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Impact of Preconception Counselling on Preconception Care Utilization among Women Planning Pregnancy in Nigeria

Abstract

Preconception care is an important component of reproductive and maternal health because it provides an opportunity to identify and address health, nutritional, behavioural, and reproductive factors that may affect pregnancy outcomes before conception occurs. Women planning pregnancy may benefit from interventions such as health assessment, counselling on nutrition and healthy lifestyles, folic acid supplementation, immunization review, screening for chronic diseases and infections, medication review, and appropriate management of existing health conditions. However, utilization of preconception care services among women in Nigeria may remain limited because of inadequate awareness, misconceptions about the purpose of preconception care, financial constraints, cultural beliefs, limited access to healthcare facilities, and inadequate integration of preconception services into routine reproductive healthcare. Preconception counselling provides an opportunity to improve women's knowledge of the benefits and availability of preconception services and encourage timely utilization. Against this background, this study investigates the impact of preconception counselling on preconception care utilization among women planning pregnancy in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Social Ecological Model. The Health Belief Model explains how women's perceptions of their susceptibility to pregnancy-related health risks, perceived severity, perceived benefits of preconception care, perceived barriers, and cues to action may influence utilization of preconception services. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and perceived healthcare needs influence women's use of healthcare services. The Social Ecological Model emphasizes the interaction between individual, interpersonal, organizational, community, and broader societal factors in determining access to and utilization of preconception care. Collectively, these theoretical perspectives provide a suitable framework for explaining how preconception counselling may influence preconception care utilization among women planning pregnancy in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women of reproductive age who are planning pregnancy and attend selected hospitals, primary healthcare centres, reproductive health clinics, family planning facilities, fertility clinics, community health programmes, and other relevant healthcare settings across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible women. Preconception counselling will be assessed using indicators such as exposure to counselling, frequency and duration of counselling sessions, information on healthy pregnancy preparation, nutrition and folic acid, immunization, screening for hypertension and diabetes, infection prevention, medication review, lifestyle modification, reproductive health assessment, genetic or family-history considerations where appropriate, and pregnancy planning. Preconception care utilization will be assessed using indicators such as attendance at preconception care consultations, health assessment, nutritional counselling, folic acid use, immunization review, screening for chronic diseases and infections, medication review, reproductive health assessment, lifestyle counselling, and follow-up attendance. Data will be collected using structured questionnaires, healthcare records where appropriate, clinic attendance registers, and relevant programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to preconception counselling, and patterns of preconception care utilization. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of preconception counselling on preconception care utilization. Where a quasi-experimental design is adopted, preconception care utilization before and after structured counselling may be compared, while relevant demographic, socioeconomic, reproductive, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that preconception counselling has a significant positive impact on preconception care utilization among women planning pregnancy in Nigeria. Women who receive structured and evidence-based preconception counselling are expected to be more likely to utilize recommended preconception services than women with limited exposure to counselling. Counselling may improve women's understanding of the importance of preparing for pregnancy and encourage appropriate nutritional practices, folic acid use, immunization review, screening for chronic conditions and infections, medication assessment, healthy lifestyle practices, and timely reproductive healthcare. Early engagement with preconception care may also provide opportunities for healthcare professionals to identify and address modifiable risk factors before pregnancy occurs. However, financial constraints, limited availability of preconception services, geographical barriers, cultural beliefs, low awareness, inadequate counselling personnel, and poor integration of preconception care into routine healthcare may reduce utilization. The study therefore expects accessible, affordable, culturally appropriate, and well-integrated preconception counselling to contribute significantly to improved utilization of preconception care among women planning pregnancy in Nigeria. The study is expected to contribute to the literature on preconception counselling, preconception care utilization, reproductive health, maternal health, pregnancy planning, preventive healthcare, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, reproductive health clinics, healthcare providers, nurses, midwives, community health workers, women's health programmes, development partners, and policymakers regarding strategies for improving preconception care utilization. The study will also provide evidence-based recommendations for integrating preconception counselling into routine reproductive and primary healthcare services, training healthcare workers in preconception counselling, improving access to preconception screening and preventive services, strengthening community-based pregnancy-planning education, developing culturally appropriate educational materials, and promoting early engagement with preconception care among women planning pregnancy across Nigeria.

Keywords: Preconception counselling, preconception care utilization, women planning pregnancy, reproductive health, maternal health, pregnancy planning, preventive healthcare, preconception health, women's health, Nigeria, public health.