Couple-based preconception care as a gender-responsive strategy for improving health and well-being: a systematic review

BACKGROUND: Adverse reproductive outcomes such as infertility, miscarriage, preterm birth, and congenital anomalies remain major public health concerns. Preconception care (PCC) can help address these risks, but most programmes focus mainly on women, leaving men under-involved. Couple-based preconception care (CB-PCC) offers a more inclusive and gender-responsive approach. This review aimed to synthesise global evidence on CB-PCC interventions and their effects on reproductive health outcomes. METHODS: A systematic search was conducted in PubMed Central, Scopus, CINAHL, and JSTOR, with additional hand searches. Studies were included if they involved couples or men of reproductive age, delivered PCC interventions before conception, and reported couple-related outcomes. Data were extracted using a structured form and appraised with Joanna Briggs Institute tools. A thematic synthesis was used to summarise findings. RESULTS: Fourteen studies from 10 countries were included, most from high-income settings. CB-PCC interventions covered biomedical, lifestyle, psychosocial, and family planning components. Reported outcomes included improved fertility treatment success, healthier lifestyle habits, reduced psychosocial distress, stronger partner communication, and increased contraceptive uptake. However, studies varied in design, delivery mode, and measurement, limiting direct comparisons. CONCLUSION: CB-PCC shows promise in promoting shared responsibility and improving preconception health behaviours. However, most evidence comes from high-income countries and heterogeneous study designs. More high-quality research is needed in low- and middle-income settings. Future programmes should adapt CB-PCC to local contexts, promote male engagement, and integrate it into existing health systems to strengthen reproductive health outcomes.