Preconception care: promoting reproductive planning

Abstract

IntroductionPreconception care recognizes that many adolescent girls and young women will be thrust into motherhood without the knowledge, skills or support they need. Sixty million adolescents give birth each year worldwide, even though pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20-29 years. Reproductive planning and contraceptive use can prevent unintended pregnancies, unsafe abortions and sexually-transmitted infections in adolescent girls and women. Smaller families also mean better nutrition and development opportunities, yet 222 million couples continue to lack access to modern contraception.MethodA systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.ResultsComprehensive interventions can prevent first pregnancy in adolescence by 15% and repeat adolescent pregnancy by 37%. Such interventions should address underlying social and community factors, include sexual and reproductive health services, contraceptive provision; personal development programs and emphasizes completion of education. Appropriate birth spacing (18-24 months from birth to next pregnancy compared to short intervals <6 months) can significantly lower maternal mortality, preterm births, stillbirths, low birth weight and early neonatal deaths.ConclusionImproving adolescent health and preventing adolescent pregnancy; and promotion of birth spacing through increasing correct and consistent use of effective contraception are fundamental to preconception care. Promoting reproductive planning on a wider scale is closely interlinked with the reliable provision of effective contraception, however, innovative strategies will need to be devised, or existing strategies such as community-based health workers and peer educators may be expanded, to encourage girls and women to plan their families.

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

“…A particular problem in many countries is teenage pregnancy, which, in many cases, is unplanned and may be associated with socioeconomic factors, poverty, lack of education for girls, lack of access to family planning services, and child marriage. Interventions targeting birth spacing have been shown to reduce LBW and preterm birth [272]. The rates of teenage pregnancy vary globally, with the highest rates of pregnancies in women/girls under age 19 years being reported in Latin America (peak 288 per 1,000 live births in Nicaragua) [273].…”

“…The rates of teenage pregnancy vary globally, with the highest rates of pregnancies in women/girls under age 19 years being reported in Latin America (peak 288 per 1,000 live births in Nicaragua) [273]. Teenage pregnancies are associated with higher risks of preeclampsia, eclampsia, infections, anemia, LBW, and preterm birth [272,273,274]. First or recurrent teenage pregnancy can be reduced by 15-37% through implementation of comprehensive targeted strategies [272].…”

“…Teenage pregnancies are associated with higher risks of preeclampsia, eclampsia, infections, anemia, LBW, and preterm birth [272,273,274]. First or recurrent teenage pregnancy can be reduced by 15-37% through implementation of comprehensive targeted strategies [272]. Preconception health is, therefore, not only related to obstetric and medical risk factors, such as chronic diseases, but also to lifestyle, education, working conditions, experience of violence, geography, and the socioeconomic status of women [265,266,275].…”

Preconception health and care (PHC)—a strategy for improved maternal and child health

“…PHC should recognize the importance of avoiding adolescent pregnancies. It is estimated that 60 million adolescents give birth each year worldwide, even though globally pregnancy in adolescence has mortality rates at least twice as high as pregnancy in women aged 20–29 years (8). The issue of gender-based violence and abuse is intertwined in all mentioned aspects and should be appropriately addressed early as well as later (3,5,7).…”

“…In total, 29% of women wanting termination of pregnancy and 22% in the family planning group reported IPV. Women seeking abortions were significantly more likely to report IPV (adjusted odds ratio 1.6, 95% CI 1.2–2.1), and among women with repeated terminations the prevalence of IPV was 51% (8,15). …”