Preconception advice, care and services in the UK: who delivers what, where, how and to whom? A cross-sectional survey

Objective: to describe the provision of preconception care across publicly funded or contracted health and social care settings in the UK. Design and setting: online cross-sectional survey conducted October-December 2025. Population: healthcare professionals delivering preconception care, recruited via professional organisations and networks. Methods: quantitative data were analysed using descriptive statistics and qualitative free-text responses using inductive content analysis. Outcome measures: preconception care content, target population, frequency of provision, funding and commissioning models, and approaches for reporting and monitoring. Results: Eighty-seven healthcare professionals completed the survey. Most were women (89.3%), aged 41-60 (63.1%) and based in England (84.5%). Participants represented diverse roles, mainly obstetric/maternal-fetal specialists (23.0%), specialist nurses (16.0%), GPs and midwives (13.8% each). Preconception care primarily targeted women [≥]20 years (98.9%), with fewer targeting men and adolescents. Care was usually embedded within relevant consultations (69.4%), particularly contraception, medication and health condition reviews, and often a one-off interaction (75.3%). Content focused on condition-related management/medication (68.6%), folic acid (66.3%), risky behaviours (smoking, alcohol, illicit drugs) (40.7%), diet (37.2%) and weight (36.0%). Services were mostly not formally commissioned (62.4%), lacked financial incentives (84.7%) and had no audit/service evaluation requirements (81.2%). Conclusions: Preconception care in the UK is delivered by a wide range of healthcare professionals. Their engagement has improved considerably when compared with studies conducted over a decade ago, but preconception care remains fragmented, opportunistic and poorly supported by commissioning and system infrastructure. Strengthening integrated care pathways, funding mechanisms and use of standardised resources is essential to achieve consistent and equitable preconception care.