Bule Hora University

College of Health Sciences

Department of Midwifery
Module Title: Preconception and Reproductive
Health Module
Course Title: Preconception care

By:- M.D.M(MSC IN
CNMW )
MARCH

2025
 Think about your before getting
baby pregnant!
 Are you ready for
pregnancy?
 There are lots of things you need to
know before you get pregnant!
 Objectives
After the end of this class ,students will be able to:
 Define pre conception care
 Explain the concepts of pre-conception care
 Demonstrate counseling on pre-conception care to
couples
 List and discuss components of pre
conception care
 Definitions of Pre-conception Care

• Various definitions have been formulated for

preconception care.
• In 2005 the American College of Obstetricians and
Gynecologists defined preconception care as:
“…a care that optimize women's health and
knowledge before planning and conceiving a
pregnancy to reduce the risk of adverse
health effects for the woman, fetus, or neonate”.
• Other definitions can be found in the literature,
such as active preparation for pregnancy with
a view of offering the earliest embryonic cells
the best possible environment.
• Pubmed's Database in 1992: “An organized and
comprehensive program of health care
that identifies and reduces a woman's
reproductive risks before conception through risk
assessment, health promotion, and
interventions”.
• The Centers for Disease Control and Prevention defines
pre connectional care as
• “a set of interventions that aim to identify and modify
biomedical, behavioral, and social risks to a
woman’s health or pregnancy outcome through
prevention and management” (Johnson, 2006).
• Who is candidate for preconception care?
• Every woman of reproductive age who is capable of
becoming pregnant is a candidate for
preconception care, regardless of whether
she is planning to conceive and married or
unmarried.
• Preconception care is aimed at identifying and
modifying biomedical, behavioral, and social
risks through preventive and management
interventions for woman and couples before
conception occurs.
• Inter conception care is defined as care provided
between delivery and the beginning of
the woman’s next pregnancy.
• The term inter conception health has
limited familiarity among many medical
providers, with preconception care being the
term used more often in medical circles to
refer to care that can maximize parental
health before pregnancy.
• During the inter conception period, intensive
interventions are provided to women who had a
previous pregnancy that ended in an adverse
outcome (fetal loss, preterm birth [PTB], low
birth weight [LBW], birth defects, or infant death).
• Many medical conditions among reproductive-age
women frequently become apparent during
pregnancy and may contribute to negative birth
outcomes in the infant.
• Hence, inter conception care typically refers to enhanced
interventions after an adverse pregnancy outcome.
• However, for purposes of this discussion, preconception
and inter conception care are essentially
interchangeable.
 The concept of preconception care
 Preconception care extends from some months before
conception to the first few weeks there after.
• Opportunities to prevent and control diseases occur at
multiple stages of life
• So strong public health program 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
What is the Rationale for preconception
care ?
 Rationale for preconception
• The evidence and rationale for providing these
services are multiple.
 First, increasing evidence suggests that human health
status in adulthood is dictated by micro and macro
environmental conditions around the time of
conception
• Preconception intervention is more important than
prenatal intervention; important fetal development
happens prior the woman’s first prenatal visit.
• Maternal risk factors are associated with preterm
birth, spontaneous abortion, stillbirth, fetal death,
infant death, low birth weight, fetal growth
restriction, fetal alcohol disorders, and neural tube
defects.
• Hence, the first prenatal visit may be too late to address
modifiable behaviors that could optimize not
only
pregnancy outcome but the health of the child and
future
adult
.
 Second, significant contribution to adverse pregnancy
outcome is related to congenital anomalies, PTB, and
LBW.
• Children born with these conditions
contribute significantly to neonatal and infant mortality
as well as to family and society health care costs.
• Clients who present at their first prenatal visit, even as
early as the first trimester, are often too late to
initiate behaviors
• Therapeutic to prevent
interventions abnormalities developmental risk for
or
anomalies and potential LBW, congenital
preterm delivery.
mitigate
 Third, almost half of pregnancies are mistimed,
unplanned, or unwanted such that women may
not be at optimal health or practicing ideal
health behaviors at the time of conception,
and this is particularly true for adolescents and/or
low-income women.
 Fourth, the proportion / n u m b e r of
women who delay childbearing or get
pregnant with significant medical
conditions is increasing, and specific
opportunities exist too optimize fertility and
pregnancy outcomes as it relates to
medication management for those
planning pregnancy
• Specifically, for those planning pregnancy,
preconception/inter conception visits provide
an opportunity for teachable moments,
and data suggest couples planning
pregnancy are more likely to change
behaviors.
Why we invest in preconception care?
• 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

• Prevent vertical transmission of HIV/STIs

 Some world wide Facts:
• 4 out of 10 women report that their pregnancies are
unplanned.
• As a result, essential health interventions should be
provided
• Maternal under nutrition and iron-deficiency anemia
increase the risk of maternal death, accounting for
at least 20% of maternal mortality worldwide.
• In 2010, 58 000 newborn babies died from
neonatal tetanus.
• Female genital mutilation increases the risk
of neonatal death (including stillbirths) by 15% to
55% .
• Perinatal deaths are 50% higher among children born
to mothers under 20 years of age compared to
mothers aged 20–29 years.
• 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.
• In the absence of interventions, rates of HIV transmission
from mother to child are between 5 and 45%.
• 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.
• 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.
• Evidence 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.
• The aim of preconception care is to promote the health
of women before conception in order to
reduce preventable adverse pregnancy outcomes
by facilitating
 Risk screening,

 Health promotion, and

 Effective interventions as part of routine health care.

 Pre-conception counseling on
 Environmental Toxins such as smoking,, anesthetic gases,
antineoplastic drugs and exposure to lead, selenium and
inorganic mercury.
 Smoking cessation

 Screen for alcoholism and use of illegal drugs

 Occupational exposures
 Pre-conception counseling …

 Material Safety(Household chemicals such as

paint thinners/strippers, other solvents,
pesticides )
 Radiation
 exposureregular
Recommend exercise, avoid
moderate hyperthermia (hot tubs)
 Counsel to maintain a healthy
weight
 Pre-conception counseling …
 Assess risk of nutritional deficiencies: Vegan, Pica,
Milk intolerance, Calcium or iron deficiency,
Avoid over use of: Vitamin A, Vitamin D,
Caffeine
 Counsel on the use of over-the-counter medications,
nutritional supplements and substances.
 Pre-conception counseling …
Genetic conditions
 Family history:
 Sickle cell anemia,
 Cystic fibrosis/thick mucose(Cystic fibrosis which causes
severe damage to
the lungs, digestive system and other organs in the body.
 Thalassemia(body makes an abnormal form of hemoglobin)
 Scrotal injury and temperature effects (for men)
and Infertility/sub-fertility.
Pre-conception Care to promote healthy pregnancy

 Supplementing iron and folic acid

 Iodization of salt

 Vaccine-preventable diseases (Vaccination against

tetanus, rubella, diphtheria, Hepatitis B and others )
 Assessment of Previous Pregnancies related
Medical and Surgical Complication
 Cesarean section

 Premature delivery/preterm labor

 Hypertensive disorder of pregnancy

 Diabetes

 Rh incompatibility

 Postpartum hemorrhage and

 Thrombotic event (DVT/PE)

 Components of Preconception Care

• Key components include

 Risk assessment,

 Health promotion,

 Medical and psychosocial intervention

• Every woman of reproductive age who is
capable of pregnant is a candidate
for preconception
becoming care, even if she is not
planning to conceive.
• Men should also receive preconception care,
although the components are not as well defined in
men as they are in women.
• The American Academy of Pediatrics and the
American College of Obstetricians
and Gynecologists classify the main
components of preconception care into four
categories:
 Physical assessment,

 Risk screening,

 Vaccinations, and counseling.

 Components of Preconception Care
A:Risk assessment
 Reproductive life plan: A reproductive life plan is a
personalized set of goals regarding whether or not to
have children and the desired number.
• The process of developing a RLP can assist both
women and men to reflect upon and discuss their reproductive
plans, timeline, the desired number of children, and
contraception methods appropriate for the timeline.
• Ask your patient if she plans to have children (or
additional children if she is already a mother)
and how long she plans to wait until she
becomes pregnant; help her develop a plan,
based on her values and resources, to achieve
those goals
 Reproductive history: Review previous adverse
pregnancy outcomes (e.g,infant death, fetal
loss, birth defects, low birth weight, preterm
birth) and assess on going bio behavioral
risks that could lead to recurrence in a
subsequent pregnancy
 Medical history: Ask if the patient has a history of
conditions that could affect future pregnancies
(e.g., rheumatic heart disease, thrombo
embolism, autoimmune diseases); screen for
ongoing chronic conditions such as hypertension
and diabetes
 Medication use: Review the patient’s current
medication use;
• Avoid FDA pregnancy category X medications and
most category D medications unless
potential maternal benefits outweigh fetal
risks; review the use of over-the-counter
medications, herbs, and supplements
 Infections and immunizations:

Screen for periodontal/easily preventable ,

urogenital, and sexually transmitted infections as
indicated; update immunization with hepatitis B, rubella,
varicella, human papillomavirus, and influenza vaccines
as needed; counsel the patient about preventing
TORCH infections
 Genetic screening and family history: Assess the
patient’s risk of chromosomal or genetic
disorders based on family history, ethnic
background, and age.
• Offer cystic fibrosis and other carrier screening
as indicated; discuss management of known
genetic disorders
 Nutritional assessment: Assess
nutrition: anthropometric factors (e.g. BMI),
biochemical factors (e.g. anemia), clinical
factors, and dietary risks
 Substance abuse: Ask the patient
about tobacco, alcohol, and drug use
 Toxins and teratogen agents: Counsel the patient about
possible toxins and exposure to teratogen agents at home,
in the neighborhood, and in the workplace (e.g, heavy
metals, solvents, pesticides, endocrine disruptors,
allergens)
 Psychosocial concerns: Screen for depression,
anxiety, domestic violence, and major
psychosocial stressors
 Physical examination: Focus on periodental,
thyroid, heart, breast, and pelvic examinations
• Laboratory testing: Testing should include a complete
blood count; urinalysis; blood type and screen;
and,
when indicated, screening for rubella, syphilis,
hepatitis B, human deficiency virus,
gonorrhea, immune chlamydia,diabetes and cervical
cytology; considerandmeasuring thyroid-stimulating
hormone levels
B:Health promotion
 Family planning: Promote family planning based on
the patient’s reproductive life plan; for women
who are not planning to become pregnant,
promote effective contraceptive use and
discuss emergency contraception
 Healthy weight and nutrition:

 Promote a healthy pre pregnancy and ideal

weight BMI through exercise and
nutrition
 Discuss macro- and micronutrients
 Healthy behaviors: Promote healthy behaviors such
as nutrition, exercise, safe sex, effective
contraceptive use, dental flossing, and use of
preventive health services.
 Discourage risky behaviors ,smoking, alcohol and
substance abuse
 Stress resilience/relief : Promote nutrition,
exercise, sufficient sleep, and relaxation and address
ongoing stressors (e.g., domestic violence)
 Identify resources to help the patient develop problem
solving and conflict-resolution skills, positive mental
health, and strong relationships
 Healthy environments: household,
Discuss neighborhood, and exposures
to occupational
heavy metals, organic solvents, pesticides,
endocrine disruptors, and allergens and give
practical tips such as how to avoid exposures
 C.Medical and psychosocial interventions
for identified risks

• Interventions should identified medical and

address psychosocial risks
 Folic acid supplementation,

 Testing for rubella seronegativity and vaccination

if indicated,
 Tight control of pregestational diabetes,

 Careful management of hypothyroidism,

 Avoidance of erotogenic agents

Which areas addressed by the preconception
care package?
 Nutritional conditions

• Screening for anemia and diabetes

• Supplementing iron and folic acid

• Information, education counselling Monitoring

and nutritional status
• Management of diabetes, including counselling people with
diabetes mellitus

• Promoting exercise

• Iodization of salt
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 behavioral 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
 Genetic conditions

• Taking a thorough family history to identify risk

factors for genetic conditions
• Genetic counselling

• Carrier screening and testing

• Appropriate treatment of genetic conditions

• Community-wide or national screening among

populations at high risk
 Environmental health
• Providing guidance and information on environmental
hazards and prevention
• Protecting from unnecessary exposure in
radiation occupational,
• Environmental and medical settings

• Avoiding unnecessary use/providing

pesticide 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
 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
 Interpersonal violence
• Health promotion to prevent dating violence

• Providing age-appropriate sexuality

comprehensive
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.
 Too-early, unwantedand 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 and 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
 Sexually transmitted infections (STIs)
• Providing age-appropriate comprehensive
sexuality education and services
• Promoting safe sex practices through
individual, group and community-level behavioral
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
 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
 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
 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 programs to reduce substance
use in adolescents
 Vaccine-preventable diseases

• Vaccination against rubella

• Vaccination against tetanus and diphtheria

• Vaccination against Hepatitis B

• Vaccination against HPV and others

 Female genital mutilation
(FGM)
• 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
Intimate Partner Violence and/or
Reproductive Coercion

• Counsel: Increased risk of unintended pregnancy,

abortion, repeat pregnancy, STIs, preterm
labor, obstetric complications, pregnancy-related
mortality, postpartum depression, smoking in
pregnancy, drug use in pregnancy.
Areas addressed by the preconception care package
 Environmental Exposures
• Contact with environmental substances is
inescapable.
• Thus, it is fortunate that only a few agents
have been shown to cause adverse
pregnancy outcomes.
• Likewise, contact with some chemicals may
impart/cause significant maternal and fetal risks.
• The embryo or fetus is more susceptible to environmental
toxins than adults.
• Drug or chemical exposure causes 3 to 6 percent
of anomalies.
• The timing of the exposure determines the type
and severity of anomaly.
• For example, an exposure before 17 days of fetal life could
be lethal.
• Employers are legally required to inform
workers the chance of exposures to
hazardous substances and to furnish/provide
them with Material Safety Data Sheets.
• In the home, pregnant women should
avoid prolonged exposure to pesticides
and to solvents such as paint thinners and
strippers
• Ask about the non-prescription (obtained from
a pharmacy, super market or health food
shop)
• Provide or direct women to reputable
sources of information regarding the
safety of these medicines during
pregnancy
 Nutrition, vitamins and minerals
• Nutrition, including ideal caloric intake
and weight gain
• Counsel on healthy eating and physical
activity
• Ahealthy diet adequate energy,
contains protein, minerals, obtained
vitaminsthe and
through consumption of a variety of foods,
including green vegetables, meat, fish, beans,
nuts, whole grains and fruit
• Anemia is associated with iron, folate and
vitamin A deficiencies.
• Major contributory factors to anemia include
parasitic infections such as malaria, hookworm
and schistosomiasis(parasitic infection) in areas
where these infections are endemic.
• In addition, chronic infections such as
tuberculosis (TB) and HIV, and
haemoglobinopathies such as sickle-cell
disease, contribute to the prevalence of anemia
• Associated with an increased risk of maternal
and infant mortality.
• It is estimated that about half of the
anemia found in pregnant women is
amenable/agreeable to iron supplementation.
• Calcium deficiency is associated with an increased risk
of preeclampsia ,and deficiencies of other vitamins
and minerals, such as vitamin E, C, B6 and zinc,
have also been postulated to play a role in
preeclampsia.
• Zinc deficiency is associated with impaired immunity.
• Vitamin C intake enhances iron absorption from the
gut.
 Taking folic acid before conception reduces the
incidence of neural tube defects(birth defects of the
brain, spine, or spinal cord) such as
• Spinal bifida(It happens if the spinal column of the
fetus doesn't close completely during the first month of
pregnancy) and
• Anencephaly(lacks part or all of the cerebrum).
• The average woman receives about 100 mcg of folic
acid per day from fortified breads and grains.
• Beginning at least one month before conception and
continuing through the first three months of
pregnancy, women should take a daily vitamin
supplement containing at least 400 mcg of folic acid.
• Higher dosages are indicated for special-risk
groups.
• A dosage of 1 mg per day is recommended
for women with diabetes mellitus or epilepsy.
• Mothers who have given birth to children with neural
tube defects should take 4 mg of folic acid per day
for subsequent pregnancies.
• Assess risk of nutritional deficiencies (vegan, pica,
milk intolerance, calcium, iodine or iron
deficiency)
• Other nutritional problems to watch for include pica,
vegetarian diets, and milk intolerance.
• Pica is usually manifested as cravings for dirt, clay, or
starch, and may result in malnourishment
and ingestion of toxins and infectious agents.
• Work-up should include evaluation for anemia and
possibly a psychiatric evaluation.
• If the patient cannot stop the behavior, nutritional
counseling can focus on substitutions, such
as powdered milk, pudding/sweet, or rice.
• Vegetarians who consume eggs or dairy products
usually have no nutritional deficiency; however,
strict vegans/fruits may have deficiencies in amino
acids, zinc, calcium, iron, and vitamins D and B12
• Such may need to referred
clients a be who can to
nutritionist
selection recommend
and supplementation. proper
food
• Milk intolerance is particularly common among
black, Asian, and Native American women and
may result in calcium deficiency.
• These women may be able to tolerate yogurt or
cooked cheese.
• They can also benefit from using lactose-reduced
milk, lactase tablets, or calcium supplements.
• Overdoses of vitamin A, vitamin D, and caffeine may
be toxic.
• Vitamin A is teratogenic in dosages of 20,000
to 50,000 IU per day.
• The FDA recommends a limit of 3,000 IU per day.
• Dosages of vitamin D greater than 1,600 to
2,000 IU per day may cause fetal hyperkalemia and
growth retardation
• Women should not exceed total dosages of
400 IU per day of vitamin D alone or combined in
calcium supplements

• Consumption of caffeine in amounts up to 300 mg per

day (two cups of coffee or six glasses of tea )
is considered safe by most authorities.

• Higher amounts of caffeine may be associated

with increased rates of abortion and low birth
weight.
• Iodine deficiency mainly occurs in developing
countries.
• Encourage a varied diet - sources of iodine include
sea salt, iodized salt and most bread
• women should start a dietary supplementation of
150 micrograms of iodine while attempting
pregnancy or as soon as possible after confirming
they are pregnant
• Women with thyroid disorders should consult their
treating physician before staring
iodine supplementation
Exercise and Nutrition
• Regular moderate exercise is generally beneficial and
has not been found to increase the risk of low
birth weight or other problems.

• In the first trimester, hyperthermia related to hot tub

use has been associated with increases in

congenital anomalies.
• Pregnant women should limit vigorous exercise to
avoid an increase in core body temperature
above 38°C (100.4°F).
• They should be adequately hydrated, wear loose
clothing, and avoid extreme
environmental temperatures.
• Counsel to maintain a healthy weight
 Correct both obesity and underweight

• Under weight
<18.5 kg/m 2
• Normal (healthy)weight
18.5 to 24.9 kg/m2
• Overweight
25-29.9 kg/m2
• Obese
>30 kg/m2
 Obesity increases the risks of hypertension,
preeclampsia, diabetes and large for gestational
age infant.
• Advice about healthy diet before conception
 Underweight:

• Increased incidence of amenorrhea, infertility, small

for gestational age infant, preterm birth, and
anemia
Radiation exposure
• Pregnant women are at risk of exposure to
nonionizing and ionizing radiation resulting
from necessary medical procedures, workplace
exposure, and diagnostic or therapeutic
interventions before the pregnancy is known.
Forms of Radiation
• Radiation is fast- energy emitted as
moving particles or waves.
• It is commonly into two categories:
divided
nonionizing and ionizing radiation.
• Nonionizing radiation is low frequency radiation that
disperses energy through heat and
increased molecular movement.
• Non ionizing radiation encountered in pregnancy is
ultrasound.
• Magnetic resonance imaging (MRI) is emerging as
another form of medical nonionizing radiation
• In utero exposure to nonionizing radiation is not
associated with significant risks;
therefore, ultrasonography is safe to perform
during pregnancy.
IONIZING RADIATION
• Ionizing radiation acts directly with the biochemical
structures in tissue (including proteins, DNA,
and other molecules) or indirectly by
causing the formation of free radicals, which
in turn break the structure of proteins, DNA, or
any other critical parts of the cell.
 Preconception care delivery strategies
A)Delivery within the education system School health
and reproductive health education programs
• Information and services must be made available to
adolescents to educate them on their sexuality and
protect themselves from unwanted pregnancies,
STIs, or risks of infertility.
• School-wide accepted sexed programs have shown to
delay the onset of sexual activity and increase
safer sexual practices by those that are already sexually
active.
 A)Delivery within the education system School
health and reproductive health education programs…
• All females should be counselled through regular
school health programs about eating disorders,
such as anorexia/loss of appetite or bulimia and
the risks to fertility and future pregnancies it might
have.
• Adolescents should be guided as to how to make
responsible decisions concerning their sexual lives,
as well as how to practice safe sex, and how to
 b) Delivery within health system Primary-level
(e.g. community health workers)

• The primary level health workers are the backbone to the

whole establishment of primary health care.
• CHWs can be trained to offer guidance and increase
awareness regarding STIs, to assess maternal health and
nutrition status in order to improve postpartum outcomes.
• They can also provide information about all forms of
contraceptives, their benefits and efficacy and also provide
information on emergency contraception to the female
population of child bearing age in a community
 C) Other platforms
(Community support groups)

• Community-based programs that pre-

provide
conception services will cater directly to the specific
needs of the particular community.
• Instead of a larger scale system of preconception care,
support groups will be able to distribute care
into smaller communities, villages, and rural areas.
 Mass media campaigns/ Social marketing
• Modern marketing techniques and social
communications have been successfully used in
many regions to promote the importance of
reproductive health.
• Many of the interventions can be delivered through
health facilities but to reach a larger audience
mass mobile text messages or radio
announcements may also be used where
applicable.
• Mass campaigns regarding immunization programs in
a locality or on the importance of family
planning may be advertised on TV channels, radio
 Workplace programs or referrals

• Educational workshops may be conducted that are

mandatory in workplace venues where men
and women both need to attend sessions on
sexual health/STI’s, smoking cessation, and
other health- related topics
 Barriers of preconception

• Barriers to more widespread utilization of

preconception care include lack of
provider knowledge and training about
essential components of preconception care.
 Barriers of preconception
• Motivations and goals, environmental context
and resources,
• Constraints, lack of women presenting at the preconception
stage
• Issues relating to the cost of and access to
preconception care, and the
• Lack of resources for assisting in the delivery
of preconception care guidelines.
 References
1. Basic Emergency obstetric and Newborn Care/BEmONC/ National in- service
training Manual, Ministry of Health, 2018
2.Management Protocol on Selected Obstetrics Topics for Hospitals, Ministry
of Health-Ethiopia, 2021
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Thanks