Published in PLOS One on 2026-06-05, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Yared Asmare Aynalem, Pauline Paul, Zohra S. Lassi, Salima Meherali
Source: PLOS One • DOI 10.1371/journal.pone.0351142
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Although Ethiopia introduced its first national preconception care (PCC) guideline in 2024, PCC remains rarely integrated into routine practice, and existing studies have largely focused on women’s knowledge and behaviors. Little is known about how adults navigate PCC within broader social, cultural, and structural contexts. This study provides an in-depth urban Ethiopian analysis of how adults experience and negotiate PCC within intersecting gender, moral, and institutional systems, offering insights beyond individual-level understanding.
An interpretive description design guided semi-structured interviews with 18 adults (10 women, 8 men; 19–45 years) recruited through maximum-variation sampling from two public hospitals in Addis Ababa. Interviews were conducted in Amharic, transcribed, translated, and analyzed inductively. Data analysis was guided by ID principles, complemented by thematic analysis techniques informed by grounded theory, including line-by-line coding, constant comparison, and analytic memoing. Field notes captured contextual and relational dynamics.
Seven interrelated themes highlighted complex dynamics in PCC. Knowledge was fragmented and often recognized only after complications, shaped by marital gatekeeping, faith-based beliefs, and exclusion of unmarried women. PCC was valued as protective and morally significant, but stigma, poverty, staff shortages, and inconsistent services constrained practice. Men were largely financial supporters, though many expressed a desire to participate, limited by gender norms and women-centered services. Pharmacies and digital media provide informal but sometimes unsafe guidance. Emotional experiences, fear, guilt, secrecy, and hope were central to PCC engagement. Education, peer influence, schools, and community leaders emerged as catalysts for uptake, yet participants emphasized that sustainable PCC required visible institutional support, reliable services, and government recognition. Strategies to enhance practice included simplifying communication, creating accessible clinic entry points, and mobilizing community networks to normalize pre-pregnancy preparation.
This study reveals PCC in urban Ethiopia as a socially negotiated, morally contested, and structurally uneven practice, far more complex than knowledge deficits imply. These findings offer novel, actionable direction for implementing Ethiopia’s PCC guideline through visible, inclusive, relational, and community-anchored approaches that address the social conditions shaping PCC access.
Introduction
Maternal and child health remains central to the Sustainable Development Goals (SDGs), which aim to reduce the global maternal mortality ratio to fewer than 70 per 100,000 live births and to end preventable newborn deaths by 2030 [1,2]. However, progress remains insufficient. In 2023, an estimated 260,000 women died from pregnancy-related causes, corresponding to a global maternal mortality ratio of approximately 197 per 100,000 live births, nearly three times the SDG target [2]. Each year, about 2.3 million newborns die within the first month of life, with most of these deaths occurring in low- and middle-income countries [3]. These preventable losses highlight that health trajectories are shaped well before conception and that interventions limited to antenatal care are often too late to avert complications [4,5]. To address this gap, the World Health Organization (WHO) defines preconception care (PCC) as a package of biomedical, behavioral, and social interventions delivered before conception to optimize parental health and improve pregnancy outcomes [6]. In 2024, WHO renewed its call to integrate PCC within national health systems as a proactive strategy to prevent complications and break intergenerational cycles of inequity [7]. This reflects recognition that pregnancy outcomes are influenced not by isolated events but by lifelong exposures, behaviors, and social determinants [8].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Yared Asmare Aynalem, Pauline Paul, Zohra S. Lassi, Salima Meherali. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Preconception care services in Northern Ethiopia: A qualitative exploration of awareness, experiences, challenges, opportunities, and prospects
- Evidence brief: Urban-rural disparities in receipt of treatment for obstetric complications in Ethiopia: A multivariate decomposition analysis
- Evidence brief: Lived experience of depression in women living with Human Immunodeficiency Virus in Gondar City health facilities, Northwest, Ethiopia: A phenomenological study
