Morris - value of preconception care

Well preconception care for adolescents is a huge challenge because most of the adolescents aren’t planning their pregnancies. When we see teens for family planning in clinic we ask them, “Do you want to be pregnant?” And we get three different responses. One is they look horrified and they say, “Why would I want to be pregnant?” – and we know they’ll contracept effectively. And then the other group says, “I want to be pregnant” and we don’t give them contraception. We actually give them preconception counselling and prescription for prenatal vitamins. And the third group says, “Well I don’t want to be pregnant but I don’t mind if I do” and that’s the hardest group to capture because if they’re not motivated to use contraception and they will get pregnant and we just don’t know when. So that group we can’t capture with preconception counselling. 

The preconception, when we can do it, we talk about reducing risky behaviours. We actually have a high percentage of our teens coming in pregnancy smoking and most of them are able to cut down and we have the kids that are engaged in recreational drug use and sometimes more serious drug use. So we can take that opportunity to educate them about the risks of all of those things. And a big issue for teens is actually weight. Pregnancies are much healthier if you’re at an ideal body weight and we have seen a rising number of obese teenagers and we shamelessly take advantage of that opportunity to get them to lose some weight and lead a healthier lifestyle.

So if we could do preconception counselling we would include the folic acid and the behavioural changes and try and give them a solid idea of the challenges they’d be facing and work on getting to a healthy body weight and good health status before they get pregnant. But we don’t get very many opportunities to do that.