Table 5 Actions before and between pregnancy to reduce the risk of preterm birth

• Assess situational need for preconception care services and opportunities in local health system to deliver.

• Use every opportunity to reach girls and women and couples with preconception messages, beginning in school and extending to healthcare settings and community events. Preconception health must also involve boys and men, to improve their health; and to engage them in ensuring better outcomes for women and girls.

• Develop consensus around the use of a term and a definition for preconception care grounded in a conceptual framework.

• Publish the existing evidence base, and identify gaps in the evidence base.

• Raise the profile of preconception care and engage key stakeholders to support action and research in this area (including through advocacy documents, scientific publications, participation in meetings of professional organizations; engaging experts and organizations in fields outside of maternal and child health).

• Prepare guidelines on preconception care.

• Develop a list of tools to support policy development, implementation, monitoring and capacity-building in preconception care.

Implement

Seize opportunities through existing programs (including non-health programs) to:

• Educate women and couples of reproductive age to have a reproductive plan that includes age at first pregnancy, method to prevent unintended pregnancy, and number of children they wish to have.

• Scale up personal development programs and skills-building to negotiate safe sexual behavior in adolescence. Adapt preconception interventions to maximize uptake by adolescents.

• Implement universal coverage of childhood and booster vaccinations for infectious diseases known to cause adverse pregnancy outcomes.

• Screen for and treat infectious diseases, particularly sexually transmitted infections.

• Promote healthy nutrition and exercise to prevent both underweight and obesity in girls and women.

• Promote food security for communities and households. Expand nutrition programs to include adolescent girls and women. Particularly for underweight women, provide protein calorie supplementation and micronutrients. A cost-effective way to ensure adequate levels of micronutrient consumption would be to enact large-scale fortification of staple foods.

• Implement public health policy to reduce the number of men and women of reproductive age who use tobacco.

• Implement strategies for community development and poverty reduction, since living environments and socioeconomic constructs have a significant impact on health.

• Ensure universal access to education to empower girls and women with the basic knowledge and skills they need to make decisions for themselves, such as when to access care.

Scale up

• Promote effective contraception for women/couples to space pregnancies 18 to 24 months apart.

• Screen for chronic conditions, especially diabetes, and institute counseling and management as early as possible to improve neonatal outcomes.

Inform and improve program coverage and quality

• Develop indicators for baseline surveillance and to monitor progress in preconception care.

• Include preterm birth among tracking indicators.

• Develop a common analytical framework to evaluate existing preconception care programs and document their processes and outcomes to inform and inspire others.

• Develop national and global indicators to track progress in delivery of preconception care.

Innovate and undertake implementation research

• Invest in research and link to action.

• Identify opportunities to incorporate in-service and pre-service training on preconception care within existing capacity-building efforts, including through distance education.

• Stimulate and support country-level action.

• Carry out demonstration projects to strengthen the evidence base for the value and feasibility of preconception care.

We all share in the responsibility of making sure that all women before and between pregnancies receive the care they need for healthy pregnancies and birth outcomes.