Exploring Preconception Care in Tigray, Ethiopia: Insights from the Primary Healthcare settings

Background: Preconception care, which provides biological, behavioral, and social health interventions to women and couples before conception, has shown to yield significant long-term benefits, by addressing health concerns before conception, particularly chronic conditions such as diabetes mellitus and hypertension. Since measures conducted before and after birth are deemed insufficient, preconception care provides crucial possibilities to deliver interventions that improve the health of the mother and the unborn child. Research indicates that interventions targeted at preconception care may enhance various pregnancy outcomes. For instance, adequate management of maternal health can lead to improved iron reserves for both the mother and the baby, an increase in birth weight, and a healthier pre-pregnancy body mass index (BMI). These factors are crucial as they have been associated with reduced risks of complications during pregnancy and childbirth. Moreover, the influence of preconception health extends beyond pregnancy. Evidence suggests that children born to mothers who received proper preconception care are more likely to experience positive growth and development outcomes. This includes not only physical health but also cognitive and social development, leading to increased productivity and physical activity in adulthood.

Ethiopia, with its expanding network of health extension workers, has been exerting its efforts to alleviate maternal and child mortality and morbidity for the past two decades. This has resulted in significant success, although other efforts are needed to be in place. As part of its commitment to the Sustainable Development Goal (SDG), and its further determination to reduce the mortalities, Ethiopia has initiated pilot preconception care delivery programs in selected districts by integrating them into the routine antenatal care (ANC) visits before a nation-wide implementation begins.

Preconception care delivery faces significant difficulties despite its benefits. Evidence highlighted that low understanding of the community on the perceived benefits, lack of access to service, infrastructure, shortage of health care providers, long-distance travel, and financial hurdles are commonly documented barriers to preconception care utilization. On the other hand, facilitators include community-based programs, the existence of routine antenatal services, mobile health applications, social media, policy, and programmatic support. However, our review of the literature shows that a significant gap remains in addressing misconceptions surrounding pregnancy, behavioral factors, lifestyle choices, and the influence of the religious system, cultural beliefs, and societal norms. Additionally, opportunities and challenges associated with adolescent preconception care and health, along with the role of innovative technologies, remain largely unexplored. Adopting a comprehensive health systems approach to understand the barriers and facilitators of preconception care service delivery in Tigray is also essential for ensuring full-scale implementation. Therefore, it appears reasonable to explore those gaps that have the potential to enhance the development of context-specific interventions for preconception care implementation.