Preconception health promotion: analysis of means and constraints.

OBJECTIVES

To assess means and constraints of preconception care implementation.

METHODS

Three strategies were applied to promote preconception health: organisation of a campaign, production of guidelines, and implementation of a preconception pilot clinic. Three surveys investigated the knowledge and practices of women before and after the campaign, and one survey assessed the attitudes of gynaecologists.

RESULTS

Posters and leaflets are more efficient than TV spots; implementation of a pilot clinic enhances all activities in the field of preconception health. With regard to constraints, we observed that (i) preconception care could not be provided when pregnancy was unplanned; (ii) the necessity of postponing pregnancy interfered with vaccinations; (iii) the compliance of women with regard to the prolonged intake of folates is poor; (iv) the application of guidelines by providers is inconsistent; (v) providers lack training regarding genetic ethical stakes; and (vi) practitioners find it difficult to integrate the concept of private eugenics and to envision the probabilistic character of the clinical manifestations of inherited diseases.

CONCLUSIONS AND RECOMMENDATIONS

We propose (i) flour fortification with folic acid; (ii) timely immunisation by preventive medicine at school, and (iii) continuous training of health care providers in the provision of preconception care.