The research, led by academics at UCL and published in The Lancet Public Health, compiled a mix of evidence – including previous studies, new data on women’s preferences, and case studies of existing practice across the globe – to develop a model that could be used to help design services in a way that better meets the needs of women and their partners.

Researchers found that, currently, health services only view women to either be pregnant or not pregnant, and do not consider their health during the in-between stage – before trying to conceive. Not only can this exert an important influence on their chances of becoming pregnant and of having a healthy pregnancy but it can also affect their own health in the short and long term.

Ninety per cent of women of reproductive age are estimated to have at least one modifiable risk factor affecting pregnancy, such as a low or high BMI. Consequently, the health of women before they become pregnant is an important factor in maternal deaths and a contributor to the inequalities seen in the rates of maternal deaths in marginalised groups.

Alongside health services, the team found that educational settings and social media could also be more supportive in helping people consider their reproductive preferences.

The researchers are calling for societal-wide efforts to help bring together family planning, contraception, and preconception care. And they have developed a framework that can be adapted both to different settings and the healthcare system.

The model suggests that children could be taught about reproductive needs – such as preconception health advice and contraception – in school. Social media campaigns could also be used to raise awareness of the opportunities and benefits of choosing if or when to have children.

Additionally, professionals could routinely ask patients about their reproductive preferences, and digital tools could be made available to direct people to appropriate sources of advice or services.

Study limitations

Some limitations were highlighted, including the fact that the researchers examined studies published in English and from high-income countries. It’s suggested that wider considerations of healthcare systems for the delivery of preconception care, stakeholders involved, and socio-cultural practices influencing health behaviours in the preconception period may need to be considered if translating the model to low-and middle-income countries.

A lack of evidence exists, too, on the impact of preconception interventions and outcomes, so the literature used was on a small scale. And some studies experience selection bias by only focusing on women from certain socioeconomic backgrounds and education levels.

Nevertheless, lead author Dr Jenny Hall, from the UCL EGA Institute for Women’s Health, argued that the model proposed can be “adapted and implemented across a range of primary care settings, including general practice and sexual and reproductive health services, with appropriate training for health professionals”.

She added: “Doing so will bridge the gap between contraception and antenatal services, providing services in a way that better meets women’s needs as they move through their reproductive life course, in line with the ambitions of the recent Women’s Health Strategy.”

The Women’s Health Strategy for England was launched in August last year and cites fertility, pregnancy, pregnancy loss and postnatal support as priority areas.

Ten-year targets include supporting women through high-quality information and education to make informed decisions about their reproductive health, including if and when to have a child; as well as giving children a high-quality, evidence-based education from an early age on fertility, contraception and pregnancy planning, maternity care and pregnancy loss.

Dr Hall concluded: “The review of evidence and model put forward in our study shows how preconception healthcare in the community can shift from concept to reality and how the gap between contraception and antenatal services can be bridged to holistically support women’s needs across their reproductive life course.”

The project was funded by Public Health England and NIHR.