Exploring the concept and nature of premarital preconception care in indonesia: a qualitative comparative case study design

This qualitative comparative case study explores the experiences of premarital preconception care (PPCC) in Indonesia. High maternal mortality rates in LMICs are often linked to women's preconception health. Research highlights the growing provision of preconception services in LMICs, emphasising the need to engage women and men (as couples) to improve health outcomes. However, understanding of PPCC in Indonesia remains limited, despite its potential to enhance pre-pregnancy health when effectively implemented.
This study aims to explore the concept and nature of PPCC from the perspectives of service users and providers.
Initially, a scoping review was conducted to characterise PCC models involving couples in LMUICs, identifying research gaps, and guide the development of research questions for the Indonesian context. A qualitative comparative case study design was employed to collect data from 93 service users and 29 providers across two case sites through interviews, observations, and document reviews. Thematic and content analyses explored individual cases, while narrative synthesis facilitated cross-case analysis, offering a comprehensive study overview.
The findings suggest that involving couples in PPCC services can improve pre-pregnancy health and strengthen relationships, especially when tailored to local religious and socio-cultural values. However, further efforts are needed to improve service management, accessibility, and organisation for positive user experiences. PPCC services must address socio-cultural and religious factors within the local context.
This study provides insights into the experiences of service users and providers in PPCC implementation and recommends enhancing service structures, infrastructure, and training to meet local community needs. It highlights that PPCC's maternal focus limits support for men, despite their potential to aid maternal health, strengthen relationships, and prepare for fatherhood. Sociocultural and religious considerations are important for acceptable, and effective PPCC. Adequate funding and effective communication are also vital to ensure equitable access, maximising the program’s benefits for maternal and family health.