ABSTRACT

Preconception care (PCC) is a critical yet often neglected component of maternal and child health, particularly in low-resource settings. This study assessed the knowledge, practices, and challenges of PCC among women of reproductive age (14–49 years) in the Muea community, Cameroon.

A cross-sectional design was employed, with data collected from 80 women using structured questionnaires. Findings revealed that 62.5% of respondents were aware of PCC, though understanding was often fragmented, with misconceptions about its scope.

Key components such as folic acid supplementation (31.3% uptake) and male partner involvement (minimal participation) were poorly adopted. Major barriers included lack of awareness (38.0%), financial constraints (32.0%), and limited access to healthcare facilities (16.0%). Cultural beliefs and insufficient community-based education further hindered PCC utilization.

The study emphasizes on the urgent need for targeted interventions, including community sensitization programs, subsidized services, and male engagement initiatives, to enhance PCC uptake and improve maternal and neonatal outcomes. These findings align with global evidence highlighting systemic gaps in PCC implementation, particularly in Sub-Saharan Africa.

Keywords: Preconception care, maternal health, reproductive age, knowledge gaps, health interventions, barriers.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Safe motherhood starts before conception and continues with proper prenatal care resulting in the prevention and treatment of complications and ensuring safe delivery of the baby and a healthy postpartum period ( CDC ,2019). Preconception care (PCC), an important component of safe motherhood is defined as methods of enhancing pregnancy outcomes by optimizing women s’ health through biomedical, behavioral and social health interventions that are preventive, promotional and curative , delivered to women and their partners before conception (WHO, 2023 ; Temel et al., 2015 ). It is aimed at improving their health status, reducing behaviors, individual and environmental factors which could contribute to poor maternal and child health outcomes. Preconception care includes the care before the first pregnancy and the care between the subsequent pregnancies(Mason, et al., 2014).

It is therefore patient education, evaluation, and management aimed to prevent unplanned pregnancies and decrease the risk of adverse health effects for the woman, fetus, and neonate by optimizing the woman’s health and knowledge before planning and conceiving a pregnancy ( New York State Of Health AIDS Institute, 2010 ). It involves any intervention provided to women of childbearing age , regardless of their pregnancy status or desire before pregnancy, to improve health outcomes of women, newborns and children ( Olowoskere et al., 2020 ). It is a very important aspect of maternal health care which has been neglected over the years especially in developing countries ( Alessia et al., 2020 ).

Preconception health encompasses a wide range of intervention areas that can potentially cause adverse pregnancy and birth outcomes such as women s’ genetic risk, overall health status, reproductive history, exposure to environmental toxins and high-risk lifestyle behaviors ( Delgado, 2018 ). Every woman deserves good health in mind and body especially before, during and after birth. This also goes for babies they deliver; hence , giving birth to preconception care ( WHO, 2023 ).

Preconception care (PCC) is the most important maternal health care service to reduce maternal and child mortality and morbidity ( WHO, 2023 ). The WHO recommended implementation of preconception care in 2013 ; unfortunately there is no global consensus on the place of preconception care as part of an overall strategy to prevent maternal and childhood mortality and morbidity ( WHO, 2023; Munthali et al., 2021 ).

The preconception period is a period of three months before pregnancy occurs. It is the time where an individual makes life changes that can help improve fertility, reduce health problems during pregnancy and aid in recuperation from childbirth (Pregnancy birth & baby, 2016). Since a majority of women and couples of reproductive age are normally unaware of the effects that their own health conditions and health-related behaviors may have on the fetus during pregnancy, preconception care addresses the care before pregnancy occurs.

Even though antenatal care is part of care in the Maternal, Newborn, and Child Health (MNCH), it begins too late thereby neglecting the most critical time of embryonic development which frequently occurs even before a woman knows she is pregnant. Evidence strongly suggests that earlier care before pregnancy leads to improved women s’ health and improved pregnancy outcome for both the mother and the newborn. Preconception care therefore is any intervention provided to women and couples of reproductive age, regardless of pregnancy status or desire, before pregnancy, to improve health outcomes for women, newborns and children (Dean, et al., 2013).

In the Old Testament the practice of preconception care is portrayed before the birth of Samson in the following passage “The angel of the Lord appeared to her and said you who are sterile and childless, but you are going to conceive and have a son. Now see to it that you drink no wine or other fermented drink and that you do not eat anything that is unclean because you will conceive and give birth to a son”(Judges 13:3-5 New International Version).

This means that preconception care was greatly valued and practiced in the ancient days and it clearly indicates that even before the birth of Christ, preconception care was in existence and it is currently being improved as medical interventions and technology is improving. In developed countries where preconception care is available and patronized , it is observed that there has been improvement in the health of women and also reduction of pregnancy related morbidity and mortality as well as abnormalities affecting newborns during and after pregnancy ( Akwasi et al., 2020 ).

The reverse is true for Sub-Saharan Africa ( SSA), a region that recorded the highest maternal mortality ratios in the world, in 2021 this country recorded nearly 550 maternal deaths per 100,000 live births compared to a global rate of 216 deaths per 100,000 live births  ( Nepali and Sapkota, 2022 ). Spatial inequalities in access to life-saving maternal and newborn health services persist within SSA. Preconception care is also reported to be poorly provided within maternal health services in the region ( Rebekah-Nkrumah, 2019 ). In developing countries such as Sudan, Ethiopia and Kenya, studies show that women s’ knowledge of preconception care is 15.4%, 27.5% and 38.3% respectively ( Ahmed and Kamil, 2015; Ayalew et al., 2017 and Mutale et al., 2017 ).

There is no data available for Cameroon.The Core preconception care services include; screening for undiagnosed, untreated, or poorly controlled medical conditions, checking the immunization history to ensure it’s up to date, assessment of the nutritional status of the mother, assessment of family history and genetic risk factors, assessment of tobacco and substance use and other high-risk behaviors among other components to allow early detection and intervention before the woman conceives (Department Of Health, New York, 2009 ).

Preconception care is a neglected but vital component of maternal and child healthcare services and it serves as a form of primary prevention for the baby and secondary prevention for prospective mothers ( Akinajo et al., 2019 ). Majority of pregnancy and childbirth complications could be prevented through adequate preconception care (Howson et al., 2012 ).

Iron supplementation for example decreases the risk of anaemia by 27% in non-pregnant reproductive-age women. Prenatal folic acid supplementation prevents neural tube defects in 72% of cases and reduces the risk of recurrence in 68% of cases. Prenatal multivitamin supplementation reduces congenital defects by 42%-62% and pre-eclampsia by 27% ( Bhutto et al., 2013 ).

Preconception counseling about contraception reduces first-time teenage pregnancy by 15% and repeat in adolescent pregnancy by 37% ( Bhutta et al., 2011 ). In addition, good blood sugar regulation before and after pregnancy decreases the risk of pre-eclampsia, fetal macrosomia, congenital malformations and stillbirth in women with diabetes ( Sataloff et al., 2014 ).

1.2. Problem Statement

Preconception care ( PCC) is one of the most important components of health care for every woman of reproductive age. These groups of women are candidates for PCC regardless of whether they are planning to conceive or not as care received at this vital period is essential and critical as it lays the foundation for the future health of the mother, her baby and her family ( Lu and Geffen, 2017 ).

For the past years that I have been working in the hospital I have been noticing many woman coming for antenatal clinics  and diseases such as Gonorrhea are being detected, a haemoglobin level less than 11g/dl or 75% whereas all these were to be detected and treated during preconception period and equally I never saw any woman coming for check up just to know how her status is or to know about her overall health so this made me to ask myself if these women have knowledge on preconception care.

Also, following research that have been carried out on preconception care, less than one third of women of childbearing age around the world attend health facilities to see a healthcare provider about their health status and possible effects on pregnancy outcomes before becoming pregnant (WHO, 2023 ).

Preconception care was also reported to be poorly provided within maternal health services in the region of Sub-Saharan Africa ( Rebekah-Nkrumah, 2019 ); the situation is critical in Cameroon with no evidence of an established preconception care service. Most pregnancy complications predate pregnancy and worsen during pregnancy, thereby causing a lot of pregnancy-related morbidity/mortality, especially if not managed as part of the PCC ( Chou et al., 2014 ).

Despite this importance , majority of women lack awareness of their health before conception and this may influence their risk of an adverse pregnancy outcome. As it is important for every woman to attend the antenatal clinic during pregnancy, so it is important for them ( including their partners), to patronize preconception care before they decide to conceive. Hence, there is need to assess the knowledge of preconception care among women of reproductive age.

1.3. Rationale of the study

WHO states that even where strong public health programs are in place across the life-course, they do not guarantee that women enter pregnancy in good health ( WHO, 2023 ). It is necessary that certain steps should be taken before conception or early pregnancy to maximize positive health outcomes, hence provision of preconception care is highly recommended. A study revealed that women who receive PCC have more knowledge, uptake PCC services and often show risk alleviation behaviors ( Esonga et al., 2018 ). Identifying the knowledge of preconception care at the local context is a very crucial and timely issue, this can accelerate the reduction in maternal and neonatal mortality for progress towards the Sustainable Development Goals (SDGs). Hence, the purpose for this study.

1.4. Research Questions

1.4.1. Main Research Question

• What knowledge do women of reproductive age in the Muea community have on preconception care?

1.4.2. Specific Research Questions

1. What knowledge do women of reproductive age have on preconception care in the Muea community?
2. What are the activities carried out during preconception care ?
3. What are the challenges faced by the women of reproductive age in the Muea community in the practice of preconception care?

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