Perception and Factors Influencing Willingness to Use Preconception Care Services among Urban-
Dwelling Women of Reproductive Age in Ibadan North Local Government Area, Oyo State, Nigeria.
Uchendu Obioma C1, 3, Oyesanwo Funmilayo T2, Olabumuyi Olayide O3, Green Pauline A.4
1Department of Community Medicine, College of Medicine, University of Ibadan, Oyo State, Nigeria. 2Department of
Community Medicine, Faculty of Public Health, University of Ibadan, Oyo State, Nigeria. 3Department of Community
Medicine, University College Hospital, Ibadan, Oyo State, Nigeria. 4Rivers State University, Nkpolu Oroworukwu, Rivers
State, Nigeria
ABSTRACT
Correspondence
Uchendu Obioma Chukwudi
Department of Community
Medicine,
College of Medicine,
University of Ibadan, Oyo State,
Nigeria
+2348066717229, +2348023280468
obioma234@gmail.com
Background: Preconception care (PCC) offers biomedical, behavioral, and
social health interventions to women and couples before conception, with the
potential to reduce maternal morbidity and mortality, particularly in low-income
countries where pregnancy-related deaths are prevalent. This study assessed
perception, willingness to use PCC services, and factors associated with
willingness. Methods: The descriptive cross-sectional study utilized two-stage
cluster sampling to recruit 509 women of reproductive age in Ibadan North Local
Government Area. Data was collected using an interviewer-assisted
questionnaire and analyzed with SPSS version 21. Results: Among respondents,
71.3% had good perceptions of PCC, and 84.7% were willing to use PCC
services, although only 32.8% were aware of them. Willingness was significantly
associated with the highest level of education (p=0.002), ANC attendance (p =
0.023), routine drug use (p = < 0.001), health service utilization (p = 0.029), and
overall perception (p = 0.019). Multivariate analysis showed that respondents
with secondary education and those with fair or good routine drug use behavior
were three and two times more likely, respectively, to be willing to utilize PCC
compared to those with primary education or poor drug use behavior (OR=2.6
95%CI = 1.190-5.783; OR = 2.2 95%CI = 1.273-3.677). Women earning above
the minimum wage were twice more likely to use PCC services willingly (OR =
2.4 95% CI = 1.002 - 5.515). Conclusion: Despite good perception and
willingness to use PCC services, awareness was poor, highlighting the need for
better health education to promote PCC utilization.
Keywords: Preconception Care, Perception, Willingness, Women of
Reproductive Age
INTRODUCTION
Many women enter into motherhood without appropriate
knowledge or skills needed to go through the important
milestones without adverse health outcomes. Poor
maternal health is a key risk factor for adverse delivery
outcomes, particularly among pregnant women.1,2 First-
time mothers, especially those with unexpected
pregnancies and minimal support, are particularly
vulnurable.3 Efforts to address maternal mortality have
primarily focused on antenatal and delivery period but
significant reductions in maternal mortality remain
elusive, especially in Low and Middle-Income Countries
(LMICs) like Nigeria.4
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Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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Preconception care (PCC) is a paradigm shift
considering interventions beyond antenatal and delivery
care to include those that could be delivered prior to
conception.5,6 The World Health Organization (WHO)
recognizes preconception care as a key preventive
strategy in maternal and newborn health (MNH), deemed
feasible for implementation in both developed and
developing countries.7 Improving birth outcomes takes
promoting maternal health not only during pregnancy,
but before pregnancy is established, in between
pregnancies and across the woman’s lifespan.8 Findings
show that adequate and proper PCC targeted at all
women of reproductive age before their first pregnancy
and between pregnancies can significantly improve
maternal outcomes.9
According to the World Health Organization
(WHO), Preconception care is the interventions that are
given in order to identify and modify the biomedical,
behavioural and social risks to a woman’s health or
pregnancy outcome through prevention and management
of such identified risks.10 PCC encompasses the
following services; assessment of nutritional status of
mothers, identification of pre-existing medical
conditions, infectious diseases, and, genetic conditions,
counseling on family planning, immunization services,
control of tobacco, alcohol, and psychoactive active
substance use, provision of information and management
of the underlying causes of infertility.10 Preconception
care is a preventive strategy that could be delivered either
at the facility or community level.11,12 It is the set of
interventions to optimize women’s health before
pregnancy with the overall goal of improving maternal
and newborn health outcomes.13
PCC could commence during the early stage of a
woman’s life since it is specifically targeted at girls and
women of reproductive age (15-49 years).9
Preconception care helps to ensure that pregnancies
occur when individuals are physically and emotionally
ready, and it minimizes early pregnancies, particularly
among young people.14 According to research,
pregnancies spaced less than six months apart can
increase risks for both the mother and the child, including
issues such as premature birth and low birth weight.
Preconception care includes family planning counseling,
which assists couples in spacing their pregnancies
appropriately, so lowering these risks.15 Because half of
all pregnancies are unexpected, posing a high risk to
mother and infant health, preconception care through
contraceptive counseling enables people to make
informed decisions about family planning and
reproductive objectives.14,16 Hence, PCC would ensure
less unwanted pregnancies occur and means of effective
contraception are made available when needed.
Preconception services are underutilized among
women of reproductive age in Africa, and actively
planning for pregnancy before conception remains a
challenge in many cultural settings, including Nigeria.17
Preconception care rates in developing countries
including Ethiopia,18 Nigeria,19 Bhutan,20 Nepal,21 and
Sri Lanka22 were found to be 22.3%, 23.4%, 21.8%, 2%,
and 27.2%, respectively. Women’s perception about
preconception care (PCC),23,24 and willingness to uptake
preconception care services have not been extensively
studied despite these studies on utilization in different
countries.25,26 However, perception of PCC and the level
of awareness of the risk factors for pregnancy
complications or being unaware of the need for
preconception care25 may affect the willingness to use
PCC. Findings from a Malaysian study revealed the
perspective of preconception care among reproductive-
age women.27 The majority of the women agreed that
preconception care is an important health concern during
the reproductive age and was a priority prior to
pregnancy. In a study in Nigeria, women who were aware
of preconception care perceived it to be beneficial to
maternal and child health while others (10.6%) were
undecided about their perception about preconception
care.28 A study conducted among women with chronic
health conditions found that the women reported
preconception care services contributed to emotional
stress for them.29 Also, women of reproductive age (19-
34 years) in the West Midlands of the UK reported
preconception counseling as a factor associated with fear
of pregnancy complications to a level that it made the
decision to conceive more difficult.30
The willingness to utilize PCC services was
reported among women of reproductive age in the North
West zone of Nigeria as they believed it had potential
health benefits despite being unaware.23 Another study in
Southeast Nigeria reported that the majority of the
women were willing to take up PCC in their subsequent
pregnancies.31 However, because of the cultural diversity
in Nigeria, this findings may not apply to the entire
county, this study therefore aimed to assess the
perception and willingness to uptake PCC among women
of reproductive age group in a state in the Southwestern
region of the country. Furthermore, it aimed to determine
the factors associated with willingness to use PCC
services.
MATERIAL AND METHODS
Study Area
The study was conducted in Ibadan North Local
Government Area (IbNLGA), Ibadan, Oyo State. The
2006 National Population Census estimated the Ibadan
metropolis to have a population of 1.34 million, while the
total population of Ibadan exceeded 2.55 million.
IbNLGA is the largest of the five LGAs located in the
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Ibadan metropolis. IbNLGA occupies a land area of 27
Km2, and had a population of 308,119 from the 2006
census with a projected population of 2.3% (440,400) in
2022.32 The inhabitants include Yoruba, Hausa, Igbo and
many other Nigeria ethnic groups. All levels (primary,
secondary and tertiary) of health facilities are available in
the LGA, including the first tertiary hospital in Nigeria.
Study Design
The study was cross-sectional in design and conducted
among women of reproductive age in Ibadan North Local
Government Area.
Sampling Technique
This study utilized a two-stage cluster sampling
technique to select women of reproductive age who had
resided in Ibadan North LGA for at least 6 months
excluding those who were severely ill. At the first stage,
a random sampling technique by balloting was used to
select four wards out of twelve, at the second stage, one
community was selected per ward by balloting. All
eligible women in communities were then selected for
this study.
The sample size was determined using the Leslie
Kish formula to estimate a single proportion. Using a
prevalence of 72.2% (women willing to uptake PCC in
Southeast zone, Nigeria),31 a 5% precision with a 10%
non-response at standard normal deviate of 95%, and
assuming a design effect of 1.5, the minimum sample size
for this study was 463 women of reproductive age.
Study Instrument and Data Collection
An Interviewer-administered, semi-structured
questionnaire was used to obtain information on socio-
demographics and perception about preconception care
services, utilization of preconception care services (ever
utilized), and willingness to utilize preconception care
services. The questionnaire was developed from the
review of the literature.23,31The questionnaire was pre-
tested among women of reproductive age group located
in a different LGA but similar to the study site. The pre-
test was conducted after translating the questionnaire into
the local language and back-translating it to ensure the
original meaning was retained and to identify any
potential ambiguities. Female research assistants who
could read and speak in the local dialect (Yoruba) and
English fluently were recruited and trained for the data
collection process.
Face and content validity was done, and factor
analysis was also conducted to identify questions that
were used as a proxy for domains of preconception care
that were assessed. Questions with factor loading
between 0.622 and 0.873 were used as proxies for the
domains that assessed for willingness. Ambiguous
questions identified were modified and a reliability test
was thereafter conducted, the Cronbach alpha for the
final instrument that was used for data collection was
0.84. A total of 544 questionnaires were administered and
509 that had complete information on all variables of
interest were included in the analysis.
Ethical Considerations
Ethical approval for this study was obtained from the
Ministry of Health Research Ethics Committee, Ibadan,
Oyo state. The purpose of the study was explained to each
participant, consent was obtained from each eligible
participant before questionnaire administration.
Data Analysis
Data was analyzed using Statistical Package for Social
Sciences (SPSS) version 21. Descriptive statistics was
done using mean, standard deviation, frequency,
proportions, and tables. Associations between variables
was assessed using the chi-square test while predictors of
willingness to uptake PCC were identified using
multivariate logistic regression, The level of statistical
significance for all tests was set at a 5% level of
significance.
Measure of Variables
Age: Respondents were asked for their age at their last
birthday, responses were then re-categorized into those
between 15-24 years (young adult) and those 25-49
(older adult).
Marital status: Respondents' responses of either single,
married, separated, widow, or cohabiting were
dichotomized. Responses of single, separated, widowed,
or co-habiting were categorized as “not currently
married” while those that were married were categorized
as “currently married”.
Educational status: This was assessed by asking
participants the highest level of education they had.
Those that responded that they either had no formal
education or had only primary education were
categorized as “≤ primary level”. Respondents who had
secondary education were categorized as “secondary
level” while those who had tertiary education were
categorized as “tertiary level”.
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Average monthly income: Respondents were asked to
estimate their average income in a month. Using the
Federal government of Nigeria's minimum wage of
30,000 NGN/ $72.95 by ($1 = 411.20NGN), their
responses was dichotomized into “< minimum wage” and
“≥ minimum wage”
Age as at last pregnancy: was re-categorized into two
groups that are 15-24 years and 25-49 years.
Previous eventful pregnancy experience: This was
dichotomized into “Yes” and “No”. Those that reported
they had either anemia in pregnancy, hypertension in
pregnancy, diabetes in pregnancy, pregnancy loss,
preterm delivery or baby with birth defect were
categorized as “Yes”. Those that had never experience
any of the above conditions were categorized as “No”
Previous eventful pregnancy experience in family
member: This was dichotomized into “Yes” and “No”.
Those that reported to have at least one family member
who had either hypertension in pregnancy, diabetes in
pregnancy, pregnancy loss, preterm delivery or baby with
birth defect were categorized as “Yes”. Those that do not
have any family member who had experienced any of the
above conditions were categorized as “No”
Routine Drug Use Behaviour: This was assessed by
asking respondents if they were routinely using folic acid
tablet as the time of this study. They were also asked
about use of medications without prescription as well as
use of herbal preparation. Those that responded “Yes” to
folic acid use, and “No” to the use of medications without
prescription and “No” to the use of herbal preparation
were categorized as having “Good” drug use behavior,
those that responded “Yes” to folic acid use or “Yes” to
the use of medications without prescription and “No” to
the use of herbal preparation were categorized as having
“Fair” drug use behavior, while those that responded
“No” to the use of folic acid, and “Yes” to the use of
medication without prescription and “Yes” to the use of
herbal preparation were categorized as having “Poor”
drug use behavior.
Health services use behaviour: History of having ever
received tetanus toxoid (TT) and Hepatitis B Virus
(HBV) vaccine as well as their history of routine medical
checkup were used to assess this behaviour. Those that
responded to had at least 1 dose of TT vaccine, and 1 dose
of the HBV vaccine and also to have ever gone for routine
medical checkup were categorized as having “Good”
health service use behavior, those that responded “No” to
the TT vaccine, or “No” to HBV vaccine or “No” to
routine medical check-up were categorized as having
“Fair” health service use behavior while those that
responded “No” to the TT vaccine, and “No” to HBV
vaccine and “No” to routine medical check-up were
categorized as having “Poor” health service use behavior.
Respondents were further asked about awareness of their
genotype as a proxy for health service utilization. This
was dichotomized into “Yes” and “No”.
Perception of preconception care (PCC): was assessed
using 22 positively worded statements that were
measured on a 5-point Likert scale (Strongly agree, agree
undecided, strongly disagree, and disagree. A score was
awarded as follows: 5 points for every response of
“strongly agree”, 4 points for every response of “agree”,
3 points for every response of “undecided”, 2 points for
every response of “disagree” and 1 point for every
response of “strongly disagree”. Thus, the maximum
obtainable score was 110 while the minimum obtainable
score was 22. An aggregate score of 88 (aggregate for
response “agree” to all 22 questions) was used to
dichotomize and those with scores < 88 were categorized
as having “poor perception of PCC” while scores of ≥ 88
were categorized as “good perception of PCC”.
Willingness to utilize PCC services: was assessed using
the question “If preconception care services are available
in our area, would you be willing to utilize any of the
services”. A response of “Yes” was categorized as
“willing” and No as “not willing”. Willingness to utilize
in six domains namely; i) Counseling and screening for
genetic conditions, ii) counseling and screening for
tobacco and alcohol use, iii) counseling and testing for
STIs including HIV, iv) uptake of family planning
methods v) education on FGM/child marriage and vi)
vaccination against vaccine-preventable disease of
preconception, was assessed using one question each.
Furthermore, the study assessed respondents'
willingness to use preconception care services, with or
without financial assistance. For the multivariate
analysis, willingness without conditions was utilized.
Predictors of willingness to utilize PCC services: The
analysis was divided into two models. Model I included
all women enrolled in the study, with variables
significant up to 10% in the bivariate analysis included.
Model II focused on women with a pregnancy history,
and similarly included variables significant up to 10% in
the bivariate analysis.
RESULTS
Socio-demographic Characteristics
The mean age of the respondents was 27.5 ± 8.0 years
and a higher percentage (39.5%) were between 24 and 32
years. Respondents who were single and who had tertiary
education were 55.2% and 53.3% respectively. (Table 1)
Udendu et al. Perception and Factors Influencing Willingness to Use Preconception Care Services
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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Obstetric History and Risks of Respondents
Respondents who had been pregnant before were 45.2%
while the majority (93.0%) of these had antenatal care
during their last pregnancy. Less than a fifth (18.7%)
reported having had previous untoward pregnancy
experience while 6.1% of them reported the use of
alcohol during pregnancy (Table 2).
Table 1: Socio-Demographic Characteristics of
Respondents
Variable
Frequency
(N=509)
%
Age (in years)
15 – 23
183
35.9
24 – 32
201
39.5
33 – 41
86
16.9
44 – 49
39
7.7
Mean (SD) years 27.5 (8.0)
Highest level of education
No formal education
24
4.7
Primary
21
4.1
Secondary
193
37.9
Tertiary
271
53.3
Average monthly income
(Naira)
≤ 5,000
140
27.5
> 5,000 to 20,000
221
43.4
> 20,000 to 50,0000
127
25.0
> 50,000 to 100,000
21
4.1
Marital status
Single
281
55.2
Married
214
42.0
Separated
8
1.6
Widowed
5
1.0
Co-habiting
1
0.2
Family type (n=214)
Monogamy
190
88.8
Polygamy
24
11.2
Parent’s family type
Monogamy
395
77.6
Polygamy
114
22.4
Respondent's Awareness of Preconception Care and
Services
About (32.8%) of the respondents reported having ever
heard of pre-conception care services before. Services
related to substance abuse were the least reported (9.0%)
they were aware of while genetic-related services were
the most reported (80.2%) pre-conception services they
were aware of (Fig 1).
Respondent’s Health-Seeking Behaviour
Less than a quarter (23.6%) of the respondents reported
the routine use of folic acid while 60.5% of the
respondents reported they engage in habitual use of
herbal preparation. With regards to their routine use of
drug, the majority (64.4 %) of respondents had fair
behavior while just a third had fair health service
utilization behavior. (Table 3)
Table 2: Obstetric History and Risks of Respondents
Variable
Frequen
cy
(n=230)
Percenta
ge
Ever been pregnant (N=509)
Yes
230
45.2
No
279
54.8
Age as at last pregnancy
(years)
15-24
37
16.1
25-49
193
83.9
Last pregnancy was planned
Yes
153
66.5
No
77
33.5
Attended ANC at last
pregnancy
Yes
214
93.0
No
16
7.0
Previous eventful pregnancy
experience
Yes
43
18.7
No
187
81.3
Previous eventful pregnancy
experience in family member
(N=509)
Yes
128
25.1
No
381
74.9
Use of alcohol in pregnancy
Yes
14
6.1
No
216
93.9
Perception of PCC by Respondents
Proportion of respondents with good perception of
different components of the pre-conception services
ranged between 31.2% and 87.6%. The proportion of
women with good perception of nutrition related services
was the least (31.2%) while those with good perception
of management of infertility and sub-fertility as
Udendu et al. Perception and Factors Influencing Willingness to Use Preconception Care Services
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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preconception services was the highest (87.6%). Overall
perception of pre-conception services was good among
71.3% of the women. (Table 4)
Willingness To Use Preconception Care Services
Willingness to utilize any of the pre-conception services
ranged from 71.5% to 84.7% and the least proportion
(71.5%) of the women were willing to utilize any of the
services if it would require them having to pay a fee.
Substance abuse related services was the pre-conception
care respondents were least willing to utilize whether
with a fee (25.1%) or even if free (61.0%) while genetic
related services was the one they were most willing to
utilize (71.5% if it would require payment and 91.4% if
would not require payment). (Figure 2).
Table 3: Health-Seeking Behavior of the Respondents
Variable
Frequen
cy
(N=509)
%
Routine use of folic acid
Yes
120
23.6
No
389
76.4
Practice of self-medication
Yes
337
66.2
No
172
33.8
Habitual use of herbal
preparation
Yes
308
60.5
No
201
39.5
Overall routine drug use
Poor
160
31.4
Fair
328
64.4
Good
21
4.2
Aware of your genotype
Yes
333
65.4
No
176
34.6
Ever had the TT vaccine
Yes
140
27.5
No
369
72.5
Ever had the HBV vaccine
Yes
55
10.8
No
454
89.2
Ever had routine medical
check-ups
Yes
132
25.9
No
377
74.1
Overall health service
utilization behavior
Poor
302
59.3
Fair
180
35.4
Good
27
5.3
Factors Associated with Willingness to Utilize Any
PCC Service (1)
With increasing levels of education, the proportion of
women who were willing to utilize any pre-conception
service was observed to significantly increase. While a
third (66.7%) of those with a primary level of education
were willing, 87.6% and 85.6% of those with secondary
and tertiary levels of education respectively were willing
to utilize the service (p=0.002). Also, even when the issue
of payment was not categorically stated, a higher
proportion (90.5%) of women whose average monthly
earning was at least minimum wage or more were willing
to utilize pre-conception care services compared to
82.3% of
Table 4: Perception of PCC by Respondents
Variable
Frequen
cy
(N=509)
%
Genetic services
Poor
105
20.6
Good
404
79.4
Substance abuse services
Poor
184
36.1
Good
325
63.9
Management of STIs/
HIV
Poor
85
16.7
Good
424
83.3
Contraceptive services
Poor
143
28.1
Good
366
71.9
Education on harmful
cultural practices
Poor
90
17.7
Good
419
82.3
Vaccination services
Poor
71
13.9
Good
438
86.1
Nutrition services
Poor
350
68.8
Good
159
31.2
Management of
infertility/ sub-fertility
Poor
63
12.4
Good
446
87.6
Overall perception of
PCC
Poor
146
28.7
Good
363
71.3
Udendu et al. Perception and Factors Influencing Willingness to Use Preconception Care Services
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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those earning less than minimum wage monthly
(p=0.019) (Table 5). The willingness of the respondents
to utilize pre-conception care services was associated
with their history of previous antenatal care (ANC)
attendance. A significantly higher proportion (84.6%) of
those who attended ANC during their last pregnancy
were willing to utilize any of the pre-conception care
services compared to 62.5% of those who did not attend
ANC. Health service utilization and drug use behavior
were found to be significantly associated with
willingness to utilize any of the pre-conception care
services. (Table 5).
There was significant association between
perception of some of the pre-conception care services
and the willingness of the women to utilize any of the
services, with higher proportion of those with good
perception being willing to use compared to those with
poor perception. Similarly, a higher proportion (83.0%)
of women with good perception of the overall
preconception care services was willing to use the service
compared to those (78.8%) with poor perception
(p=0.019) (Table 6)
Factors Associated with Willingness to Utilize Any PCC Service (2)
Table 5: Socio-demographic, Obstetric and Health-seeking Characteristics associated with Willingness to
utilize any PCC Service
Socio-
demographi
c Variables
Willingness to utilize
PCC services
P-
value
Obstetric &
Health-seeking
Variables
Willingness to utilize
PCC services
P-
value
No (n)%
Yes (n)%
No (n)%
Yes(n)%
Age (years)
Ever pregnant
15-24
32 (15.5)
175 (84.5)
0.944
No
39 (14.0)
240 (86.0)
0.353
25-49
46 (15.2)
256 (84.8)
Yes
39 (17.0)
191 (83.0)
Level of
education
Last pregnancy
planned
≤ primary
15 (33.3)
30 (66.7)
No
18 (23.4)
59 (76.6)
0.066
Secondary
24 (12.4)
169 (87.6)
0.002*
Yes
21 (13.7)
132 (86.3)
Tertiary
39 (14.4)
232 (85.6)
Average
monthly
income
(Naira)
Had ANC during
last pregnancy
< minimum
wage
64 (17.7)
297 (82.3)
0.019*
No
6 (37.5)
10 (62.5)
0.023
*
≥ minimum
wage
14 (9.5)
134 (90.5)
Yes
33 (15.4)
181 (84.6)
Marital
status
Previous poor
obstetric history
Not currently
married
44 (14.9)
251 (85.1)
0.764
No
35 (18.7)
152 (81.3)
0.138
Currently
married
34 (15.9)
180 (84.1)
Yes
4 (9.3)
39 (90.7)
Family type
Routine drug use
behavior
Monogamy
28 (14.7)
162 (85.3)
0.195
Poor
39 (24.4)
121 (75.6)
<0.00
1*
Polygamy
6 (25.0)
18 (75.0)
Fair/ Good
39 (11.2)
310 (88.8)
Health service
utilization
behavior
Poor
55 (18.2)
247 (81.8)
0.029
*
Fair/ Good
23 (11.1)
184 (88.9)
Udendu et al. Perception and Factors Influencing Willingness to Use Preconception Care Services
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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Figure 1: Awareness of Preconception Care Services among Respondents
Figure 2: Respondents willingness to Utilize Components of PCC Services under three conditions, namely
if there is no financial implication, if there is a financial implication, and without any conditions at all
Udendu et al. Perception and Factors Influencing Willingness to Use Preconception Care Services
Tropical Journal of Obstetrics and Gynaecology (TJOG) Vol. 43 No. 4 (2025)/Published by Journalgurus
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Predictors of willingness to utilize any PCC Service
Level of education and drug use behavior were identified
as independent predictor of willingness to utilize any of
the pre-conception care (PCC) services among women of
reproductive age in Ibadan North LGA. Women with
secondary level of education were found to be about three
times more likely to be willing to utilize PCC compared
to those with primary level of education (OR=2.6; 95%
CI=1.190 to 5.783). The odds of those with fair-good
drug use behavior being willing to utilize PCC was two
times higher than those with poor behavior (OR=2.2;
95% CI=1.273-3.677). Among the subset of women who
had being previously pregnant, average monthly income was
identified as a predictor of their willingness to utilize any of
the PCC package. Those earning at least minimum wage
were two times more likely to utilize PCC than those earning
less (OR=2.4; 95% CI=1.002-5.515). (Table 7).
DISCUSSION
Table 6: Association between perception of PCC services and willingness to utilize any PCC service
Variable
Willingness to utilize PCC
services
P-value
No (n)%
Yes (n)%
Overall
Perception of
PCC services
Poor
31 (21.1)
115 (78.8)
0.019*
Good
47 (12.9)
191 (83.0)
Genetic services
Poor
21 (20.0)
84 (80.0)
0.135
Good
57 (14.1)
347 (85.9)
Substance abuse
services
Poor
31 (16.8)
153 (83.2)
0.473
Good
47 (14.5)
278 (85.5)
Management of
STIs/ HIV
Poor
20 (23.5)
65 (76.5)
0.021*
Good
58 (13.7)
366 (86.3)
Contraceptive
services
Poor
30 (21.0)
113 (79.0)
0.027*
Good
48 (13.1)
318 (86.9)
Education on
harmful cultural
practices
Poor
23 (25.6)
67 (74.4)
0.003*
Good
55 (13.1)
364 (86.9)
Vaccination
services
Poor
23 (32.4)
48 (67.6)
< 0.001*
Good
55 (12.6)
383 (87.4)
Nutrition services
Poor
55 (15.7)
295 (84.3)
0.717
Good
23 (14.5)
136 (85.5)
Management of
infertility/ sub-
fertility
Poor
16 (25.4)
47 (74.6)
0.018*
Good
62 (13.9)
384 (86.1)
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Preconception care (PCC) is a crucial aspect of
reproductive health that improves obstetric outcomes for
women. The study assessed women’s perception and
willingness to utilize preconception care and services.
Nearly three-quarters of the respondents had good
perception regarding preconception care and majority
(84.7%) were willing to use any preconception care
services without any
conditions. The findings from this study showed that only
38.4% of the women were aware of preconception care
which is comparable to those reported among Nigerian
women in Southeast31, Southsouth33 and among Saudi
women.34 However, a contradictory report among
healthcare personnel in Zaria, Nigeria showed a high
awareness of 83.3%.35 This difference is expected
because the latter study was conducted among healthcare
workers, who are more likely to have medical knowledge
of PCC23 than the general population enrolled in previous
studies. Despite the low awareness in this study, the
majority of the women expressed willingness to utilize
preconception care services.
The success of preconception care largely
depends on the willingness to participate just as attitude
to it.27 The utilization of preconception care (PCC)
services has been explored in research, many of which
indicate poor utilization. In the study among women in
Abakaliki,31 Southeast Nigeria, only 10.3% utilized PCC
services and only 14.05% of women utilized PCC
services in another study in Enugu, Southeast Nigeria.28
Studies
conducted outside of Nigeria report a utilization rate of
14.5% in Ethiopia26 and 15.8% in France.36 However,
despite the low utilization rates observed, the current
study
reveals a high willingness to use preconception care,
similar to findings from a study among women in Sokoto,
Northwest Nigeria.23 The study conducted among women
from Abakaliki also revealed that the majority expressed
a willingness to receive preconception care before their
subsequent pregnancies.31
The disparity between willingness to use and
actual utilization of preconception care services as
Table 7: Predictors of Willingness to Utilize any PCC Service
Variable
Willingness
P-value
Model I (N=509)
Model II (n=230)
Yes (n)%
AOR
Lower
Upper
AOR
Lower
Upper
Level of education
≤ primary
30 (66.7)
1
1
Secondary
169 (87.6)
0.002*
2.6
1.190
5.783
1.7
0.633
4.660
Tertiary
232 (85.6)
1.8
0.809
3.779
1.1
0.360
3.250
Average monthly
income (Naira)
< minimum wage
297 (82.3)
0.019*
1
1
≥ minimum wage
134 (90.5)
1.8
0.937
3.306
2.4
1.002
5.515
Routine drug use
behavior
Poor
121 (75.6)
<0.001*
1
1
Fair/ Good
310 (88.8)
2.2
1.273
3.677
1.8
0.803
3.947
Health service
utilization
behavior
Poor
247 (81.8)
0.029*
1
1
Good
184 (88.9)
1.7
0.977
2.888
1.8
0.823
3.783
Overall perception
Poor
115 (78.8)
0.019*
1
1
Fair/ Good
191 (83.0)
1.5
0.894
2.545
1.3
0.580
2.981
Last pregnancy
planned
No
59 (76.6)
0.066
1
Yes
132 (86.3)
1.2
0.527
2.555
ANC during last
pregnancy
No
10 (62.5)
0.023*
1
Yes
181 (84.6)
1.7
0.519
5.990
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indicated in these studies, may have been from low
awareness and perception of the women about
preconception care. In previous study, most women who
learned about PCC from their healthcare providers used
the service, demonstrating increased awareness leads to
higher utilization hence influencing informed decision
making.31 Furthermore, it is agreed that the perception of
health care workers and prospective mothers can
influence the
provision and utilization of the service.37
The majority of the respondents had good
perception about preconception care. This result is in line
with the finding from a study conducted among
healthcare workers and women of reproductive age group
in Malawi. About three-quarter (74.7%) of the women
had positive perception towards preconception care.24
The women in the study conducted in Sokoto State,
Northwest Nigeria,23 indicated they would utilize
preconception care because they believed it would
benefit them. This demonstrates that a positive
perception of PCC influences the decision to use it. This
finding supports the Health Belief Model (HBM), which
suggests that perceived benefits can motivate individuals
to seek preconception care.38
Studies reporting the prevalence of willingness to
utilize PCC services did not fully explore the factors
affecting this willingness,23,31 unlike studies focusing on
actual utilization.31,39 However, research indicates that
the level of education and information from healthcare
providers significantly influence the utilization of PCC
service.31 In current study, level of education, monthly
income, routine drug use behaviour, health service
utilization and perception of PCC services were
significantly associated with being willing to utilize PCC.
However, only level of education, monthly income and
drug use behaviour were independent predictors of
willingness to utilize PCC services.
Regarding health service utilization behaviour
among respondents, more than half (59.3%)
demonstrated poor utilization in areas such as routine
medical checkups, and receiving TT and HBV vaccines.
This finding is crucial because it may impact the
population's willingness to utilize or actual utilization of
health services, including preconception care. Research
has shown better healthcare utilization among females
compared to males,40 and among married and pregnant
women compared to single women or women who have
never been
pregnant.41 The finding of poor health service utilization
may be explained by the large percentage of the
respondents who were single with nearly half that had
never been pregnant. Hence, interventions to scale up
health education among women cannot be
overemphasized.
There was increased willingness to utilize PCC
services among all the women who had higher education
and women who had ever been pregnant and who had
higher income. Higher education is frequently associated
with improved health literacy, which allows women to
understand medical advice and successfully navigate
healthcare systems. This increases the likelihood of
seeking and receiving health care services such as PCC.42
Socioeconomic status also plays a significant role, as
women from higher-income families would show greater
willingness to use PCC services. Women with greater
education levels frequently have better career
opportunities and finances, making it easier to access
healthcare services like as PCC. Economic stability can
improve access to healthcare resources and reduce costs
limitations.42
It is well acknowledged that women who
prioritize preconception care for couples intending to
become pregnant are more likely to make use of these
services. In a study, women overwhelmingly agreed that
PCC needs to come first.39 This supports the results of
our study, which show that willingness to use PCC
services is positively correlated with good perception.
Perception of preconception care services can be greatly
improved when people know about the components and
benefits of the services and how to access them.
Limitations of the Study
Although the impact of the language barrier was
mitigated by the measures implemented such as
instrument translation, and education had no significant
influence on the data collection process, one limitation of
the study was that it did not account for participants'
health literacy levels, which could influence their
perception of PCC services.
Also, the current study focused solely on women,
excluding their partners. This is significant because men
also play a vital role in preconception care services, as
emphasized by the WHO.43 Furthermore, the study was
purely quantitative and may not have fully explored some
sociocultural factors that limit women's willingness to
utilize PCC services. The cross-sectional nature of the
study also makes it impossible to clearly establish
causality. Future research could consider addressing
these aspects of PCC raised.
CONCLUSION
This study revealed that most of the women had good
perception towards preconception care and were willing
to use preconception care services. Utilization of PCC in
many parts of Nigeria remains low and since willingness
to use preconception care does not automatically translate
to actual utilization there is need for follow up measures
in improving the education of women about
preconception care services. This implies that,
Udendu et al. Perception and Factors Influencing Willingness to Use Preconception Care Services
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preconception care services could be optimally utilized if
there is improvement in the level of awareness and good
perception among the female folks.
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