From Moral Commitment to Systemic Neglect: Health System Perspectives on Preconception Care in Ethiopia From Healthcare Workers, Leaders, and Policymakers
4 affiliations
- 1Faculty of Nursing University of Alberta Edmonton Canada
- 2College of Health Science Debre Berhan University Debre Berhan Ethiopia
- 3Robinson Research Institute,College of Health Adelaide University Adelaide Australia
- 4School of Public Health College of Health Adelaide University Adelaide Australia
Abstract
Objective(s): To explore how healthcare workers, managers, and policymakers understand, perceive, and operate preconception care (PCC).
Design: An interpretive descriptive qualitative study was conducted (April–September 2025) in two government hospitals. Data from interviews, focus groups, document review, and observations were analyzed using constant‐comparative methods to generate an explanatory account of PCC practice.
Sample: Thirty‐six participants were purposively recruited, including healthcare workers, hospital managers, policymakers, health bureau staff, and NGO stakeholders. Data were collected in Amharic, transcribed, translated, and analyzed inductively, focusing on patterns, tensions, and system‐level influences.
Results: Preconception care emerged as structurally unsupported yet sustained through individual effort, shaped differently across system levels. Frontline providers delivered it through moral commitment and improvisation within routine services, rendering it invisible and inconsistent. Fragmented knowledge, shaped by a biomedical focus, limited training, and confusion with antenatal care, further undermined consistent delivery. Managers described the absence of training, supervision, and performance indicators, limiting accountability and integration into service delivery. Policymakers emphasized it as a strategic priority but highlighted gaps in operationalization, coordination, and resource allocation. Across levels, gendered norms and reliance on community trust networks shaped access and reinforced inequities, revealing a persistent misalignment between policy intent and practice.
Conclusions: PCC functions as an informal practice sustained by individual agency within weakly institutionalized systems. Strengthening implementation requires bridging policy and practice through system integration, managerial accountability, and gender‐responsive, community‐engaged care models.
Related
- Uncovering barriers to preconception care: perspectives of healthcare professionals through a Q methodology study
- Do Dispositional Peculiarities Matter? An interplay of traits and organizational commitment among healthcare professionals
- Accessibility of essential medicines and vaccines among fisherfolk, artisanal miners and pastoralists in Mainland Tanzania: a qualitative study of barriers and strategies from the perspectives of healthcare professionals and community leaders.
- Healthcare workers and caregivers’ perspectives on access to cancer screening for people with intellectual disabilities as revealed by system dynamics and group model building
- Importance-performance gap analysis of health service quality in conflict-affected Yemen: a cross-sectional facility-based survey of patients’ and healthcare providers’ perspectives
BibTeX
@article{aynalem2026from,
title = {{From Moral Commitment to Systemic Neglect: Health System Perspectives on Preconception Care in Ethiopia From Healthcare Workers, Leaders, and Policymakers}},
author = {Yared Asmare Aynalem and Pauline Paul and Zohra S. Lassi and Salima Meherali},
journal = {Public Health Nursing (Boston, Mass.)},
year = {2026},
month = jul,
doi = {10.1111/phn.70164},
url = {https://doi.org/10.1111/phn.70164},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - From Moral Commitment to Systemic Neglect: Health System Perspectives on Preconception Care in Ethiopia From Healthcare Workers, Leaders, and Policymakers
AU - Yared Asmare Aynalem
AU - Pauline Paul
AU - Zohra S. Lassi
AU - Salima Meherali
PY - 2026
DA - 2026/07/28
JO - Public Health Nursing (Boston, Mass.)
DO - 10.1111/phn.70164
UR - https://doi.org/10.1111/phn.70164
AB - Objective(s): To explore how healthcare workers, managers, and policymakers understand, perceive, and operate preconception care (PCC). Design: An interpretive descriptive qualitative study was conducted (April–September 2025) in two government hospitals. Data from interviews, focus groups, document review, and observations were analyzed using constant‐comparative methods to generate an explanatory account of PCC practice. Sample: Thirty‐six participants were purposively recruited, including healthcare workers, hospital managers, policymakers, health bureau staff, and NGO stakeholders. Data were collected in Amharic, transcribed, translated, and analyzed inductively, focusing on patterns, tensions, and system‐level influences. Results: Preconception care emerged as structurally unsupported yet sustained through individual effort, shaped differently across system levels. Frontline providers delivered it through moral commitment and improvisation within routine services, rendering it invisible and inconsistent. Fragmented knowledge, shaped by a biomedical focus, limited training, and confusion with antenatal care, further undermined consistent delivery. Managers described the absence of training, supervision, and performance indicators, limiting accountability and integration into service delivery. Policymakers emphasized it as a strategic priority but highlighted gaps in operationalization, coordination, and resource allocation. Across levels, gendered norms and reliance on community trust networks shaped access and reinforced inequities, revealing a persistent misalignment between policy intent and practice. Conclusions: PCC functions as an informal practice sustained by individual agency within weakly institutionalized systems. Strengthening implementation requires bridging policy and practice through system integration, managerial accountability, and gender‐responsive, community‐engaged care models.
SN - 0737-1209
SN - 1525-1446
ER -