Preconception care practice among pregnant women attending antenatal care at Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, southern Ethiopia, 2022: a mixed-methods study

Background: Preconception care includes biomedical, behavioral, and social health interventions for women and couples before conception, aiming to improve their overall health status. Despite its importance, studies conducted in Ethiopia reveal that the practice remains unacceptably low; this emphasizes the need for further investigation, particularly through mixed-methods studies incorporating women's perspectives.

Methods: An institution-based, cross-sectional study with concurrent triangulation was conducted at Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital between 1 April and 30 June 2022. Quantitative data were collected using a systematic random sampling method, while qualitative data were obtained through purposive sampling. A structured, interviewer-administered questionnaire was used to collect data from 332 eligible antenatal care clients. The data were entered into EpiData and analyzed using SPSS. Bivariate and multivariate analyses were performed to identify factors associated with the practice of preconception care. A 95% confidence interval (CI) and p-values <0.05 were considered statistically significant. Thematic analysis of qualitative data was performed using ATLAS.ti version 7.

Results: This study showed that 104 women (31.3%) (95% CI: 26.5–36.5) engaged in good preconception care practices. Factors significantly associated with good practices included attending college or university [adjusted odds ratio (AOR) = 3.52, 95% CI: 1.14–10.87], having a history of adverse pregnancy outcomes (AOR = 4.82, 95% CI: 2.20–10.58), receiving support from one’s husband (AOR = 2.45, 95% CI: 1.05–5.73), and having good knowledge of preconception care (AOR = 4.52, 95% CI: 2.11–9.68). The qualitative analysis revealed that client-related and health facility-related factors influenced the practice of preconception care.

Conclusion: Nearly 7 out of 10 women in this study became pregnant without the utilization of any component of preconception care. To improve the practice of preconception care, it is essential to raise awareness about its benefits among all women of reproductive age. Future efforts focusing on knowledge dissemination and awareness creation to improve partner support are crucial to enhancing preconception care practices.

Introduction

Preconception care (PCC) refers to the provision of biomedical, behavioral, and social health interventions to women and couples before conception to improve health status and minimize risk factors that may contribute to poor maternal and child health outcomes (1). PCC addresses the health of women and their partners before pregnancy and is recognized as an essential element for achieving healthy outcomes for mothers and their children (2). PCC aims to identify and, when possible, modify risk factors that are directly or indirectly linked to untoward perinatal outcomes (3).

PCC contributes to reducing maternal and childhood mortality and morbidity in addition to improving maternal and child health, in both high- and low-income countries by preventing or reducing anemia, unplanned pregnancies, sexually transmitted diseases, adolescent pregnancies, congenital anomalies, stillbirths, low birth weight, and preterm births (1, 4). PCC potentially averts 71% of neonatal deaths, 33% of stillbirths, and 54% of maternal deaths per year (5). In addition, it accelerates the seeking of antenatal care (ANC) by 39% and positively influences the continuum of maternal care (6). Due to this effect, Ethiopia has set target goals to increase the number of women who receive PCC by 25% to reduce maternal and neonatal deaths (7).

Despite its recognized importance, evidence shows that uptake of PCC among women of reproductive age remains inadequate. According to the World Health Organization, globally, 4 out of 10 women report that their pregnancies were unintended. As a result, 40% of pregnancies do not receive the necessary healthcare services before pregnancy (8). Evidence shows that PCC utilization is low in many countries, with rates of 40% in China (9), 15.9% in Brazil (10), 47% in Iran (11), 24.05% in sub-Saharan Africa (12), and 16.27% in Ethiopia (13). This limited implementation of PCC significantly contributes to maternal and childhood mortality and morbidity (1). For example, the Ethiopian Demographic Health Survey reported that 58% of women did not take iron or folate tablets during their most recent pregnancy (10), despite strong evidence that folate supplementation reduces the risk of neural tube defects (14).

Findings from different literature have shown that sociodemographic factors, such as age, marital status, residence, educational status, spousal support, family income, good knowledge of PCC, along with obstetrical factors such as multiparity, previous adverse pregnancy outcomes, and history of chronic illness, were associated with PCC practices (15–19).

Although various studies have been conducted in Ethiopia to assess PCC practices, the majority do not address women's views on PCC. Therefore, this study aimed to assess the level of practice, identify associated factors, and explore women's views on PCC among pregnant women attending Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Southern Ethiopia, using a mixed-methods approach.

Methods

Study design and setting

An institutional-based, quantitative, cross-sectional study with concurrent triangulation with qualitative interview findings was conducted between 1 April and 30 June 2022. The study was conducted at Wachemo University, Nigist Eleni Mohamed Memorial Comprehensive Specialized Hospital, located in Hosanna Town, Southern Ethiopia. It is the only comprehensive specialized hospital found in the Hadiya Zone. Hosanna Town is situated 232 km from Addis Ababa, the capital city of Ethiopia. The hospital was established in 1976 and serves approximately 1,568,000 men and 1,632,000 women annually.

Study population

All pregnant women attending ANC at Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital during the data collection period were included in the study, and purposively selected pregnant women were included for the qualitative component. However, women who were severely ill, specifically those unable to communicate, were excluded from participation.

Sample size and sampling procedure

The sample size was determined using the single population proportion formula by considering the following assumptions: confidence interval (CI) = 95%; critical value (Zα/2)² = 1.96; and degree of precision d = 0.04. The proportion (p) = 14.5% was obtained from a study conducted in West Shewa, Oromia, Ethiopia (16). This resulted in a sample size of 332 pregnant women, including a 10% non-response rate. The data collection period for this study was 3 months. A total of 747 pregnant women received ANC services in the 3 months preceding data collection. Based on this, the sampling interval was determined by dividing the total number of 747 by a calculated sample size of 332, resulting in a sampling interval of approximately 2. Finally, every other ANC patient was selected for an interview within 3 months. The first pregnant woman was randomly selected from among the first two based on the sequence of their charts.

For the qualitative component, the purposive sampling technique was used to select participants until data saturation was achieved, which occurred with eight participants. Qualitative interview participants were selected from those not involved in the quantitative component.

Study variables

The practice of PCC among pregnant women was the dependent variable and included receiving at least one of the “good practice” components of PCC [i.e., folic acid supplementation, immunization, avoiding cigarette smoking, avoiding illegal drugs, maintaining a balanced diet, caring for one’s psychosocial health, screening for sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), avoiding environmental hazards, exercising regularly, and receiving early medical checkups] (20). This threshold was chosen based on the limited integration of PCC into routine maternal health services in the study setting, as comprehensive PCC is not routinely available in this context. In the absence of comprehensive and fully integrated PCC services, receiving even a single PCC component was considered a meaningful indicator of good practice. Given these contextual limitations, such minimal engagement reflects both awareness of and initial contact with preconception services, which is particularly significant in low-resource settings. However, those who did not engage in any PCC component in preparation for pregnancy were categorized as having poor PCC practice (20).

Maternal socioeconomic, demographic, obstetric, and medical-related traits, along with access to health facilities and knowledge-related variables, were considered independent variables.

Knowledge of PCC was assessed by 12 yes-or-no questions. Study participants who answered ≥50% of the knowledge questions correctly (17).

Data collection tool and procedure

The data collection tool was adapted after reviewing different related articles and documents (16–19). First, the tool was prepared in English and then translated into Amharic. Maternal socioeconomic and demographic data, obstetric and medical-related data, access to health facility-related data, knowledge, and practice-related data were included in the tool. The data were collected using structured and pre-tested interviewer-administered questionnaires. Six midwives with bachelor's degrees were recruited as data collectors for the quantitative part, and two experienced supervisors were assigned to oversee the data collection process and to check the quantitative data for completeness, accuracy, and clarity. Qualitative data were collected by the principal investigator through audio-recorded interviews using semi-structured questions. The in-depth, individual interviews took place in a quiet room suitable for audio recording. Data collection and participant probing continued until thematic saturation was reached.

Data quality assurance

The questionnaires were pre-tested at Worabe Comprehensive Specialized Hospital on 5% of the sample size of pregnant women, 1 week before the actual data collection period. A 2-day training was given to the data collectors and supervisors. Two assigned supervisors provided close supervision throughout the entire quantitative data collection period to check data for completeness, accuracy, and clarity. The interviews were conducted privately, with assurances of confidentiality to minimize social desirability bias. Furthermore, the collected data were entered into EpiData version 3.1 to minimize data entry errors. The reliability of the practice assessment tool was evaluated using Cronbach's alpha, which resulted in a value of 0.72, indicating acceptable internal consistency. The qualitative data were transcribed, and the principal investigator checked the consistency of the transcription.

Data processing and analysis

The collected data were entered into EpiData version 3.1 and exported to SPSS version 23 for cleaning, coding, computing, and analysis. All explanatory variables with a p-value <0.25 in the bivariable logistic regression analysis were candidate variables for the multivariable logistic regression analysis. Finally, after adjusting for confounding factors, a p-value <0.05 was used to determine the final statistical significance of this study. The principal investigator listened to the audio recordings, transcribed the interviews verbatim, and translated them into English with the assistance of another author (AT). The translated data were read and reread until the full meaning of the contents was understood and familiar to the data. The translated data were coded using ATLAS.ti version 7 qualitative analysis software; codes with similar meanings were then grouped into subcategories and main themes for thematic analysis.

Ethics approval and consent to participate

Ethical clearance was obtained from the Institutional Review Board (IRB) of the Hosanna College of Health Sciences (Ref. No. Code 1102/2013 E.C.). After communicating with the responsible hospital managers, permission letters were obtained. Before data collection, written informed consent was obtained from quantitative and qualitative study participants.

Results

Sociodemographic characteristics

A total of 332 pregnant women participated, resulting in a response rate of 100%. The ages of the participants ranged from 15 to 45 years (mean age 25.7 ± 4.3 years). The majority (84%) of the study participants were of the Hadiya ethnicity, and nearly three-quarters (74.4%) were Protestant. Nearly one-fifth (21.7%) of the respondents had no formal education, and one-half (50.3%) were housewives (Table 1).

Table 1

Table 1. Sociodemographic characteristics of the study participants at Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, southern Ethiopia, 2022 (n = 332).

Obstetrical and pre-existing medical conditions of the study participants

Of the total study participants, 137 (41.3%) women were pregnant for the first time, and 102 (52.3%) respondents were multiparous. A total of 61 participants (31.3%) reported a history of adverse pregnancy outcomes, including abortion (49%) and stillbirth (19.7%). Among the total participants, 17 (5.1%) had a pre-existing medical condition (Table 2).

Table 2

Table 2. Obstetrical and medical-related characteristics of the study participants at Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, southern Ethiopia, 2022 (n = 332).

Access to health facility-related characteristics

Among the total study participants, 240 (72.3%) perceived that the distance to reach a nearby health facility on foot was less than 30 min. The majority of respondents (n = 281, 84.6%) had access to transportation, and 302 (90.9%) reported that medications were available. More than two-thirds (n = 227, 68.3%) of the study participants received support from their husbands for health services, and 242 (72.9%) had autonomy in making decisions about maternal health services.

Level of knowledge of study participants

Three-fifths (58.3%) of the study participants had heard about PCC. The main sources of information were family and relatives (28.6%), healthcare providers (19.3%), and schools (9.6%).

Regarding knowledge of practices contributing to a healthy pregnancy outcome, 204 participants (61.4%) recognized the importance of folic acid supplementation, 160 women (48.2%) recognized the importance of vaccinations, 270 respondents (81.3%) recognized the importance of exercise, and 172 women (51.8%) recognized the importance of maintaining an optimal body weight. In addition, participants reported the following as important pre-pregnancy practices: screening for chronic conditions (58.1%), testing for STIs (79.5%), avoiding alcohol consumption (46.4%), refraining from illegal drug use (58.4%), screening for psychosocial problems (46.4%), and avoiding exposure to environmental hazards (34.9%). Overall, the study showed that fewer than half of the participants (n = 158, 47.6%; 95% CI: 42.3–53) had good knowledge of PCC.

The level of practice of preconception care among study participants

This study showed that 104 (31.3%) of the participating women (95% CI: 26.5–36.5) observed good PCC practices. Furthermore, 7 in 10 women were currently pregnant without receiving PCC. Fewer than one-quarter (23.2%) of the women reported taking folic acid, and fewer than one-fifth received counseling on a balanced diet before their current pregnancy (Table 3). Qualitative findings supported these results, revealing that the majority of women did not practice PCC.

Table 3

Table 3. Level of preconception care practices among the study participants at Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, southern Ethiopia, 2022 (n = 332).

“I am neither infertile nor ill, so I do not feel the need to visit a health facility before conception. Women seek healthcare before pregnancy only when they are ill or experiencing infertility” (34-year-old multigravida housewife).

Factors associated with the practice of preconception care

Bivariate and multivariable logistic regression analyses were conducted to identify factors affecting the practice of PCC. In the bivariable analysis, educational status, history of adverse pregnancy outcomes, planned status of the current pregnancy, decision making autonomy regarding maternal health service, receiving support from a spouse, distance from the nearest health facility, and knowledge of PCC were candidate variables for the multivariable logistic regression analysis (p-value <0.25). After controlling for the confounding factors, the multivariable analysis revealed that educational status, history of adverse pregnancy outcomes, receiving support from a spouse, and knowledge of PCC were identified as being significant (p-value <0.05).

This study showed that women who attended college or university were 3.52 times more likely to observe good PCC practices than participants without a formal education [adjusted odds ratio (AOR) = 3.52, 95% CI: 1.14–10.87].

Participants who had a history of adverse pregnancy outcomes were 4.82 times more likely to observe good PCC practices compared to their counterparts (AOR = 4.82, 95% CI: 2.20–10.58). This finding is supported by qualitative results, as women who had a history of adverse pregnancy outcomes were counseled to have follow-ups before future conception to prevent the recurrence of the problem.

“My neighborhood woman, who had a history of giving birth to anencephaly, was counseled to take folic acid 3 months before pregnancy” (29-year-old, multigravida, housewife).

Participants who received support from their husbands were 2.45 times more likely to observe good PCC practices compared to their counterparts (AOR = 2.45, 95% CI: 1.05–5.73).

The present study found that women with good knowledge of PCC were 4.52 times more likely to practice it than those with poor knowledge (AOR = 4.52, 95% CI: 2.11–9.68) (Table 4). In addition, qualitative studies identified the challenge of sourcing reliable and easily available preconception health information as a barrier to utilizing the service.

Table 4

Table 4. Bivariable and multivariable logistic regression analysis of factors associated with preconception care practices among pregnant women at Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, southern Ethiopia, 2022 (n = 332).

“Even if I had an ANC follow-up in the previous pregnancy and gave birth in this hospital, no one told me about PCC and the availability of services in this hospital” (32-year-old multigravida housewife).

“I had never heard about the service and was not aware that I could, before being pregnant, go to the clinic and discuss with a healthcare provider my desire for pregnancy. I only visited the clinic for an ANC or when I became ill” (28-year-old multigravida, housewife).

Theme 1: client factors

Under this theme, lack of awareness of the service, economic factors, time constraints, and cultural factors were identified.

Economic and time constraints

Study participants were not willing to spend time and money on attending PCC. There were costs associated with transportation, laboratory services, and medication, and it was difficult for women who had no income of their own. There are no free services for non-pregnant women; hence, low-income women might be unable to afford them.

“I am a government employee; my vacation was on the weekend, but there is no preconception service on the weekend. There was not enough time to visit health facilities for PCC; the manager does not give me leave” (26-year-old employee primigravida).

“I have no money to pay for transportation service, for investigation, and medication” (34-year-old, housewife, multigravida).

Cultural factors

Specifically, women discussed the private and often secretive period between planning a pregnancy and actual conception. Many expressed an unwillingness to share their plans or desires for pregnancy with others, including healthcare professionals. In some communities, there is a common belief that health facilities are intended primarily for treatment rather than prevention, making visits to a healthcare facility seem unnecessary in the absence of apparent health issues.

“I am afraid to talk about my intention to get pregnant, and I have not told my family about being pregnant until three months have passed or until the risk of abortion is ruled out” (23-year-old student, primigravida).

“In my community, when healthy women visit health facilities, they are considered by the community as not liking work” (29-year-old housewife, multigravida).

Theme 2: health facility factors

Barriers to the uptake of PCC included a lack of service announcements, the unavailability of PCC at nearby health facilities, long waiting times at clinics, and the cost of services. Study participants reported that even women with illnesses often avoid seeking healthcare due to the high costs associated with investigations and medications. In addition, study participants were uncertain about the presence of a dedicated PCC unit in health facilities, as there were no visible posters or signs providing information or directions to the service.

“PCC services are unavailable at my nearby health facility, even though I was also referred today there for ANC” (28-year-old merchant, multigravida).

“Health facilities have not announced the presence of the service, and health education about PCC was not given to the community, nor was it posted about the service within the facilities” (25-year-old, employee, primigravida).

“Since no free service was given to non-pregnant women, I have no money to pay for PCC services like medication and laboratory. I know that before the current pregnancy, I was sick with malaria, and I paid for the card, laboratory, and medication service provided for me” (34-year-old, housewife, multigravida).

“I am busy, but I stayed a longer time in this hospital to get service, and as a result, I wouldn’t come back again to the hospital for service” (26-year-old employee, primigravida).

Discussion

The study results showed that one-third (31.3%) of participants (95% CI: 26.5–36.5) followed good PCC practices. This finding is in line with studies conducted in Nigeria (34.1%) (21) and Zambia (33.3%) (22). However, this figure is higher than the findings from studies conducted in Hosanna (19%) (15), Mizan-Aman (16.2%) (23), Fiche (21.6%) (24), West Guji Zone (22.3%) (25), Mekelle (18.2%) (18), and China (20.6%) (26). The higher prevalence in our study may be due to the difference in study settings, as previous studies were conducted in community settings, whereas the present study was conducted at a healthcare facility. Participants at specialized hospitals may have a higher level of healthcare awareness and a higher socioeconomic status, enabling them to understand the importance of PCC and access healthcare services easily. In addition, women attending specialized hospitals may be more likely to be urban-dwellers and present with pre-existing health problems, pregnancy-related complications, or perceived risks, encouraging them to be more proactive in seeking care, including preconception services. Consequently, a study limited to specialized hospital settings potentially overestimates the prevalence of preconception care among the general population of the region.

Conversely, the rate of good PCC practices in this study was lower than that reported in studies from Addis Ababa (40%) (27), Eswatini (59%) (28), Iran (47.7%) (11), Malaysia (45.2%) (29), and China (40%) (9). The possible reasons are in the differences in socioeconomic status and educational level. For instance, only approximately one-fifth of the participants in our study had attained a tertiary education, whereas nearly three-quarters of the participants in the Addis Ababa study had reached this level. Educational status was identified as one of the significant variables associated with the practice of PCC. Study participants who were attending college or university were 3.52 times more likely to undertake PCC. This finding aligns with studies conducted in Wolkite (30), Mizan-Aman (23), Belgium (31), and China (9). This trend indicates that more educated women have better access to information and understand the importance of PCC, which promotes service utilization (24). Although improving educational opportunities for women is a long-term effort, it may have a significant impact on improving the utilization of such services.

Participants in the present study who had previous adverse pregnancy outcomes were 4.82 times more likely to adhere to good practices of PCC, which is similarly reflected in studies conducted in Hosanna (15), Addis Ababa (27), and Debre Tabor (32). This adherence may be attributed to the fear of recurrence of complications among women who had experienced previous adverse pregnancy outcomes. Motivated by a desire to prevent future problems, these women were more likely to attend the counseling provided by healthcare providers and follow their medical advice in subsequent pregnancies.

Study participants who had spousal support were 2.45 times more likely to observe good PCC practices, similar to prior study findings in Fiche (24), Mekelle (18), and China (9). Male engagement is an important strategy for improving maternal health, as it empowers their partners in healthcare decision-making and care-seeking behaviors, including PCC (33).

In this study, participants with a good knowledge of PCC were 4.52 times more likely to practice it effectively. This finding is consistent with studies conducted in Wolkite (30), Mizan-Aman (23), Debre Birhan (17), Debre Tabor (32), Mekelle (18), and Nigeria (21). A current qualitative study also supports this result, highlighting poor awareness of PCC as a key factor affecting its uptake, an issue similarly reported in studies from Jimma (34) and the Netherlands (35). One possible explanation is that women with greater knowledge of PCC are more likely to understand its benefits and the consequences of not utilizing the service. Therefore, increasing awareness among women of PCC may lead to improved practices.

In addition, cultural influences were reported as barriers to the practice of PCC. The majority of women kept their pregnancy intentions secret from others, including their partners and families, as discussing the desire to become pregnant or acknowledging a pregnancy is considered shameful until the possibility of an abortion or miscarriage is ruled out. This finding aligns with studies conducted in Jimma (34), Zimbabwe (36), the Netherlands (35), and Australia (37).

This study also identified transportation costs and service charges as significant barriers to accessing PCC. These financial constraints were similarly reported in studies conducted in Jimma (34) and Zimbabwe (36), highlighting a widespread challenge that undermines equitable healthcare access. As PCC services are not free, and long distances impede access to these services, the majority of women from low-income households may be unable to afford them.

Limitations of the study

This study addressed the factors that influence the practice of PCC quantitatively and qualitatively among Ethiopian women; however, it could there are limitations associated with this article. First, the cause-and-effect relationship was not shown due to this study's cross-sectional nature. In addition, there is a risk of recall and social desirability biases, which may have affected the accuracy of reported PCC practices, potentially conflated prevalence estimates, and distorted associations. To minimize these effects, interviews were conducted privately, with assurances of confidentiality, and data collectors were trained to use non-leading questions. Another limitation of this study is its broad definition of good practice, which was based on receiving at least one PCC component. This threshold likely overestimated comprehensive PCC coverage, with the 31.3% prevalence reflecting any exposure to PCC, rather than full or recommended care. Although this approach was necessary given the limited availability of services, it may weaken the association with outcomes.

Finally, data saturation was reached after conducting eight in-depth interviews in the qualitative part of the study; however, the authors acknowledge that the sample size is relatively small. This limited number of participants may constrain the transferability of the findings to the broader population of pregnant women.

Conclusion

This study found that less than one-third of the participating women engaged in good PCC practices; on the other hand, nearly 7 in 10 women became pregnant without engaging in PCC. Attending college or university, having a history of previous adverse pregnancy outcomes, receiving support from a spouse, and having good knowledge of PCC were significantly positively associated with good PCC practices. This qualitative study identified two themes: client-related factors (lack of awareness of the service, economic factors, time constraints, and cultural factors) and health facility factors (not announcing the presence of the service, unavailability of the service at the nearest health facilities, longer waiting times, and service charges) were both identified as reasons for poor practice of PCC.

To improve PCC practices, the Ethiopian Ministry of Health should prioritize expanding health insurance coverage for low-income women to improve accessibility and utilization of PCC services. In addition, increasing awareness about PCC among all reproductive-age women should be emphasized to encourage greater engagement with PCC services. Future studies are encouraged to use a more tiered approach to comprehensive PCC, using terms like “some practice” or “minimal engagement” to more accurately reflect the observed level of care and including PCC utilization among husbands.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving humans were approved by the Institutional Review Board (IRB) of the Hossana College of Health Sciences. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

TG: Conceptualization, Data curation, Formal Analysis, Methodology, Software, Writing – original draft, Writing – review & editing. ME: Conceptualization, Data curation, Formal Analysis, Methodology, Writing – original draft, Writing – review & editing. ML: Methodology, Supervision, Validation, Writing – review & editing. TB: Methodology, Supervision, Writing – review & editing. TG: Methodology, Supervision, Writing – review & editing. EA: Formal Analysis, Methodology, Writing – review & editing. SY: Methodology, Supervision, Writing – review & editing. PP: Methodology, Writing – review & editing. AT: Formal Analysis, Methodology, Writing – review & editing.

Funding

The author(s) declare that financial support was received for the research and/or publication of this article. Hosanna Health Science College contributed to the study’s funding in part. However, they were not involved in the study’s planning, data gathering, analysis, or interpretation.

Acknowledgments

We would like to thank the research and publications directorate of Hosanna Health Science College. We would also like to express our gratitude to Wachemo University, Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital for their assistance during the preliminary survey and actual data collection. Finally, the authors are also grateful to the supervisors and data collectors who committed to this work throughout the study period and to all the participants who volunteered to participate in it.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Abbreviations

ANC, antenatal care; AOR, adjusted odds ratio; CI, confidence interval; PCC, preconception care; STI, sexually transmitted infection.

References

1. World Health Organization. Meeting to Develop a Global Consensus on Preconception Care to Reduce Maternal and Childhood Mortality and Morbidity. Geneva Meet Report. Geneva, Switzerland: WHO Headquarters (2013). p. 78.

Google Scholar

2. Dorney E, Black KI. Preconception care. Aust J Gen Pract. (2018) 47(7):424–9. doi: 10.31128/AJGP-02-18-4485

PubMed Abstract | Crossref Full Text | Google Scholar

3. Government of Belize Ministry of Health. Preconception and obstetrics: primary health care, continuum of care (2018). p. 1–124. Available online at: https://platform.who.int/docs/default-source/mca-documents/policy-documents/guideline/blz-mn-21-01-guideline-2018-eng-preconception-and-obstetrics.pdf (Accessed June 25, 2022).

Google Scholar

4. World Health Organization. Preconception Care: Report of a Regional Expert Group Consultation. New Delhi, India: WHO (2014). p. 1–82.

Google Scholar

5. Bhutta ZA, Das JK, Bahl R, Lawn JE, Salam RA, Paul VK, et al. Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost ? Lancet. (2014) 6(14):1–24. doi: 10.1016/S0140-6736(14)60792-3

Crossref Full Text | Google Scholar

6. Dean SV, Lassi ZS, Imam AM, Bhutta ZA. Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reprod Health. (2014) 11(Suppl 3):1–8. doi: 10.1186/1742-4755-11-S3-S1

PubMed Abstract | Crossref Full Text | Google Scholar

7. Ethiopia Ministry of Health. National Preconception Care Guideline. Addis Ababa: MoH-Ethiopia (2024). p. 1–80.

Google Scholar

8. World Health Organization. Preconception Care: Maximizing the Gains for Maternal and Child Health Facts. Geneva: WHO (2013). p. 1–8.

Google Scholar

9. Ding Y, Li XT, Xie F, Yang YL. Survey on the implementation of preconception care in Shanghai, China. Paediatr Perinat Epidemiol. (2015) 29(6):492–500. doi: 10.1111/ppe.12218

PubMed Abstract | Crossref Full Text | Google Scholar

10. Borges ALV, Santos OAD, Nascimento NDC, Chofakian CBDN, Gomes-Sponholz FA. Preconception health behaviors associated with pregnancy planning status among Brazilian women. Rev Esc Enferm USP. (2016) 50(2):208–15. doi: 10.1590/S0080-623420160000200005

PubMed Abstract | Crossref Full Text | Google Scholar

11. Shadab P, Nekuei N, Yadegarfar G. Prevalence of pre-pregnancy risk factors and its relationship with preconception care in Isfahan—Iran. Int J Pediatr. (2017) 5(8):5463–71. doi: 10.22038/ijp.2017.8629

Crossref Full Text | Google Scholar

12. Woldeyohannes D, Tekalegn Y, Sahiledengle B, Hailemariam Z, Erkalo D, Zegeye A, et al. Preconception care in sub-Saharan Africa: a systematic review and meta-analysis on the prevalence and its correlation with knowledge level among women in the reproductive age group. SAGE Open Med. (2023) 11(2):1–12. doi: 10.1177/20503121231153511

Crossref Full Text | Google Scholar

13. Ayele AD, Belay HG, Kassa BG, Worke MD. Knowledge and utilisation of preconception care and associated factors among women in Ethiopia: systematic review and meta-analysis. Reprod Health. (2021) 18(78):1–15. doi: 10.1186/s12978-021-01132-9

PubMed Abstract | Crossref Full Text | Google Scholar

14. Lassi ZS, Dean SV, Mallick D, Bhutta ZA. Preconception care: delivery strategies and packages for care. Reprod Health. (2014) 11(3):1–17.24383405

PubMed Abstract | Google Scholar

15. Admasu M, Id W, Gejo NG, Bedecha DY, Kerbo AA, Hagisso SN, et al. Utilization of preconception care and associated factors in Hosanna town, southern Ethiopia. PLoS One. (2022) 17(1):1–16. doi: 10.1371/journal.pone.0261895

Crossref Full Text | Google Scholar

16. Fekene DB, Woldeyes BS, Erena MM, Demisse GA. Knowledge, uptake of preconception care and associated factors among reproductive age group women in west Shewa zone, Ethiopia, 2018. BMC Womens Health. (2020) 20(1):1–8. doi: 10.1186/s12905-020-00900-2

PubMed Abstract | Crossref Full Text | Google Scholar

17. Demisse TL, Aliyu SA, Kitila SB, Tafesse TT, Gelaw KA, Zerihun MS. Utilization of preconception care and associated factors among reproductive age group women in Debre Birhan town, north Shewa, Ethiopia. Reprod Health. (2019) 16(1):1–10. doi: 10.1186/s12978-019-0758-x

PubMed Abstract | Crossref Full Text | Google Scholar

18. Asresu TT, Hailu D, Girmay B, Abrha MW, Weldearegay HG. Mothers’ utilization and associated factors in preconception care in northern Ethiopia: a community based cross sectional study. BMC Pregnancy Childbirth. (2019) 19(1):1–7. doi: 10.1186/s12884-019-2478-1

PubMed Abstract | Crossref Full Text | Google Scholar

19. Ayalew Y, Mulat A, Dile M, Simegn A. Women’s knowledge and associated factors in preconception care in Adet, west Gojjam, northwest Ethiopia: a community based cross sectional study. Reprod Health. (2017) 14(1):1–10. doi: 10.1186/s12978-017-0279-4

PubMed Abstract | Crossref Full Text | Google Scholar

20. Teshome F, Kebede Y, Abamecha F. Practice of preconception care and associated factors among pregnant women in Manna district, southwest Ethiopia: a community-based cross-sectional. J Womens Health Care. (2021) 10(3):1–8. doi: 10.35248/2167-0420.21.10.519

Crossref Full Text | Google Scholar

21. Olowokere AE1, Komolafe A1, Owofadeju C. Awareness knowledge and uptake of preconception care among women in Ife Central Local Government Area of Osun State Nigeria. J Community Med Prim Health Care. (2015) 27(2):83–92.

Google Scholar

22. Mutale P, Kwangu M, Muchemwa C, Silitongo M, Chileshe M, Siziya S. Knowledge and preconception care seeking practices among reproductive-age diabetic women in Zambia. Int J Transl Med Res Public Health. (2017) 1(2):36–43. doi: 10.21106/ijtmrph.48

Crossref Full Text | Google Scholar

23. Setegn M. What women do before pregnancy a preconception care of women in Mizan Aman town southwest Ethiopia a mixed study. Prim Health Care Open Access. (2021) 11(1):1–6.

Google Scholar

24. Fetena N, Negash A, Kebede A, Sertsu A, Nega A, Nigussie K, et al. Utilization of preconception care and associated factors among pregnant mothers in Fiche town, central Ethiopia: a community-based cross-sectional study 2021. Front Glob Womens Health. (2023) 4:1–8. doi: 10.3389/fgwh.2023.1159693

Crossref Full Text | Google Scholar

25. Amaje E, Fikrie A. Utilization of preconception care and its associated factors among pregnant women of West Guji Zone, Oromia, Ethiopia, 2021: a community-based cross-sectional study. Health Serv Res Manag Epidemiol. (2022) 9:1–10. doi: 10.1177/23333928221088720

Crossref Full Text | Google Scholar

26. You X, Tan H, Hu S, Wu J, Jiang H, Peng A, et al. Effects of preconception counseling on maternal health care of migrant women in China: a community-based, cross-sectional survey. BMC Pregnancy Childbirth. (2015) 15(1):1–10. doi: 10.1186/s12884-015-0485-4

PubMed Abstract | Crossref Full Text | Google Scholar

27. Girma A, Bedada A, Kumbi S. Utilization of preconception care and associated factors among pregnant women attending ANC in private MCH hospitals in Addis Ababa, Ethiopia. BMC Pregnancy Childbirth. (2023) 23(649):1–12. doi: 10.1186/s12884-023-05955-1

PubMed Abstract | Crossref Full Text | Google Scholar

28. Region H. Knowledge, attitudes and practices towards preconception care among child bearing women. Int J Health Nursing Med. (2019) 2(1):14–31.

Google Scholar

29. Kasim R, Draman N, Kadir AA, Muhamad R. Knowledge, attitudes and practice of preconception care among women attending maternal health clinic in Kelantan. Educ Med J. (2016) 8(4):1–13. doi: 10.5959/eimj.v8i4.475

Crossref Full Text | Google Scholar

30. Habte A, Dessu S, Haile D. Determinants of practice of preconception care among women of reproductive age group in southern Ethiopia, 2020: content analysis. Reprod Health. (2021) 18(100):1–14. doi: 10.1186/s12978-021-01154-3

PubMed Abstract | Crossref Full Text | Google Scholar

31. Goossens J, Beeckman D, Van Hecke A, Delbaere I, Verhaeghe S. Preconception lifestyle changes in women with planned pregnancies. Midwifery. (2018) 56:112–20. doi: 10.1016/j.midw.2017.10.004

PubMed Abstract | Crossref Full Text | Google Scholar

32. Degu Ayele A, Temesgen Ayenew N, Getnet Kassa B, Getie Teffera A, Nibret Mihretie G, Dagnew Yehuala E, et al. Preconception care utilization and its associated factors among women in Debre Tabor town northwest Ethiopia: community based cross-sectional study. SAGE Open. (2022) 12(2):1–9. doi: 10.1177/21582440221097392

Crossref Full Text | Google Scholar

33. Conlin M, McKee S, Grenier S. Engaging males in maternal care. (2016). Available online at: www.LMGforHealth.org (Accessed August 10, 2022).

Google Scholar

34. Teshome F, Kebede Y, Abamecha F, Birhanu Z. Why do women not prepare for pregnancy? Exploring women’s and health care providers’ views on barriers to uptake of preconception care in Mana district, southwest Ethiopia: a qualitative study. BMC Pregnancy Childbirth. (2020) 20(1):1–13. doi: 10.1186/s12884-020-03208-z

Crossref Full Text | Google Scholar

35. Poels M, Koster M, Boeije HR, Franx A, van Stel HF. A systematic review on barriers and facilitators. Obstet Gynecol Surv. (2016) 71(10):603–12. doi: 10.1097/OGX.0000000000000360

PubMed Abstract | Crossref Full Text | Google Scholar

36. Elizabeth S, Doreen MM, Mathilda Z, Dodzo L. Perceptions of preconception care among pregnant women at Masvingo general hospital, Zimbabwe: a qualitative study. J Midwifery Reprod Health. (2020) 8(2):2220–9. doi: 10.22038/jmrh.2020.41728.1474

Crossref Full Text | Google Scholar

37. Khan NN, Boyle J, Lang AY, Harrison CL. Preconception health attitudes and behaviours of women: a qualitative investigation. Nutrients. (2019) 11(7):1–12. doi: 10.3390/nu11071490

Crossref Full Text | Google Scholar