Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services

Abstract

BackgroundDespite the importance attributed to good pre-pregnancy care and its potential to improve pregnancy and child health outcomes, relatively little is known about why women invest in pre-pregnancy health and care. We sought to gain insight into why women invested in pre-pregnancy health and care.MethodsWe carried out 20 qualitative in-depth interviews with pregnant or recently pregnant women who were drawn from a survey of antenatal clinic attendees in London, UK. Interviewees were purposively sampled to include high and low investors in pre-pregnancy health and care, with variation in age, partnership status, ethnicity and pre-existing medical conditions. Data analysis was conducted using the Framework method.ResultsWe identified three groups in relation to pre-pregnancy health and care: 1) The “prepared” group, who had high levels of pregnancy planning and mostly positive attitudes to micronutrient supplementation outside of pregnancy, carried out pre-pregnancy activities such as taking folic acid and making changes to diet and lifestyle. 2) The “poor knowledge” group, who also had high levels of pregnancy planning, did not carry out pre-pregnancy activities and described themselves as having poor knowledge. Elsewhere in their interviews they expressed a strong dislike of micronutrient supplementation. 3) The “absent pre-pregnancy period” group, had the lowest levels of pregnancy planning and also expressed anti-supplement views. Even discussing the pre-pregnancy period with this group was difficult as responses to questions quickly shifted to focus on pregnancy itself. Knowledge of folic acid was poor in all groups.ConclusionDifferent pre-pregnancy care approaches are likely to be needed for each of the groups. Among the “prepared” group, who were proactive and receptive to health messages, greater availability of information and better response from health professionals could improve the range of pre-pregnancy activities carried out. Among the “poor knowledge” group, better response from health professionals might yield greater uptake of pre-pregnancy information. A different, general health strategy might be more appropriate for the “absent pre-pregnancy period” group. The fact that general attitudes to micronutrient supplementation were closely related to whether or not women invested in pre-pregnancy health and care was an unanticipated finding and warrants further investigation.

General practitioners’ knowledge, attitudes and views of providing preconception care: a qualitative investigation

“…It is possible that many strategies acting synergistically are needed to improve service delivery. This is consistent with findings from a qualitative study (11), which showed that women who take a micronutrient supplement are more likely to invest in their preconception health and care. The authors identified women belonging to three groups—the ‘prepared’ group, the ‘poor knowledge’ group, and the ‘absent pre-pregnancy’ group—and argued that different preconception strategies are needed to target different women.…”

“…Other studies (11,18) have found a low knowledge of behaviours related to preconception care and a need to increase general awareness. Women who receive preconception counselling are more likely to adopt healthier behaviours before pregnancy, leading to an improved diet, folic acid supplementation, and cutting down or stopping smoking (10,27).…”

“…We also carried out semi-structured interviews with a sub-sample of this group to investigate reasons and motivations as to why they invested in pre-pregnancy care. The findings reported elsewhere (10,11) showed that two-thirds of women plan their pregnancies, but despite this there was little change in preconception health behaviours such as uptake of folic acid by these women. It was found that prospective parents in the UK have little access to specific preconception care services but that 51% received advice from a health professional prior to pregnancy in relation to the importance of healthy lifestyle behaviours such as diet, smoking, and alcohol.…”

Preconception health behaviors among women with planned pregnancies

“…Another aspect with great relevance in women's decision to take preparation measures during the preconception period is their knowledge about importance of preconception health, which, in turn, is related to schooling. In fact, a study carried out in London, England, with women undergoing planned pregnancies showed that knowledge about preconception care favors it realization (27) .…”

Preconception care for infertile couples: Nurses’ and midwives’ roles in promoting better maternal and birth outcomes

“…While it is possible to change unhealthy lifestyle factors, to reduce or even eliminate them to help couples to conceive, adherence with these recommendations could be improved through greater awareness among health professionals in primary care and fertility clinics (Joelsson et al, 2016). However, how effective preconception interventions can best be delivered, and whether specific recommendations change behaviour (Anderson et al, 2010;Barret et al, 2015;Shawe et al (2015)) and who should deliver preconception interventions (Hemsing et al, 2017;Kelly-Weeder & O'Connor, 2006) are future research questions.…”