Women'S Preconception Health, Planning, And Behaviours: A Cross-Sectional Survey Of Pregnant Women In Australia

Aim: To determine the prevalence, degree and timing of pregnancy planning among pregnant women in Australia and identify the specific health behaviours with which pregnant women engage during specified preconception timeframes. Methods: A national retrospective cross-sectional survey conducted December 2020 to September 2021 including a convenience sample of pregnant women aged 18 to 49 years in Australia and their reproductive partners, recruited through social media platforms. Results: Overall, 615 eligible women with relevant survey items were included in this study with 59.6% (95% CI 55.6, 63.4) of pregnancies categorised as planned, 38.3% (95% CI 34.5, 42.2) as ambivalent and 2.1% (95% CI 1.2, 3.6) as unplanned. Unplanned/ambivalent pregnancies were most common in women under 20 years old and least common in women aged 30 to 39 years (p=0.05). They were also most common among women who were married (56.6% vs 47.8%; p=0.001), university qualified (70.3% vs 52.6%; p<0.001) and in full-time employment (56.9% vs 44.9%, p=0.002). Actions to improve preconception health were generally uncommon; however, they were more likely in women who planned their pregnancies. For example, 42.7% of women with ambivalent/unplanned pregnancies reported consuming folic acid/pregnancy multivitamin before pregnancy compared with 83.3% among those who planned their pregnancy (p<0.001). Preconception financial status, BMI and general health were also associated with pregnancy planning (p<0.05). Conclusion: Almost all women in this survey identified some level of pregnancy planning -- including planned and ambivalent pregnancies -- yet actions to improve their preconception health were uncommon. In addition to promoting specific actions that individuals can undertake with regards to preconception health, it is vital that the impact of structural barriers and wider determinants of health (e.g., out-of-pocket health costs, health literacy, and clear identification of health professionals trained to deliver preconception care) be adequately considered and addressed in terms of preconception health promotion, planning and policy. Such a broad approach can help strengthen attempts to improve pregnancy planning and preconception health.