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Global Preconception Health
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Photo Credit: WHO
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Preconception represents a sensitive period in human development, as there is strong scientific evidence that a woman's health in the months prior to becoming pregnant and the early weeks of pregnancy can have a direct impact on the health of her baby - at birth and beyond. The health of a child can, in turn, affect the mother and family's health for decades to come. As both high- and low-income countries seek to improve maternal and infant outcomes, there is increasing focus on the importance of preconception and interconception health.
This issue of the newsletter offers resources and examples of how organizations and leaders are working to move this change forward around the world. We will continue to foster dialogue and share resources on this important topic. We hope you will join us!
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The PrePreg Network:
Preconception Care Research in Europe  Jill Shawe, PhD,
University of Surrey
In Europe, preconception care is emerging as a developing field of research, as it is increasingly being recognised that good maternal and paternal health before conception is important for the health of pregnant women and future generations. Across Europe demographic and epidemiological trends show rising levels of obesity, development of type 2 diabetes and delayed childbearing, all of which can lead to decreased fertility and increased pregnancy complications and poor outcomes.
The PrePreg Network was founded in 2010 after the first Preconception Health and Care congress in Brussels. The network brings together a group of researchers and clinicians who have developed a programme of research to enable better understanding of the bio-psychosocial, cultural and economic factors affecting preconception health and care across Europe. The aim is to increase health promoting behavior in relation to pregnancy planning. Participating members are from the following countries: Sweden, Denmark, Finland, United Kingdom, Belgium, Italy, The Netherlands, and Ukraine.
Currently, research has four main areas of focus:
1. Evaluation of Preconception Health and Care in Europe.
2. Planned and unplanned pregnancies among women attending antenatal care.
3. Implementation of a Reproductive Life Plan.
4. Attitudes towards parenthood and understanding about fertility.
Each country is undertaking individual studies whilst collaborating in the use of questionnaires and data instruments tailored to their own situation. Examples from a selection of countries are outlined below.
In the UK, a study of pre-pregnancy health and care in England was und ertaken to inform future policy and practice. Over 4000 papers and 100 guidelines were reviewed, data from two large cohort studies were analysed, over 1000 antenatal women and over 500 male partners were surveyed, and 40 interviews with health professionals and women were conducted. The findings and recommendations are currently under review by the Department of Health.
In Denmark, a study investigated the extent to which 258 Danish women attending antenatal care planned their pregnancies. The study examined the association between pregnan cy planning and the intake of folic acid, alcohol consumption, and smoking habits prior to conception and before the 16th week of gestation. Pregnancy planning was assessed by the London Measure of Unplanned Pregnancy and the five graded Swedish Pregnancy Planning Scale. The study found that pregnancy planning was associated with a healthier lifestyle but still many women could improve their health prior to pregnancy by taking folic acid and reducing alcohol consumption (Backhausen et al 2013).
In Sweden, a randomised control trial in a group of 299 Swedish-speaking women visiting a Student Health Centre was undertaken. The  study looked at whether there was an increase in women's knowledge of reproduction and the importance of folic acid intake following reproductive life plan (RLP)-based information in contraceptive counselling before pregnancy. Knowledge was assessed at baseline and at 2 months following consultation and found to be higher in the group having the RLP intervention (Stern et al 2013).
In Belgium, a needs assessment instrument has been developed for couples with a desire for children. The instrument is currently used in order to assess the needs of these couples. A questionnaire has been  developed to assess the motivation of couples to start parenthood on a given moment in their life. The questionnaire has been piloted in 25 pregnant women. Results show that the motivation to start a family is very personal. People want to finish certain projects in their life. Career and financial motives are of small interest. Furthermore, fertility awareness has been assessed in 900 adolescents and 300 students.
In Ukraine, a survey among 1265 medical students was conducted to investigate intentions and attitude to future childbearing and their  awareness regarding female fertility. Students markedly overestimated a woman's capacity to become pregnant, and information on fertility, especially among those who intend to postpone parenthood, should be the part of family planning counseling (Mogilevkina et al, 2013).
 Italy has developed web information for women and is conducting a randomized trial evaluating different doses of folic acid intake among women.
The network has met once or twice a year in different locations in Europe, including London, Uppsala, Copenhagen, Rome and Rotterdam. In addition to research, we meet and discuss issues related to preconceptional health, including the development of websites with specific preconception care information for both professionals and lay people. Please click here for more information about The PrePreg Network.  Cited Works: Stern J, et al. Introducing the Reproductive Life Plan in midwifery counselling - a randomised controlled trial. Human Reproduction 2013, 28(9):2450-2461. Backhausen MG, et al. Pregnancy planning and lifestyle prior to conception and during early pregnancy among Danish women. The European Journal of Contraception and Reproductive Health Care, 2013 [Epub ahead of print]. Mogilevkina I, et al. Ukrainian medical students' experiences, attitudes, and knowledge about reproductive health. Am Coll Health. 2001 May;49(6):269-72.
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Improving the Health of Women & Girls:
Three Organizations Building Connections and Disseminating Best Practices
 The Partnership for Maternal, Newborn, & Child HealthThe Partnership (PMNCH), chaired by Graça Machel, joins the reproductive, maternal, newborn and child health communities into an alliance of more than 500 members, across seven constituencies: Academic, research and teaching institutions; donors and foundations; health-care professionals; multilateral agencies; non-governmental organizations; partner countries; and the private sector. The Partnership seeks to provide an institutional platform for members to share strategies, align objectives and resources, and agree on interventions, with the ultimate goal of achieving United Nations Millennium Development Goals 4 and 5 - to reduce child mortality and improve maternal health - with women and children enabled to realize their right to the highest attainable standard of health in the years to 2015 and beyond. For more information, including how to join the partnership, please click here.  Women Deliver
Women Deliver is a global advocacy organization working to generate political commitment and financial investment for fulfilling Millennium Development Goal 5 - to reduce maternal mortality and achieve universal access to reproductive health. To that end, Women Deliver is building on the commitments, partnerships, and networks mobilized at the groundbreaking Women Deliver conferences in 2007, 2010 and 2013, seeking to share the message that maternal health is both a human right and a practical necessity for sustainable development. In 2012, Women Deliver launched Catapult, a crowdfunding platform to support projects that work toward equality for women and girls, including maternal health, education, economic security, and reproductive rights. To learn more about how Catapult works, please watch the short video below.
 RAISE Initiative  Globally, 1 out of every 100 people are displaced - that's 70 million people, 80% of whom are women and children. Integrated and fully comprehensive reproductive health services, including preconception and interconception services, are not the norm in most emergency settings, yet an overwhelming number of preventable deaths and illnesses related to reproductive health affect populations in crisis. The RAISE Initiative, a project of Columbia University and Marie Stopes International, provides training and technical assistance, advocacy, research, and dissemination of evidence-based, best practices for improving reproductive health in emergency settings. Click here for more information and to sign up for their newsletter and weekly literature review. Also, see their 3 minute video, At Two Fronts, below.
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 WHO: Preconception care to reduce maternal and childhood mortality and morbidity
The World Health Organization (WHO) has released the proceedings from a meeting to develop global consensus on preconception care. This report provides packages of interventions in thirteen domains. Each lists the health problems, behaviors and risk factors that contribute to maternal and childhood mortality and morbidity as well as evidence-based interventions to address them, and mechanisms of delivering them. For the full report, a policy brief, and slide presentation, click here. |
Global Action Report on Preterm Birth: Preconception Health Plays a Vital RoleThe Partnership for Maternal, Newborn, and Child Health (see article at left) has released Born Too Soon: A Global Action Report on Preterm Birth, that provides the first national, regional, and global estimates of preterm birth. It shows the concerning rise of preterm birth globally, and proposes actions for policy, programs and research by all partners - from governments to NGOs to the business community -- that will reduce the toll of preterm birth, particularly in countries with a high burden.
The report gives special attention to preconception health as an opportunity to increase the odds that women and their babies will be healthy. It makes a case for preconception health globally and has recommendations for implementation of priority, evidence-based interventions.Please click here for more information and to read the report.
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Conceptual Framework Linking Family Planning & Human Rights
In August 2013, Engender Health and the Futures Group published a concept paper titled
Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights: A Conceptual Framework, with support from the Bill & Melinda Gates Foundation.
This comprehensive framework brings together human rights laws and principles with family planning quality of care frameworks to assist policymakers, program managers, donors, and civil society organizations with program design, implementation, and monitoring and evaluation. The framework applies rights principles and approaches within family planning programming, strongly linking issues of quality of care with human rights. For more information, including links to two supporting systematic reviews of the evidence and tools, please click here.
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GirlEffect.org
Launched in 2008 after the movie of the same name, GirlEffect.org seeks to help development practitioners and the
wider girl effect community make a powerful case for supporting girls, and to equip them the tools they need to do this well. Created by the Nike Foundation, in collaboration with the NoVo Foundation, United Nations Foundation and Coalition for Adolescent Girls, GirlEffect.org uses data to support the case for investing in, and developing programs for, girls. It includes case studies to show the girl effect in action, along with toolkits, images, and videos to download. For more information, please click here.
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About the Newsletter
Thanks for reading! Is your organization doing exciting work to promote preconception health? We would love to feature you in an upcoming newsletter! Email us for details, or if you have any questions about the newsletter.
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To receive a bi-weekly media and literature update on preconception and interconception health through a listserv please email Cheryl Robbins.
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