Parenthood begins before pregnancy

In rural India, women often visit their local Public Health Centre (PHC) only after missing a period and suspecting pregnancy—typically around the tenth or twelfth week, well into the first trimester. While
the PHC provides vital services like iron and folic acid supplements, vaccinations, and monetary aid, by then, a crucial window of foetal development has already passed.

What if the visit had happened earlier—before conception?

Most assume that taking care of health during pregnancy is enough. Even government schemes like Janani Suraksha Yojana and the Pradhan Mantri Matru Vandana Yojana begin only after pregnancy is confirmed. But few realise that a baby’s brain, heart, spinal cord, and other vital organs begin forming within the first four to six weeks — often even before the woman even knows she is pregnant.

This is where preconception care comes in. It involves a set of health interventions provided before pregnancy to improve maternal and child health outcomes in the long term. Research shows that a healthy lifestyle before conception—good nutrition, adequate rest, and avoiding tobacco and alcohol—can significantly impact a child’s intelligence, health and well-being. Of course, every pregnancy carries some unpredictability: genetics, unforeseen complications, and the postnatal environment all play a role. But planning and preparation before pregnancy increase the chances of a healthy outcome.

What is often overlooked is the role of the father. The health and quality of sperm matter as much as maternal health. Male fertility is affected by factors like obesity, alcohol and tobacco use, stress, poor diet, and lack of physical activity. Damaged sperm DNA can raise the risk of miscarriage or long-term health issues in the child.

Yet, infertility and miscarriage are often blamed solely on women. In reality, male factors contribute to nearly half of all infertility cases, as per WHO and ICMR studies. This misunderstanding can cause emotional trauma, stigma, and even abuse and abandonment in communities where bearing children—especially sons—is socially valued.

Traditionally, pregnancy often followed soon after marriage, a time when both partners were typically young, healthy and supported by extended families. Women received nourishment, rest, and the support of an extended family, especially when they returned to their maternal homes for childbirth and the early months of motherhood. These customs created ideal conditions for early child development.

But those traditions are fading. Economic pressures and nuclear families have left many young couples—especially women—without knowledge, support, or time to care for themselves. Many return to work in fields, construction sites, or homes soon after childbirth.

Most government programmes still begin only after pregnancy is confirmed. Very few address how to prepare for it.

Imagine every newly-wed couple receiving a health kit and counselling at the local PHC. Imagine ASHA workers guiding families on nutrition, rest, spacing pregnancies, and screening for health conditions. Such small interventions could profoundly change the lives of children.

The Navachetana Framework for Early Childhood Stimulation rightly aims to ensure children are ready to learn and thrive from an early age. But growing evidence suggests that the readiness begins even before birth. Here are five practical ways to integrate preconception care into this framework:

Early PHC registration post-marriage: Encourage newly-weds to undergo basic health check-ups and receive a preconception care booklet, even if they are not planning a pregnancy right away.

ASHA-led awareness sessions: Train ASHA workers to lead
discussions with young couples and family elders on physical and mental preparation for pregnancy.

Male engagement programmes: Organise informal camps in community places like temples, self-help groups, or local gatherings—to raise awareness about male reproductive health.

Culturally sensitive messaging: Use familiar metaphors like farming: “You cannot expect a good harvest without preparing the soil.” Share messages via videos, songs, and stories.

Media campaigns for public awareness: Partner with local TV channels, community radio, and social media to spread awareness about pre-
conception health. 

Preconception care is not a luxury — it is a necessity, especially in rural India, where medical care begins too late. By expanding the timeline of maternal and child healthcare to include the pre-pregnancy period, we can profoundly impact the health, intelligence, and potential of future generations.

(The writer is the founder-trustee of Pratham Mysore)