What support is needed for preconception health improvement, and by whom? A qualitative study of women's views

Systematic reviews suggest preconception health interventions may be effective in improving maternal and infant outcomes . However, few studies have explored women’s views on the types of support required for preconception health improvement, nor when and to whom this support should be provided. We purposively sampled women aged 18-48 years in the West of England from respondents to a survey, and conducted semi-structured in-depth interviews to explore their views on support needs in the preconception period and target populations for this support. We analyzed the data using a data-driven framework analysis. The women we interviewed (N=20) broadly supported promoting greater awareness of preconception health and felt the limited focus on health before pregnancy downplays its importance relative to antenatal health. Some women opposed support services and structural interventions to improve preconception health, due to concerns these are less impactful than encouraging individual responsibility for health. Women who supported structural interventions highlighted broader determinants of health and socioeconomic barriers to preconception health improvement. Men were considered a key target population for preconception support, to help share the burden for preconception health improvement. Women broadly supported ‘age-appropriate’, school-based preconception health education, highlighting young women as an under-served group in need of additional preconception education. Our findings indicate a need to deliver early preventive support ahead of first pregnancy through services, interventions and policies co-produced with women and women’s partners. Future research should explore how to increase public understanding of the socioeconomic, environmental and commercial determinants of preconception health. • Women broadly supported promoting greater awareness of preconception health • Neoliberal views on responsibility underlay opposition to structural interventions • Awareness of wider health determinants underlay support for structural interventions • Suggested support included preconception health checks and community support groups • Young women were considered an under-served group in terms of preconception support