Moving beyond antenatal care: Need for a life-course approach to women’s health, South Africa

Researchers: Jagidesa Moodley, Yogan Pillay, Olive P. Khaliq

November 2025

What Is The Study About?

South Africa, like many low- and middle-income countries (LMICs), is now facing a double burden of disease, rising rates of non-communicable diseases alongside ongoing infectious disease challenges. Increasing numbers of women of reproductive age are entering pregnancy with obesity, diabetes, hypertension and HIV – conditions that significantly raise the risk of maternal and neonatal complications. Moreover, many women experience short inter-pregnancy intervals, unresolved complications from previous pregnancies and undiagnosed mental health issues. In addition, the postpartum period is often a neglected window for continuing healthcare, with limited follow-up or structured support. As a result, opportunities to promote recovery and reduce the risk of recurrence of medical conditions are missed. Preconception care and inter-conception care provide a framework to address these gaps. Preconception care includes health promotion, screening for chronic diseases and infections, nutritional interventions and reproductive life planning provided prior to pregnancy. Inter-conception care focuses on improving health between pregnancies, with emphasis on birth spacing, mental health and managing prior medical and socio-economic issues. Both forms of care (preconception and inter-conception care) share a common goal: to prepare women for healthy pregnancies and to improve their long-term health. 

Why Is This Important?

Adopting a life-course approach could have a particularly powerful impact in South Africa. For example: Optimising glycaemic control before conception among women with diabetes could prevent congenital anomalies, miscarriage and stillbirths. Ensuring adequate folic acid supplementation could reduce the incidence of neural tube defects. Identifying and treating hypertension and obesity before pregnancy could lower rates of pre-eclampsia, placental abruption and preterm birth. Promoting HIV awareness and regular testing in communities.  Ensuring that all teenagers receive Human Papillomavirus (HPV) vaccinations. Addressing mental health and gender-based violence in the postpartum period could improve maternal well-being and reduce adverse outcomes in subsequent pregnancies. Promoting healthy birth spacing could reduce risks of pregnancy complications such as preterm birth and low birth weight babies. Promoting healthy lifestyles, including appropriate and affordable diets and regular physical exercise or activities. Ensuring that learning institutions (schools and higher education) introduce and promote social and reproductive health issues for all scholars to overcome the issues of teenage pregnancies and sexually transmitted infections.

Importantly, these interventions are not high-cost or technology-dependent – they are achievable through better integration of services within the existing primary health system and the community health worker programmes.

What We Know…

Despite the clear benefits, preconception and inter-conception care remain underdeveloped in South Africa. Several barriers persist: Fragmented care: Family planning, HIV services, Noncommunicable diseases (NCD) management and maternity care are delivered in silos, with little continuity. Limited awareness: Many women and healthcare providers do not recognise the importance of preconception health. Resource constraints: Overburdened primary care facilities may lack capacity for systematic preconception interventions. Social barriers: Stigma around contraception and limited reproductive autonomy for many women.  Partner healthcare: Many men, including adolescents, do not visit clinics for healthcare and pose a risk for sexually transmitted infections. 

What Was Discovered…

There is an urgent need for policy and programmatic action to strengthen preconception and inter-conception care in South Africa: Integrate preconception care, use all health system contacts, train healthcare workers, including community health workers, strengthen postpartum care, develop public awareness campaigns to empower women, include indicators of preconception and inter-conception care.

Policy and governance - Adopt a national Life-Course Policy Note (annex to the Maternal, Newborn, and Child Health & Prevention of Mother to-Child Transmission [PMTCT] policy) that defines service packages by life stage (adolescence, preconception, pregnancy, postpartum and/or inter-conception, early childhood). Mandates such as joint Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) planning across Primary Healthcare (PHC), HIV, NCDs, sexual reproductive health, mental health and social services.

Service packages by life stage - What to deliver: Adolescents: GBV assistance, SRH awareness, HPV vaccination, contraception, HIV testing and pre-exposure prophylaxis (PrEP) where necessary, and nutrition and mental health screening. Preconception: Tuberculosis (TB) symptom screening where appropriate, folate and/or anaemia and/or nutrition, contraception for birth spacing, targeted non-communicable disease optimisation, fertility counselling and risk screening (HIV, syphilis, diabetes and hypertension). Pregnancy: Maternal immunisation, TB/HIV/NCD integration and routine antenatal care with risk-stratified routes (medical and societal risks). Postpartum and inter-conception (up to 12 months): Organised postnatal check-ups (6 weeks, 3 months, 6 months, and 12 months) for mental health, cardiovascular diseases (CVD) risk, diabetes/hypertension management, contraception, tuberculosis prevention treatment (TPT) as necessary and return to chronic care for long-term problems. Early childhood (0-5-years-old): Nutrition, immunisations, growth and neurodevelopment monitoring, and early learning referrals – all utilising the ChCC-style ‘every contact counts’ methodology. These priorities are in line with the South African perspective that was uploaded regarding preconception and/or inter-conception care and its anticipated effects on congenital abnormalities, hypertensive disorders, stillbirths and preterm deliveries.

Data and digital tools - build once, use everywhere. Person ID spine, interoperability and life-course registry logic.

Artificial intelligence where it adds value - Risk prediction, eligibility nudges, linkage automation and dashboards.

The Future/ Possible Solutions…

To further reduce maternal and neonatal mortality, South Africa must move beyond a narrow focus on antenatal care and embrace a life-course approach that addresses women’s health before, between and after pregnancies. Preconception and inter-conception care should be recognised as essential components of comprehensive maternal and neonatal health services; integration of these components into primary care and community engagements are the next critical steps in improving the long-term well-being for women and their families.