Prevention and health promotion for women of childbearing age: Preconception healthcare in a Midwest rural state

Background/Objectives: Women's preconception health affects pregnancy and children health outcomes. This study aimed to assess women's awareness of preconception healthcare, and to identify preconception services they received. Methods: Five years after the Center for Disease Control (CDC) recommendations, we conducted a cross-sectional study among women age 18 to 45 attending WIC clinics. Women completed a questionnaire adapted from Frey and Files, based on CDC recommendations. Data from 1,426 surveys were analyzed and adjusted odd ratios (OR) (95% confidence interval [CI]) were calculated to investigate associations between women's awareness of preconception healthcare and demographic and reproductive characteristics. Results: Most women saw a health provider the year before, yet 49% were either unaware or did not receive preconception healthcare, and 67% reported previous unintended pregnancies. Two-thirds were offered five or fewer preconception services known to improve perinatal outcomes. One half had their blood pressure checked; 33.7% received reproductive planning assessment; less than 18% were advised on folic acid supplementation, or hepatitis B and rubella immune status. Preconception healthcare awareness was lower among women with previous unintended pregnancies (95%CI =1.45, 12.47), no health insurance (95%CI=1.05, 1.81), who were single (95%CI=1.03, 1.60), used primarily Emergency Room care (95%CI=1.07, 2.08), and had lower educational level (95%CI=1.01, 1.61). Conclusions: A gap was identified between preconception healthcare recommendations and actual services received. Modifiable variables associated with lower awareness and lack of preconception services were identified, representing a good starting point to develop interventions and policies to make preconception healthcare a reality for childbearing age women.