Addressing reproductive health needs across the life course: an integrated, community-based model combining contraception and preconception care

January 13, 2023

Contraception (prevention of pregnancy) and preconception care (preparation for pregnancy) are two services that most people need during their reproductive life. However, service provision of preconception care is far from routine, despite the growing recognition that health before pregnancy is crucial.

Using data from the P3 study, as well as a comprehensive review of the literature, case studies of current practice and discussions with women of reproductive age, we have developed an integrated, community-based model that combines reproductive life planning, contraception, and preconception care, providing a holistic, life course approach. By taking a life course approach we highlight the need to consider pregnancy prevention and preparation simultaneously, creating a more cohesive approach to addressing reproductive health needs.

A key part of the model is encouraging individuals to consider their reproductive preferences; this could be a simple inquiry, a set of screening questions, or the development of a more structured reproductive life plan. This could be done by any health-care professional or self-completed digitally. Our model also recommends a community-level increase in awareness of reproductive life planning and the importance of preconception health through societal and school-based interventions, which would help to normalise these discussions.

Once the person’s needs have been assessed, individualised advice and information on contraception or preconception health should follow; most people could be signposted to online sources or apps (however, non-digital platforms should also be available for people who cannot access digital interventions). For example, if an individual indicated that they wanted children in the future, but not right now they would be directed to a source of information on the importance of health before pregnancy, and then on to information on contraception, at each contraception review the health-care professional should check whether the person’s view on pregnancy has changed and support them accordingly. For individuals who are considering pregnancy in the next year, they could be directed to an online tool to self-complete a risk screening for tailored advice on how to improve their health before pregnancy.

Overall, we have developed an evidence-based model of integrated community-based preconception care that includes contraception. This model shows how preconception care in the community can shift from concept to reality, and how the gap between contraception and preconception care can be bridged to holistically support women’s needs across their reproductive life course. For more information, read the full paper here.