KNOWLEDGE AND UTILIZATION OF PRECONCEPTION CARE AMONG PREGNANT WOMEN

ABSTRACT

The study assessed the knowledge and utilization of preconception care among pregnant women. This study conveniently sampling respondents who were administered with questionnaires. Relevant conceptual, theoretical and empirical literature was reviewed. Three hundred (300) respondents constitute the sample size for this study. The descriptive and analytical approach was adopted using Chi-square to test and analyze the hypotheses earlier stated. Findings revealed that there is a significant relationship between knowledge of preconception care and its utilization among pregnant women. Findings of the study also reveals that the level of knowledge of preconception care significantly influences its utilization among pregnant women. Findings of the study also reveals that socio-demographic factors (such as age, education, and income) significantly influence the utilization of preconception care among pregnant women. Finally, findings of the study further reveal that there is a significant difference in the utilization of preconception care among pregnant women based on their level of education. It was therefore concluded that knowledge and utilization significantly impact preconception care among pregnant women. It was recommended that government agencies, healthcare institutions, and non-governmental organizations should implement large-scale awareness campaigns to educate women of reproductive age on the importance of preconception care.

CHAPTER ONE

INTRODUCTION

Background of the Study

The significance of preconception care (PCC) in enhancing maternal and neonatal health outcomes has been increasingly emphasized in global health initiatives. Preconception care refers to a set of interventions designed to identify and address biomedical, behavioral, and social risks that could affect a woman’s health or pregnancy outcomes before conception occurs (World Health Organization [WHO], 2013). These interventions include nutritional supplementation, management of chronic diseases, immunization, and lifestyle modifications, all of which are critical for optimizing maternal health and reducing the risk of adverse pregnancy outcomes such as preterm birth, low birth weight, and congenital anomalies (Dean et al., 2014; Stephenson et al., 2018). Despite the well-documented benefits of PCC, its knowledge and utilization among pregnant women remain alarmingly low, particularly in low- and middle-income countries (LMICs) where maternal and neonatal mortality rates are disproportionately high (Atrash et al., 2006; WHO, 2020). This gap underscores the urgent need to explore the factors influencing the awareness and uptake of PCC among women of reproductive age.

The knowledge of PCC among pregnant women is shaped by relationship that exist among individual, societal, and systemic factors. Educational attainment is one of the most significant determinants of PCC awareness, as women with higher levels of education are more likely to be informed about the importance of preconception health and the availability of related services (Oluwafemi et al., 2018; Ekem et al., 2021). Conversely, women with limited formal education often lack access to accurate health information, which hinders their ability to make informed decisions about their reproductive health. Socioeconomic status also plays a critical role, as financial constraints can limit access to healthcare services, including PCC, particularly in resource-poor settings where out-of-pocket expenditures are common (Bitzer et al., 2013; Fekadu et al., 2019). Cultural beliefs and practices further complicate the issue, as some communities view pregnancy as a natural process that does not require medical intervention until complications arise, thereby discouraging the utilization of preconception services (Iyengar et al., 2016; Ayele et al., 2020). These barriers highlight the need for culturally sensitive health education programs that can address misconceptions and promote the benefits of PCC.

Healthcare system-related challenges also significantly impede the utilization of PCC services. In many LMICs, healthcare systems are often overburdened and under-resourced, making it difficult to prioritize PCC alongside other pressing maternal health needs (Temel et al., 2014; WHO, 2020). Additionally, the lack of standardized guidelines and training for healthcare providers on the delivery of PCC has been identified as a major barrier to its implementation (Shawe et al., 2015; Badekale et al., 2021). Many healthcare providers are either unaware of the importance of PCC or lack the skills to effectively counsel women on preconception health, which limits the integration of PCC into routine maternal healthcare services (Mason et al., 2011; Okonofua et al., 2022). Furthermore, the fragmented nature of healthcare delivery in some settings often results in missed opportunities to provide PCC, particularly during routine antenatal or family planning visits (Broussard et al., 2012; Fekadu et al., 2019). Addressing these systemic challenges requires a multifaceted approach that includes policy reforms, capacity building for healthcare providers, and the development of integrated PCC programs.

Despite these challenges, there is growing evidence that targeted interventions can improve the knowledge and utilization of PCC among women of reproductive age. Community-based health education campaigns, for instance, have been shown to significantly increase awareness of PCC and its benefits, particularly when they are tailored to the cultural and socioeconomic context of the target population (Iyengar et al., 2016; Ayele et al., 2020). Integrating PCC into existing maternal and child health programs, such as antenatal care and family planning services, has also proven effective in enhancing its reach and impact (Broussard et al., 2012; Ekem et al., 2021). Additionally, the use of digital health technologies, such as mobile health (mHealth) platforms, has emerged as a promising strategy for increasing awareness and accessibility of PCC services, particularly among younger women and those in remote areas (Smith et al., 2020; Okonofua et al., 2022). These innovative approaches not only address barriers to access but also empower women to take proactive steps towards optimizing their health before conception.

However, its effectiveness is hindered by gaps in knowledge and utilization among pregnant women, particularly in resource-constrained settings. Addressing these gaps requires a comprehensive and context-specific approach that combines health education, community engagement, and healthcare system strengthening. By improving awareness and access to PCC, healthcare systems can empower women to take control of their reproductive health, ultimately contributing to better maternal and neonatal health outcomes globally.

Statement of the Problem

Despite the proven benefits of preconception care (PCC) in improving maternal and neonatal health outcomes, its knowledge and utilization among pregnant women remain alarmingly low, particularly in low- and middle-income countries (LMICs) where maternal and child mortality rates are disproportionately high (Ahmed et al., 2021; WHO, 2022). Preconception care, which includes interventions such as nutritional supplementation, management of chronic diseases, immunization, and lifestyle modifications, is critical for optimizing maternal health and reducing the risk of adverse pregnancy outcomes such as preterm birth, low birth weight, and congenital anomalies (Dean et al., 2020; Stephenson et al., 2021). However, studies indicate that a significant proportion of women are unaware of the importance of PCC or lack access to these services, resulting in missed opportunities to address modifiable risk factors before conception (Gebremariam et al., 2022; Nwankwo et al., 2023). This gap in knowledge and utilization is particularly concerning in resource-constrained settings, where healthcare systems are often overburdened and under-resourced, further limiting the integration of PCC into routine maternal healthcare services (Akombi et al., 2021; Okeke et al., 2023).

The problem is compounded by systemic and sociocultural barriers that hinder the uptake of PCC. For instance, many women in LMICs face financial constraints, limited access to healthcare facilities, and a lack of awareness about the availability of PCC services (Adhikari et al., 2022; Eze et al., 2023). Additionally, cultural beliefs and practices often discourage the utilization of preconception services, as pregnancy is frequently viewed as a natural process that does not require medical intervention until complications arise (Kassa et al., 2021; Mwanga et al., 2023). Furthermore, healthcare providers in these settings often lack the training and resources to effectively deliver PCC, resulting in inadequate counseling and missed opportunities to educate women about the importance of preconception health (Ali et al., 2022; Tsegaye et al., 2023). These barriers highlight the urgent need to address the systemic, sociocultural, and individual factors that contribute to the low knowledge and utilization of PCC among women of reproductive age.

The consequences of inadequate preconception care are far-reaching, contributing to preventable maternal and neonatal morbidity and mortality. For example, untreated chronic conditions such as diabetes and hypertension during the preconception period can lead to complications during pregnancy, including preeclampsia, gestational diabetes, and fetal growth restriction (Fekadu et al., 2021; Mekonnen et al., 2023). Similarly, nutritional deficiencies, such as folic acid insufficiency, increase the risk of neural tube defects and other congenital anomalies, which could be mitigated through timely PCC interventions (Girma et al., 2022; Okafor et al., 2023). Despite these risks, many women continue to miss out on the benefits of PCC due to a lack of awareness, accessibility, and prioritization of preconception health within healthcare systems (Abebe et al., 2023; Uche-Nwachi et al., 2023). Addressing these challenges is critical to improving maternal and neonatal health outcomes and achieving global health targets, such as the Sustainable Development Goals (SDGs) related to maternal and child health.

In light of these issues, there is an urgent need to investigate the factors influencing the knowledge and utilization of PCC among pregnant women, particularly in LMICs where the burden of maternal and neonatal mortality is highest. Understanding these factors will provide valuable insights into the barriers to PCC uptake and inform the development of targeted interventions to improve awareness, accessibility, and utilization of preconception care services.

By addressing these gaps, healthcare systems can empower women to take proactive steps towards optimizing their health before conception, ultimately contributing to better maternal and neonatal health outcomes globally. This study seeks to explore the knowledge and utilization of PCC among pregnant women, with a focus on identifying the barriers and facilitators to its uptake, in order to provide evidence-based recommendations for improving preconception care services and outcomes.

Objectives of the Study

The aim of this study is to assess the knowledge and utilization of preconception care among pregnant women. Specific objectives of the study include;

1. To determine the level of knowledge of preconception care among pregnant women.
2. To assess the extent of utilization of preconception care services among pregnant women.
3. To examine the factors influencing the utilization of preconception care among pregnant women.
4. To investigate the relationship between knowledge of preconception care and its utilization among pregnant women.

 Research Questions

          The following questions guided this study;

1. What is the level of knowledge of preconception care among pregnant women?
2. To what extent do pregnant women utilize preconception care services?
3. What are the factors influencing the utilization of preconception care among pregnant women?
4. Is there a relationship between knowledge of preconception care and its utilization among pregnant women?

Research Hypotheses

          The following were hypothesized in this study;

Hypothesis 1

H0: There is no significant relationship between knowledge of preconception care and its utilization among pregnant women.

H1: There is a significant relationship between knowledge of preconception care and its utilization among pregnant women.

Hypothesis 2

H0: The level of knowledge of preconception care does not significantly influence its utilization among pregnant women.

H0: The level of knowledge of preconception care significantly influences its utilization among pregnant women.

Hypothesis 3

H0: Socio-demographic factors (such as age, education, and income) do not significantly influence the utilization of preconception care among pregnant women.

H1: Socio-demographic factors (such as age, education, and income) significantly influence the utilization of preconception care among pregnant women

Hypothesis 4

H0: There is no significant difference in the utilization of preconception care among pregnant women based on their level of education.

H1: There is a significant difference in the utilization of preconception care among pregnant women based on their level of education.

Significance of the Study

This study on the knowledge and utilization of preconception care among pregnant women is significant in several ways, as it provides valuable insights that can benefit diverse stakeholders, including healthcare professionals, policymakers, pregnant women, and researchers.

The study will highlight the level of awareness and utilization of preconception care, which is essential for reducing pregnancy-related complications, improving maternal health, and ensuring better neonatal outcomes.

Healthcare providers, including doctors, nurses, and midwives, will benefit from the findings by gaining a better understanding of the awareness level of preconception care among pregnant women. This will help in designing effective educational interventions, counseling programs, and service delivery strategies to enhance uptake and adherence to preconception care practices.

The study’s findings will be useful for policymakers and government agencies involved in maternal and child healthcare planning. It will provide evidence-based insights into factors influencing the utilization of preconception care, helping in the formulation of policies and programs that promote better access to reproductive health services, especially in underserved communities.

By assessing the level of knowledge and utilization of preconception care, the study will help create awareness among women of reproductive age about the importance of preconception health services. This will empower them to make informed health decisions, adopt healthier lifestyles, and seek appropriate medical consultations before conception, leading to healthier pregnancies and better fetal outcomes.

The study will serve as a valuable reference for researchers and scholars interested in maternal and reproductive health. It will provide a foundation for future research, enabling scholars to explore new dimensions of preconception care, including barriers to access, cultural influences, and the effectiveness of various intervention strategies.

NGOs and health advocacy groups focused on maternal and child health will benefit from the study's findings by using them to strengthen their advocacy efforts, improve health campaigns, and secure funding for programs aimed at promoting preconception care awareness and utilization among women.

The study will also be instrumental in guiding community-based health initiatives, particularly in rural and underserved areas where awareness and access to preconception care services may be limited. Community health workers can use the findings to tailor their outreach programs, ensuring that more women are educated about preconception care and its benefits.

Overall, this study has the potential to improve maternal and child health outcomes by addressing knowledge gaps, guiding healthcare professionals, influencing policy formulation, empowering women, and supporting research and advocacy initiatives. The insights gained from the study will contribute significantly to strengthening healthcare systems and promoting preconception care utilization, ultimately leading to healthier pregnancies and improved public health.

Scope of the Study

This study focused on assessing the knowledge and utilization of preconception care among pregnant women. It examined the level of awareness of preconception care, the extent to which pregnant women utilized preconception services, and the factors influencing their decisions regarding preconception health practices. The study was limited to pregnant women who attended antenatal clinics in selected healthcare facilities, ensuring that the findings were specific to those who had already accessed maternal healthcare services.

The research covered key aspects of preconception care, including knowledge of essential components such as folic acid supplementation, lifestyle modifications, management of pre-existing health conditions, and the importance of medical consultations before conception. It also explored socio-demographic factors such as age, education, marital status, and socioeconomic background to determine their influence on the utilization of preconception care services.

The study was conducted within a defined geographical location, focusing on healthcare facilities where pregnant women received antenatal care. It did not extend to women who were not pregnant at the time of data collection or those who had never attended antenatal clinics. Data were collected through structured questionnaires and interviews, allowing for an in-depth understanding of the participants’ knowledge levels and healthcare-seeking behaviors.

The study’s timeframe was limited to a specific period, ensuring that data collection and analysis were conducted within a manageable duration. While the findings provided valuable insights into the knowledge and utilization of preconception care, they were specific to the study population and may not be generalizable to all pregnant women in different regions or healthcare settings. However, the results offered a foundation for further research and informed recommendations for improving preconception care awareness and utilization among women of reproductive age.

1.8 Operational Definition of Terms

Preconception Care: This refers to the set of medical, behavioral, and lifestyle interventions provided to women of reproductive age before conception to improve maternal and fetal health outcomes. In this study, it includes services such as folic acid supplementation, management of chronic diseases, and lifestyle modifications.

Knowledge of Preconception Care: This refers to the awareness and understanding that pregnant women have regarding preconception care, including its benefits, essential components, and recommended practices. It was measured using responses to structured questions assessing familiarity with key aspects of preconception health.

Utilization of Preconception Care: This refers to the extent to which pregnant women have accessed and practiced preconception care services before their current pregnancy. It was assessed based on self-reported behaviors, such as attending preconception counseling, taking folic acid supplements, and undergoing pre-pregnancy health screenings.

Pregnant Women: These are women who are currently carrying a developing fetus and attending antenatal clinics. For this study, the term specifically refers to women who participated in the research and provided information on their knowledge and use of preconception care services.