Summary Pregnancy prevention (contraception) and pregnancy preparation (preconception care) are services that most people need during their reproductive lives. Despite increased attention and growing recognition that prepregnancy health is crucial to addressing disparities in maternal outcomes, service delivery is far from routine. We bring together evidence from the literature, new quantitative and qualitative data on women’s preferences, and case studies of existing practice, to develop an integrated community model that synthesizes reproductive life planning, contraception, and preconception care. . Our model provides a holistic life course approach, encompassing school-based education, social media and national campaigns, and highlights the need for system-level training and support for the range of health professionals who can provide it. This high-level model can be adapted in all settings, leading to a step-change in the provision of preconception care in the community with consequent improvements in health and well-being, and reductions in inequalities at the community level. of the population. |
Comments
The research, published in The Lancet Public Health , brought together a range of different types of evidence, including previous studies, new data on women’s preferences and case studies of existing practices around the world, to develop a model that could be used to help design services in a way that best meets the needs of women and their partners.
Researchers found that health services currently only see pregnant or non-pregnant women, and do not consider their health in the middle stage, before trying to conceive. This can have a major influence on both your chances of getting pregnant and having a healthy pregnancy, as well as affecting your own short- and long-term health.
Since 90% of women of reproductive age have at least one modifiable risk factor that affects pregnancy (such as low or high BMI), women’s health before they become pregnant is a major factor in maternal deaths and contributes to observed inequalities in maternal death rates in marginalized groups.
Along with health services, the team found that educational environments and social networks could also be more supportive in helping people consider their reproductive preferences.
As a result, they call for society-wide efforts to help unite family planning, contraception, and preconception care. And they have developed a framework that can be adapted to both different environments and the healthcare system.
The model suggests that children could be taught about reproductive needs, such as preconception health advice and contraception, in school. Meanwhile, social media campaigns could be used to raise awareness about the opportunities and benefits of choosing whether or when to have children.
Additionally, professionals could routinely ask patients about their reproductive preferences and digital tools could be available to direct people to appropriate sources of advice or services.
Lead author Dr Jenny Hall (UCL EGA Institute for Women’s Health) said: “The model proposed in this paper can be adapted and implemented in a variety of primary care settings, including general practice and services. of sexual and reproductive health, with appropriate training for health professionals.
“Doing so will close the gap between contraception and prenatal services, providing services in a way that better meets the needs of women as they progress through their reproductive life cycle, in line with the ambitions of the recent Health Strategy of the Women".
The Women’s Health Strategy for England was launched in August 2022 and cites fertility, pregnancy, pregnancy loss and postnatal support as one of its priority areas.
Ten-year ambitions for this area include supporting women through high-quality information and education to make informed decisions about their reproductive health, including whether and when to have a child. And provide children with high-quality, evidence-based education from an early age on fertility, contraception and pregnancy planning, maternity care and pregnancy loss.
Dr Hall said: "The review of the evidence and model presented in our study shows how preconception healthcare in the community can move from concept to reality and how the gap between contraception and birth control can be closed. prenatal services to comprehensively support the needs of women throughout their reproductive lives."
The project was funded by Public Health England and NIHR.
