Investing in preconception care: lessons learned from a multi-component research on the economics of preconception health and care

Background: preconception care is clinically compelling yet remains under-prioritised in many low- and middle-income countries, in part because its economic value is poorly articulated. This article synthesises findings and methodological lessons from a multicomponent research programme on the economics of preconception health care (2021-2025), integrating previously published studies to inform policy and future research. Approach: evidence was drawn from (i) a scoping review and causal loop diagram, mapping pathways from preconception risks and interventions to maternal, perinatal and child outcomes; (ii) cost-ofillness analyses estimating the economic burden of poor preconception health in Nigeria and, across 15 low- and middle-income countries; and (iii) modelling-based cost-benefit analyses in Senegal assessing returns to preventing child marriage and expanding access to modern contraception. Synthesis of findings: the causal loop diagram highlights interlocking subsystems, through which preconception risks elevate adverse pregnancy and childbirth-related outcomes. Cost-of-illness estimates indicate that inaction on key preconception risks is associated with sizable macroeconomic losses, primarily due to productivity losses from mortality. Cost-benefit analyses suggest that selected preconception care strategies can yield benefit-cost ratios well above one when valued conservatively. Lessons learned: (1) An explicit economic narrative makes preconception care visible to planners and treasuries; (2) many “broad” social and population measures (e.g., child-marriage prevention) can yield returns when viewed through a preconception lens; (3) adapting cost-of-illness and cost-benefit analyses methods to to data environments in low- and and middle-income countries is feasible when assumptions and uncertainties are transparent; and (4) country-led evaluations using local data are pivotal for uptake. Conclusion: positioning preconception care as an investment, rather than an expenditure, can align health and development agendas. Priorities include strengthening preconception indicators in routine data systems, broadening economic evaluations to additional interventions and risk factors, and embedding equity and intergenerational effects in valuation frameworks.