Preconception care received by women attending antenatal clinics at a Teaching Hospital in Southern Sri Lanka

Introduction: Preconception Care (PCC) is an important component of reproductive health care. Objectives: To study the level of preconception preparedness of pregnant women, and factors influencing it, in order to identify possible strategies to improve PCC. Design and Setting: A descriptive cross-sectional study conducted from 10th July to 13th August 2012 in the Antenatal Clinics of the Academic Obstetrics and Gynaecology Unit at Teaching Hospital, Mahamodara, Galle. Method: A consecutively recruited, convenient sample of 250 pregnant women presenting for booking at <28 weeks gestation was studied. Data on demographic characteristics, PCC received and responses to 18 questions on preconception health knowledge were collected using an interviewer-administered, pre-tested structured questionnaire. Responses for each question were scored out of 10 and correlated with the demographic data of the subjects. Results: The mean age of the subjects was 27.8 years (95% CI 27.0-28.6) and 124 (49.6%) were primigravidae. Only 68 (27.2%) of subjects had received PCC and 95 (38%) had unplanned pregnancies. Age <26 yrs, monthly family income of < Rs. 15,000, educational level < General Certificate of Education, Ordinary Level (G.C.E.O/L) and unemployment carried almost a doubling of the risk of unplanned pregnancies. (RRs 1.7 2.4, 95% CIs 1.2 -3.9, p < 0.005). An educational level < G.C.E.O/L also carried a higher risk of not receiving PCC (RR 1.4, 95% CI 1.2 -1.6, p < 0.0001). Knowledge of the value of early registration with a Public Health Midwife (PHM) and preconceptional Rubella vaccination, and the risks associated with increased age, consanguinity, and exposure to passive smoking were satisfactory. Knowledge regarding pregnancy planning, awareness of PCC, effects of pre-pregnancy weight on fertility, folic acid supplementation, fertile period and birth spacing were unsatisfactory. The leading sources of preconceptional health knowledge were PHM (16.8%), specialist obstetrician (8.4%) and media (7.6%). Conclusion: PCC of women is suboptimal and needs more attention. The primary health care team, general practitioners and specialist obstetricians should be motivated and trained to provide preconception health education and PCC to late adolescents and young women in Southern Sri Lanka.