"Preconception care is the foundation: maternal health begins on a shaky foundation if preconception care is missing." This idea stayed with many of us during the Alliance for Preconception Care (ALL4PCC) meeting held on 28 February 2026. It challenged a familiar pattern in health systems: waiting until pregnancy has begun before acting. But what if the most meaningful window for healthier mothers, babies, and families opens much earlier?
That question shaped the day's conversations. Experts, clinicians, researchers, and policymakers came together to discuss how preconception care can move from being an overlooked idea to becoming a practical, people-centred approach within India's health systems.
The message was simple but powerful: care before pregnancy is not a luxury or an add-on. It is a chance to prevent avoidable risks, support informed choices, and place women and families on a healthier path for life.
Why starting earlier matters
Most health interventions for pregnancy begin after conception. By then, however, important opportunities may already have been missed from improving nutrition and managing chronic conditions to addressing mental health, sleep, environmental risks, and lifestyle factors.
Preconception care focuses on improving health before pregnancy. It supports women and couples to understand risks, prepare better, and access the right care at the right time. Crucially, it also reframes women's health as more than pregnancy alone as part of a lifelong journey shaped by biology, environment, social conditions, and access to care.
The health challenges we can no longer ignore
The discussions highlighted how women of reproductive age are navigating multiple and often connected health challenges. These are not isolated medical issues; they are signals that prevention must begin earlier and continue across the life course.
Across the discussions, a fuller picture emerged of the pressures shaping women's health before pregnancy. Rising obesity, prediabetes and conditions such as Polycystic Ovary Syndrome (PCOS) are already placing many women at higher risk; in some settings, prediabetes affects as many as 30-40% of women. Nutritional gaps remain equally important, with anaemia and imbalances in Vitamin B12, folate and Vitamin D continuing to affect health long before conception. These biological risks are further complicated by the world around women: pollution, heat stress and exposure to harmful chemicals are increasingly linked to reproductive and metabolic health concerns.
Mental health was another urgent thread running through the conversation. Anxiety, depression and suicide are still too often pushed to the margins of maternal and reproductive health, even though suicide has been identified as a leading cause of maternal death in some regions. Sleep, too, was recognised as an overlooked part of the story, with poor sleep linked to diabetes, resistant hypertension, infertility and overall reproductive health. Alongside these concerns, everyday lifestyle pressures: unhealthy diets, limited physical activity and stress continue to shape long-term outcomes in ways that health systems cannot afford to ignore.
Together, these issues show why preconception care must be broad, practical, and sensitive to real lives. It is not only about clinical screening; it is also about trusted information, supportive services, and creating conditions that allow women and families to act early.
A life-course approach, not a one-time intervention
One of the strongest themes from the meeting was that preconception care should not begin only when someone is planning a pregnancy. Health needs to be supported from adolescence through the reproductive years, between pregnancies, and beyond childbirth.
The life-course approach also includes men. Their health, lifestyle choices, and support before conception can influence fertility, pregnancy outcomes, and the health of the child. Bringing men into the conversation helps make preconception care more comprehensive and family centred.
Interpregnancy care: care between pregnancies was highlighted as especially important. It can help manage weight, correct nutritional deficiencies, strengthen mental health support, and reduce risks before the next pregnancy. The overall message was clear: care should be continuous, not fragmented.
Making preconception care part of everyday health systems
Participants agreed that preconception care should not become another separate vertical programme. Instead, it should be embedded into existing health system, within integrated programmes such as RMNCHA+ (Reproductive, Maternal, Newborn, Child, and Adolescent Health) and link with other programs like non-communicable diseases. This would make it easier for health workers to identify risks early and for women and families to receive support without navigating disconnected systems.
Digital tools were seen as promising for outreach, risk tracking, and follow-up. At the same time, the group recognised a growing challenge: misinformation, especially through social media and messaging platforms. Strengthening health literacy and ensuring access to reliable, culturally relevant information will be essential.
From discussion to action
The meeting did not stop at identifying the problem. Its most important contribution was to show what must happen next: preconception care needs to become visible, practical, and embedded in the places where women, men, adolescents, families, and health workers already interact with the health system.
Several practical ideas began to take shape. A web-based PCC survey app could help identify lifestyle, environmental, nutritional and metabolic risks earlier, generating evidence that can guide both care and policy. But data alone will not be enough. Health workers and providers also need the confidence and tools to act on that information through stronger training in diabetes in pregnancy, mental health screening, nutrition counselling and interpregnancy care.
The conversation also pushed preconception care beyond the clinic. Schools, colleges and communities were seen as vital spaces for building awareness before pregnancy is even being considered. In these settings, young people can be supported to understand nutrition, physical activity, mental health, sleep and reproductive health as part of everyday wellbeing, not only as concerns that appear during pregnancy.
For this to work at scale, preconception care must be woven into existing national programmes rather than built as a separate vertical. RMNCHA+, non-communicable disease services, adolescent health programmes, vaccination efforts and digital health systems all offer entry points. With a shared roadmap, working groups, public outreach and sustained policy engagement, these entry points can become part of a coordinated pathway rather than scattered efforts.
Taken together, these actions tell a larger story: understand risks earlier, equip providers better, reach people before pregnancy, integrate services into systems that already exist, and align partners around implementation. This is how preconception care can move from a promising idea to a practical part of everyday health.
Building the alliance
A strong alliance will be essential to move this agenda forward. The ALL4PCC initiative brings together global and national leaders, including Professor Jane Hirst, Program Director, Women's Health, The George Institute for Global Health, and Dr Usha Sriram, Founder DIWAS Head of Diabetes and Endocrinology Voluntary Health Services Chennai. It includes institutions and partners such as The George Institute for Global Health, ECHO India, and the National Health Mission, with support and encouragement from public health leaders including Dr Soumya Swaminathan, Chairperson, M.S. Swaminathan Research Foundation, Chennai, Tamil Nadu.
What makes ALL4PCC especially promising is the diversity of voices at the table. Doctors, researchers, policymakers, NGOs, public health practitioners, and international experts contributed perspectives grounded in evidence, implementation, and community realities.
This collaboration matters because preconception care cannot be delivered by the health sector alone. It needs education systems, community platforms, environmental action, digital innovation, and policy commitment to come together around a shared goal: helping women, men, and families build healthier futures before pregnancy begins.
The way forward
The biggest takeaway from the ALL4PCC meeting was that women's health is not a niche issue. It is central to the health of families, communities, and future generations. Preconception care offers a powerful opportunity to act early, prevent complications, and improve long-term outcomes.
If maternal health begins on a foundation, then preconception care is where that foundation is laid. Strengthening it means giving every woman and every family a better chance at health; not only during pregnancy, but across life.
Blog written by Manmeet Kaur Bhatia, Research Fellow, The George Institute India, and Priya Limbu, Research Fellow, The George Institute India.
