{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:58:50Z","timestamp":1781614730571,"version":"3.54.5"},"reference-count":27,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"unspecified","delay-in-days":76,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,5,29]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Preconception iron and folic acid supplementation (IFAS) is a key intervention to prevent neural tube defects (NTDs) and maternal and child iron deficiency anaemia (IDA). Despite its potential benefits, many healthcare systems rarely provide preconception IFAS to women who plan to become pregnant and mothers with a history of spontaneous abortion who declined contraceptive use. The aim of this study was to explore stakeholder perspectives on the challenges and opportunities for implementing preconception IFAS for these high-risk groups in the Ethiopian healthcare system, a country with a high burden of NTDs and IDA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An exploratory qualitative study was conducted among 45 participants, including women attending antenatal care, women planning pregnancy including mothers with a history of spontaneous abortion who declined contraceptive use, healthcare providers and maternal and child care experts. Participants were selected using purposive sampling. Data were first analysed separately for each participant group and then triangulated to synthesise a comprehensive understanding of practices, challenges and opportunities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Major barriers operate at policy, health system and individual levels, including the absence of a structured national preconception care programme, inadequate health system capacity, limited knowledge among women and providers, behavioural constraints to preconception care utilisation and a high prevalence of unplanned pregnancies. However, existing health extension programme, family planning clinic and gynaecology department with supportive policy frameworks offer viable entry points for integrating preconception IFAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identified major gaps in the implementation of preconception IFAS within the Ethiopian healthcare system. Women with a history of spontaneous abortion who decline contraceptive use represent an overlooked group with unmet preconception nutritional needs. Strengthening policy, training and community awareness is essential. Future implementation research is needed to support integration of preconception IFAS and improve maternal and neonatal outcomes, contributing to Sustainable Development Goals for maternal and child health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004177","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:27:22Z","timestamp":1781612842000},"page":"e004177","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding challenges and opportunities to implement preconception iron and folic acid supplementation to prevent neural tube defects and iron deficiency anaemia in Ethiopian health care system: a qualitative study"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5078-8703","authenticated-orcid":false,"given":"Anteneh","family":"Berhane","sequence":"first","affiliation":[{"name":"School of Public health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia"},{"name":"Department of Nutrition and Dietetics, Faculty of Public health, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tefera","family":"Belachew","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Public health, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"2026061605252935000_4.2.e004177.1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-neuro-062012-170354"},{"key":"2026061605252935000_4.2.e004177.2","doi-asserted-by":"crossref","unstructured":"De-Regil LM , Pe\u00f1a-Rosas JP , Fern\u00e1ndez-Gaxiola AC , et al . n.d. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. 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Neural tube defects. World Scientific, 2010.","DOI":"10.1142\/9789814273855"},{"key":"2026061605252935000_4.2.e004177.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0318422","article-title":"Folic acid supplementation during preconception period in sub-Saharan African countries: A systematic review and meta-analysis","volume":"20","author":"Aweke","year":"2025","journal-title":"PLoS One"},{"key":"2026061605252935000_4.2.e004177.11","unstructured":"(FMOH)., F.M.o.H . National nutrition program ii (nnp ii) 2016-2020. 2016."},{"key":"2026061605252935000_4.2.e004177.12","unstructured":"Ministry of Health, E . National food and nutrition policy. 2018."},{"key":"2026061605252935000_4.2.e004177.13","doi-asserted-by":"crossref","DOI":"10.3389\/frhs.2025.1226206","article-title":"Healthcare providers\u2019 preconception care practice and associated factors in Ethiopia: a systematic review and meta-analysis","volume":"5","author":"Zeleke","year":"2025","journal-title":"Front Health Serv"},{"key":"2026061605252935000_4.2.e004177.14","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0337548","article-title":"Preconception care services in Northern Ethiopia: A qualitative exploration of awareness, experiences, challenges, opportunities, and prospects","volume":"20","author":"Gebretsadik","year":"2025","journal-title":"PLoS One"},{"key":"2026061605252935000_4.2.e004177.15","unstructured":"Gebremariam BM , et al . Demand and supply side enablers and barriers of periconceptional folic acid supplementation among pregnant women in southern Ethiopia: A phenomenological qualitative study: Enablers and Barriers of Periconceptional Folic Acid Supplementation. Journal of Science and Development 2025;13."},{"key":"2026061605252935000_4.2.e004177.16","doi-asserted-by":"crossref","first-page":"3096","DOI":"10.4102\/phcfm.v14i1.3096","article-title":"Current state of preconception care in sub-Saharan Africa: A systematic scoping review","volume":"14","author":"Ukoha","year":"2022","journal-title":"African Journal of Primary Health Care & Family Medicine"},{"key":"2026061605252935000_4.2.e004177.17","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1159\/000539803","article-title":"Preconception Folic Acid and Multivitamin Supplementation for the Prevention of Neural Tube Defect: An Umbrella Review of Systematic Review and Meta-analysis","volume":"59","author":"Abate","year":"2025","journal-title":"Neuroepidemiology"},{"key":"2026061605252935000_4.2.e004177.18","doi-asserted-by":"publisher","DOI":"10.1007\/s00381-023-05913-4"},{"key":"2026061605252935000_4.2.e004177.19","doi-asserted-by":"crossref","DOI":"10.1017\/S1463423622000706","article-title":"Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature","volume":"24","author":"Mohseni","year":"2023","journal-title":"Prim Health Care Res Dev"},{"key":"2026061605252935000_4.2.e004177.20","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2025-099143","article-title":"Understanding preconception care: a scoping review of knowledge, attitudes and practices among reproductive age individuals, healthcare workers and stakeholders in low- and middle-income countries","volume":"15","author":"Aynalem","year":"2025","journal-title":"BMJ Open"},{"key":"2026061605252935000_4.2.e004177.21","doi-asserted-by":"crossref","DOI":"10.1177\/20503121251345598","article-title":"Knowledge of healthcare providers on preconception care in east Africa: Systematic review and meta-analysis","volume":"13","author":"Taye","year":"2025","journal-title":"SAGE Open Med"},{"key":"2026061605252935000_4.2.e004177.22","doi-asserted-by":"crossref","DOI":"10.3389\/frph.2025.1702378","article-title":"Factors influencing preconception care awareness and knowledge among women in Africa: a systematic review","volume":"7","author":"Doe","year":"2025","journal-title":"Front Reprod Health"},{"key":"2026061605252935000_4.2.e004177.23","doi-asserted-by":"crossref","DOI":"10.1017\/jns.2022.32","article-title":"Preconception of folic acid supplementation knowledge among Ethiopian women reproductive age group in areas with high burden of neural tube defects: a community based cross-sectional study","volume":"11","author":"Begashaw","year":"2022","journal-title":"J Nutr Sci"},{"key":"2026061605252935000_4.2.e004177.24","doi-asserted-by":"crossref","DOI":"10.1177\/2054270420980875","article-title":"Folates, folic acid and preconception care - a review","volume":"12","author":"House","year":"2021","journal-title":"JRSM Open"},{"key":"2026061605252935000_4.2.e004177.25","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1007\/s10995-015-1705-2","article-title":"Association Between Preconception Counseling and Folic Acid Supplementation Before Pregnancy and Reasons for Non-Use","volume":"19","author":"Bixenstine","year":"2015","journal-title":"Matern Child Health J"},{"key":"2026061605252935000_4.2.e004177.26","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s43477-023-00102-6","article-title":"Optimizing Health Before Pregnancy: Evaluating the Feasibility of Community-Based Preconception Care Package in Rural Central India","volume":"4","author":"Kolhe","year":"2024","journal-title":"Glob Implement Res Appl"},{"key":"2026061605252935000_4.2.e004177.27","doi-asserted-by":"crossref","unstructured":"Lassi ZS , Kumar R , Bhutta ZA . Community-based care to improve maternal, newborn, and child health. 2016.","DOI":"10.1596\/978-1-4648-0348-2_ch14"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004177","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:27:32Z","timestamp":1781612852000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6,16]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bmjph-2025-004177"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004177","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}