Table 1 Evidence-based preconception care interventions to address health problems contributing to maternal and child mortality
Problems that can be addressed by preconception care interventions | Examples of evidence-based interventions |
|---|---|
Nutritional deficiencies and disorders | • Screening for anaemia and diabetes • Supplementing iron and folic acid • Information, education and counselling • Monitoring nutritional status • Supplementing energy- and nutrient-dense food • Management of diabetes, including counselling people with diabetes mellitus • Promoting exercise • Iodization of salt |
Vaccine-preventable infections | • Vaccination against rubella • Vaccination against tetanus and diphtheria • Vaccination against Hepatitis B |
Tobacco use | • Screening of women and girls for tobacco use (smoking and smokeless tobacco) at all clinical visits using “5 As” (ask, advise, assess, assist, arrange) • Providing brief tobacco cessation advice, pharmacotherapy (including nicotine replacement therapy, if available) and intensive behavioural counselling services • Screening of all non-smokers (men and women) and advising about harm of second-hand smoke and harmful effects on pregnant women and unborn children |
Environmental risks | • Providing guidance and information on environmental hazards and prevention • Protecting from unnecessary radiation exposure in occupational, environmental and medical settings • Avoiding unnecessary pesticide use/providing alternatives to pesticides • Protecting from lead exposure • Informing women of childbearing age about levels of methyl mercury in fish • Promoting use of improved stoves and cleaner liquid/gaseous fuels |
Genetic disorders | • Taking a thorough family history to identify risk factors for genetic conditions • Family planning • Genetic counselling • Carrier screening and testing • Appropriate treatment of genetic conditions • Community-wide or national screening among populations at high risk |
Early pregnancies, unwanted pregnancies, and rapid successive pregnancies | • Keeping girls in school • Influencing cultural norms that support early marriage and coerced sex • Providing age-appropriate comprehensive sexuality education • Providing contraceptives and building community support for preventing early pregnancy and contraceptive provision to adolescents • Empowering girls to resist coerced sex • Engaging men and boys to critically assess norms and practices regarding gender-based violence and coerced sex • Educating women and couples about the dangers to the baby and mother of short birth intervals |
Sexually transmitted infections | • Providing age-appropriate comprehensive sexuality education and services • Promoting safe sex practices through individual, group and community-level behavioural interventions • Promoting condom use for dual protection against STIs and unwanted pregnancies • Ensuring increased access to condoms • Screening for STIs • Increasing access to treatment and other relevant health services |
HIV | • Family planning • Promoting safe sex practices and dual method for birth control (with condoms) and STI control • Provider-initiated HIV counselling and testing, including male partner testing • Providing antiretroviral therapy for prevention and pre-exposure prophylaxis • Providing male circumcision • Providing antiretroviral prophylaxis for women not eligible for, or not on, antiretroviral therapy to prevent mother-to-child transmission • Determining eligibility for lifelong antiretroviral therapy |
Infertility and subfertility | • Creating awareness and understanding of fertility and infertility and their preventable and unpreventable causes • Defusing stigmatization of infertility and assumption of fate • Screening and diagnosis of couples following 6–12 months of attempting pregnancy, and management of underlying causes of infertility/sub-fertility, including past STIs • Counselling for individuals/couples diagnosed with unpreventable causes of infertility/sub-fertility |
Female genital mutilation | • Discussing and discouraging the practice with the girl and her parents and/or partner • Screening women and girls for FGM to detect complications • Informing women and couples about complications of FGM and about access to treatment • Carrying out defibulation of infibulated or sealed girls and women before or early in pregnancy • Removing cysts and treating other complications |
Mental health disorders | • Providing educational and psychosocial counselling before and during pregnancy • Counselling and treating depression in women planning pregnancy and other women of childbearing age • Strengthening community networks and promoting women’s empowerment • Improving access to education for women of childbearing age • Reducing economic insecurity of women of childbearing age |
Psychoactive substance use | • Screening for substance use • Providing brief interventions and treatment when needed • Treating substance use disorders, including pharmacological and psychological interventions • Providing family planning assistance for families with substance use disorders (including postpartum and between pregnancies) • Establishing prevention programmes to reduce substance use in adolescents |
Interpersonal violence | • Health promotion to prevent dating violence • Providing age-appropriate comprehensive sexuality education that addresses gender equality, human rights, and sexual relations • Combining and linking economic empowerment, gender equality and community mobilization activities • Recognizing signs of violence against women • Providing health care services (including post-rape care), referral and psychosocial support to victims of violence • Changing individual and social norms regarding drinking, screening and counselling of people who are problem drinkers, and treating people who have alcohol use disorders |