaccination against rubella
Vaccination against tetanus and diphtheria
Vaccination against Hepatitis B
Discussing and discouraging the practice with the girl and her parents and/ or partner
Screening women and girls for FGM to detect complications
Informing women and couples about complications of FGM and about access to treatment
Carrying out defibulation of infibulated or sealed girls and women before or early in pregnancy
Removing cysts and treating other complications
An agenda for action: Learning from experience, supporting change
In February 2012, a World Health Organization (WHO) meeting brought together researchers, practitioners and programme managers with experience in preconception care, as well as United Nations agencies and partner organizations to achieve a global consensus on the place of preconception care as part of an overall strategy to prevent maternal and childhood mortality and morbidity (1). An agenda for action was agreed upon at the meeting, including actions to:
Build regional and national capacity to plan, implement and monitor preconception care programmes and services.
Stimulate and support country action.
Carry out demonstration projects in selected countries.
Document and disseminate good preconception care practices. The “Draft action plan for the prevention and control of noncommunicable diseases 2013–2020” which were discussed at the 66th World Health Assembly in May 2013, calls governments to reduce modifiable risk factors for noncommunicable diseases and underlying social determinants. Preconception care, as part of the national policy framework, is recognized as an important contributor to noncommunicable disease prevention and control.