Effectiveness of focused preconception education and counseling (FPEC) on conception preparedness among premarital couples: A quasi-experimental pre-post study

Background Maternal and neonatal morbidity and mortality remain major public health challenges in sub-Saharan Africa, where modifiable preconception risk factors contribute to approximately 75% of adverse pregnancy outcomes. Preconception education and counseling provide a proactive strategy to optimize health before conception and improve safe pregnancy; however, it is less practiced and underexplored in low-resource settings like Rwanda. This study aimed to pilot and evaluate the effectiveness of focused preconception education and counseling (FPEC) on conception preparedness attitudes and practices among premarital couples in Rwanda. Methods A quasi-experimental pre-post study was conducted from May to August 2024 involving 600 premarital couples who were systematically assigned to either the intervention group or control group with 300 couples (150 males and 150 females) in each group. Only the intervention group received a single 45-minute group and couple-based FPEC session post-baseline, addressing fertility, screenings, nutrition, supplements, substance use, stress, gender-based violence, and environmental risks, supplemented by refresher handouts. The control group received routine premarital education without preconception content. Conception preparedness was measured using a 32-item questionnaire completed by each individual to assess their personal level of preparedness, with data collected at baseline and three months later. Analysis included descriptive statistics, paired t-tests, difference-in-differences (DiD), and linear regression in SPSS version 29 (p < 0.05). Results Participants were mostly young (64.7% aged 21–30 years), rural (81.5%), with primary education and low income. Baseline scores showed no group differences. Post-intervention, the intervention group demonstrated marked improvements in screenings (e.g., blood type/Rh + 64.3%, anemia + 59.7%), prophylactics (folic acid + 30.7%, tetanus + 42.0%), planning (conception timing + 56.3%), and risk reduction (alcohol − 18.6%). Mean scores rose from 35.3 to 58.3 (+ 23.0 points, p < 0.01) versus 38.2 to 41.7 in controls (+ 3.5, non-significant). DiD test confirm a + 19.5-point net effect (p < 0.001); regression showed nearly 20-fold higher scores in the intervention group (B = 19.8, 95% CI: 18.4–21.1, p < 0.01). Conclusion FPEC significantly enhanced conception preparedness among premarital couples compared to those who did not, supporting its integration into reproductive health, maternal health and premarital programs to promote healthy conception, safe pregnancy and family wellness. Future research should explore long-term outcomes and scalability.