Implementing Preconception Care in Zambia: Addressing Gaps and Leveraging Opportunities

Abstract

Background: The Zambian government's investment in maternal and child health, specifically in life-saving interventions during pregnancy, delivery, postpartum, and for children under five years of age, has resulted in noteworthy progress to reduce maternal and child mortality in the past decade. Yet adverse pregnancy outcomes persist and remain a public health concern. There is growing evidence that interventions provided during pregnancy, delivery, and postpartum periods may come too late to change some pregnancy outcomes. Preconception care (PCC)—care provided during the pre-pregnancy period—offers the potential to provide key interventions to optimize health, increasing the likelihood of better pregnancy experiences and healthy newborns. Currently, no existing government policy focuses exclusively on PCC in Zambia. Aims: This study explored the current practices, knowledge, and attitudes about PCC in Zambia to identify opportunities for incorporation of PCC into the health system. Methods: In-depth interviews were conducted among four participant groups: healthcare workers, health managers and policymakers from the Ministry of Health and non-governmental organizations, women and men of reproductive ages (18–45 years), and religious leaders. Key findings from the in-depth interviews were presented to key stakeholders from the advocacy subcommittee of the Safe Motherhood Technical Working Group to review and develop recommendations to facilitate systematic implementation of PCC services in the Zambian health system. Results: PCC would be a beneficial investment to improve reproductive, maternal, neonatal, child, and adolescent health and nutrition in Zambia. Analysis of interviews revealed vital information on the lack of a policy environment conducive to PCC. This has prevented the health workforce from routinely providing PCC and women of reproductive ages from consistently seeking care due to poor community awareness. The greatest opportunity for change is within the leadership and governance WHO building block of developing a policy framework to create a conducive environment for implementing PCC. Conclusion: The positive perception and universal support for PCC as part of the continuum of care provide an opportunity for the Zambian government to develop a national policy and plan for implementing PCC within public health facilities.