PRECONCEPTION CARE

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.
Preconception care has a positive effect on a range of health outcomes. Among others,
preconception care can:
 reduce maternal and child mortality
 prevent unintended pregnancies
 prevent complications during pregnancy and delivery
 prevent stillbirths, preterm birth and low birth weight
 prevent birth defects
 prevent neonatal infections
 prevent underweight and stunting
 prevent vertical transmission of HIV/STIs
 lower the risk of some forms of childhood cancers
 lower the risk of type 2 diabetes and cardiovascular disease later in life.
Package of preconception care interventions :
1. Nutritional conditions
 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
 Promoting exercise
 Iodization of salt
2. Tobacco use
 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
3. Genetic conditions
 Taking a thorough family history to identify risk factors for genetic conditions
 Family planning
 Genetic counselling
 Carrier screening and testing
 Appropriate treatment of genetic conditions
 Community-wide or national screening among populations at high risk
4. Environmental health
 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
5. Infertility/Sub-fertility
 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
6. Interpersonal violence
 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
7. Too-early, unwanted, and rapid successive pregnancies
 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
8. Sexually transmitted infections (STIs)
 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
9. HIV
 Family planning
 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
10. Mental health
 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
11. Psychoactive substance use
 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
12. Vaccine-preventable diseases
 Vaccination against rubella
  Vaccination against tetanus and diphtheria
 Vaccination against Hepatitis B
13. Female Genital Mutilation
 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