Published on International Journal of Health, Nursing, & Medicine
ISSN: 2193-3715, Volume 2, Issue 1, page 14 – 31
Publication Date: March 11, 2019
Bonkhe B Dlamini, Mndeni N Nhlengetfwa & I.T. Zwane
Department of Nursing Science, Faculty of Health Sciences
Eswatini Medical Christian University
Introduction: Childbearing women face many challenges during pregnancy and delivery. Preconception care has recently been introduced to reduce the challenges and complications faced during pregnancy. Preconception care is a set of interventions that aim to identify and modify biomedical, behavioural, and social risks to a woman’s health or pregnancy outcome through prevention and management. The aim of the study was to explore knowledge, attitudes and practices towards preconception care in Hhohho, Eswatini.
Methodology: This is a descriptive, correlational study where data was collected from 100 women conveniently selected from Piggs Peak PHU who are pregnant. A self-explanatory questionnaire was administered to the 100 pregnant women adopted from Dr Nani Draman validated with a Cronbach’s alpha of 0.79. the questionnaire consists of two sections: section A for demographic data and section B for the three domain namely, knowledge, attitude and practices of preconception care.
Results: The mean knowledge, attitudes and practices were 11.40, 16.37 and 12.81 respectively. In total, 52.5% of the respondents had fair knowledge on preconception care, and 75.4% of the respondents had good attitude and 59% of respondents had fair practices towards preconception care.
Conclusion: Childbearing women in Piggs peak have fair knowledge, good attitudes and good practices towards preconception care. However, they there is still gaps to be filled especially in giving knowledge.
Keywords: Knowledge, Attitude, Practices, Preconception Care & Childbearing Women.
1. Background of the Study
Preconceptual care can be defined as the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs to improve health status (World Health Organization, 2012). The term ‘preconceptual care’ includes both the period before conception and the interconception period (Moos & Cefalo, 2017). There is an increase in adolescent pregnancies and poorly spaced pregnancies which contribute to maternal, perinatal and infant mortality, and the vicious cycle of ill-health and poverty (Kallner & Danielsson, 2016). There are adverse effects of childbearing teenagers which extend to the health of the infants as these babies are more likely to have low birth weight. According to (World Health Organisation 2014), perinatal deaths are found to be 50% higher among babies born to mothers under 20 years of age than among those born to mothers aged 20–29 years.
The main goal of preconception care is to provide health promotion, screening, and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies (Gerberding, Snider, & Popovic, 2006). According to Ministry of Health, Eswatini (2017), preconceptual care is more than a single visit to a health care provider and less than all well woman care, including the full scope of preventive and primary care services for women before first pregnancy.
1.2 Background information
Preconception care is defined as a set of interventions that aim to identify and modify biomedical, behavioural, and social risks to a woman’s health or pregnancy outcome through prevention and management (Brellochs & Rossin-Slater, 2012). According to World Health Organization (2013), preconception health care is an essential component of reproductive health which focuses on the conditions and risk factors that could affect a woman if she became pregnant.
Preconception should be viewed as an early opportunity not for family planning or to reduce maternal and neonatal mortality but also to improve long term health outcomes for adolescent girls and women (Dile, Ayelew, & Mulat, 2017). Preconception care is important to reduce several risk behaviours and exposures that can affect fetal development and subsequent outcomes. Therefore, it should be planned to address the reproductive system problems.
Preconceptual care aim at improving the overall health status of adolescents, women and children, as well as ensuring healthy adulthood by targeting risk behaviours for non-communicable diseases (Finer & Zolna, 2014). Preconception care provides a full range of effective interventions, focused on the health of women of reproductive age, and their partners, prior to or between pregnancies, that promote the opportunity.
According to OPHA (2014), it is important to understand the benefit of shifting to preconception health as it highlights current data on well recognized reproductive health indicators such as preterm birth, birth weight, congenital anomalies, infant mortality and maternal mortality. The reason behind shifting to preconception health was to draw attention on the detrimental impact of these indicators on maternal and infant health to further support to call for action. Preconception care has impact on selective reproductive health indicators as shown in figure 1 above (OPHA, 2014).
Knowledge of preconception care can be acquired though experience or education (Dunlop, Logue, Thorne, & Badal, 2013). Education can be attained from multiple sources, e.g., books, newspapers, radio channels, television, the Internet or medical staff consultations. Studies have shown that women who receive pre-pregnancy care have more knowledge and often show risk reduction behaviours.
Literature reveal that women’s knowledge and attitude regarding preconception care was affected by women’s age, ethnicity, occupation, educational status, pregnancy intention, previous history of abortion, monthly income, previous history of stillbirth, parity and family planning (Centers for Disease Control, 2006).
According to Dunlop, Logue, Thorne, & Badal, (2013), a study also showed that women who receive an intervention for preconception care have more knowledge of preconception care and that even brief counselling can improve their knowledge of general and personal preconception health risks.
In a recent study conducted in Oklahoma, 2010, only 13.5% to 15.2% of women in Oklahoma receive preconception care (Oklahoma State Ministry of Health, 2010). Although several variables most likely influenced those findings, one potential contributor was lack of awareness of the importance and value of preconception care. Only 12.0% of Oklahoma women received advice and counselling to prepare for becoming pregnant. Out of these women, only 1.0% of Oklahoma mothers met all the criteria for the Oklahoma Preconception Health Index, indicating multiple risk factors were present before conception, which could have been addressed during a preconception care visit.
According to Mazza & Chapman (2010), child bearing women exhibit lack of preconception care behaviour. Their practice of preconception care behaviour depended on their life stage and whether they were planning on having children. They perceived pregnancy as a normal process for human beings, and thus medical attention prior to pregnancy was not considered needed, and medical care was important only once they became pregnant.
According to Kasim, et al., (2016), preconception counselling helps prevent poor pregnancy outcomes. Ideally all women of reproductive age should receive preconception counselling before becoming pregnant. This type of counselling should be offered to all women who attend visits for contraception, Pap smears or for follow-up for chronic diseases such as diabetes mellitus, hypertension and epilepsy.
The kingdom of Eswatini is among the countries where preconceptual care is not initiated to clients who are willing to go for it, and nothing much is known about the knowledge, attitude and practices of preconception care in child bearing women, although these factors are known to contribute to good pregnancy outcomes. In simple terms, preconception care is neglected in Eswatini while it is a critical component to maternal and child health care. Promoting preconceptual care to Eswatini will help to reduce unintended pregnancy especially among teenagers, complications of antenatal care, delivery and postnatal care. Family planning methods especially contraceptives are not well understood as a way of preconceptual care in most countries including Eswatini.
Thus, the objective of this study was to determine the knowledge, attitudes and practices towards preconception care. The main purpose of this study will be addressing the knowledge deficit with regard to attitude and practices associated with preconception care among childbearing women.
1.3 Problem Statement
More than half of pregnancies in Eswatini are unintended as 58% pregnancies are recorded to be unplanned among childbearing women (Ministry of Health, Eswatini, 2016). Birth resulting from unintended pregnancies are associated with adverse health outcomes including delaying in prenatal care. Pregnant women in Eswatini continue to die from four major preventable causes which include severe postpartum haemorrhage, obstetric infections, hypertensive disorders, unsafe abortion and obstructed labour. Currently, the maternal mortality rate is 389 deaths per 100,000 live births (World Health Organisation, 2018). This indicates that there is a need to shift care to the time before a child is conceived, in order to allow for greater potential to prevent unplanned pregnancy and adverse pregnancy outcomes. Preconception care is part of a large healthcare model that results in healthy women, infants and families (Johnson, et al., 2006). There are studies conducted in other countries including Nigeria but there is little information concerning preconceptual care in Eswatini. There are no previous studies that have been conducted concerning knowledge, attitudes and practices towards preconceptual care in Eswatini. This issue then raised concern to the researchers on whether women have knowledge or they are aware concerning preconceptual care.