Background
Every pregnant woman faces risk of complications during pregnancy, birth, not only due to pregnancy, birth related problems but preexisting disorders which get exaggerated during pregnancy. Prepregnancy awareness of various prepregnancy, peripregnancy factors for safe maternity is essential. 
Objective:
Community based study was to know awareness about prepregnancy issues for safe maternity. 
Material methods
Study was conducted in tribal communities of remote forestry hilly region. Randomly from each village 20 married women of 15-40 yr in whom pregnancy was possible, 2400 became study subjects in 100 villages around village with health facility. 
Results
Of 2400 study subjects, 1396 (58.2%) had scatchy awareness, 30.3% right age for pregnancy, 34.2% possibility of diseases running in family, 35.5% essentiality of knowing last menstruation date (LMD), 935 (35.10%) necessity of good health, 45.6% stress free life, 24.4% avoidance of heavy work and 30% need of care for good health during  pregnancy. Only 1247 (52%) were aware of prepregnancy anaemia, (27% said it was due to lack of food, 73% lack of supplements), 51.7% knew about need of extra micronutrients, (41.7% by blood improving tablets, 58.3% extra energy providing diet), 1039 (43.3%) were aware of need of prepregnancy prevention / treatment, of anaemia for preventing complications, (34.6% giddiness, 29.4% legs swelling, nausea, 36.0% dangers of bleeding), 1164 (48.5%) were aware of genital hygiene, (38.0% said prevented genital infection, 62.0% urinary infection, retention).     

Every pregnant woman faces risk of complications during pregnancy, and birth which can lead to severe illnesses, even death of the mother and / or the baby. However many women and new-borns also die due to disorders which are present before pregnancy. Such disorders affect pregnancy and also get exaggerated during pregnancy and add risk to a woman’s and her baby’s life. Prepregnancy awareness about safe maternity is essential, for safe pregnancy, safe birth and safe future of the mother as well as the baby. It is opined that it remains unclear whether awareness translates into appropriate actions, but awareness should lead to better outcome. Women need to know about right age for having pregnancy, right interval between too pregnancies and many other issues which need to be taken care preconception and also during pregnancy. For all this prepregnancy care (PPC) is essential so that detection, treatment or counselling of pre-existing disorders and environmental, social conditions that may come in the way of safe maternity. Dangers of exposure to harmful practices, medication during early pregnancy and general health are all essential. It also includes encouraging behavioural change allowing early identification of risk factors and try prevention before pregnancy. So prepregnancy period has been proposed for improving pregnancy outcome. While results from studies have been encouraging, not much is known about women of rural remote regions.

Objective:

Community based study was carried out to know about awareness of prepregnancy issues for safe maternity amongst tribal women in rural remote region.

Study Setting

Community based study was conducted in rural tribal communities of remote forestry hilly region in 100 villages near the village having health facility.

Study design

Descriptive research with predesigned tool. 

Study period – one year 

Study sample - 2400 sample calculated by descriptive study formula 1

Inclusion exclusion criteria 

Women of 15-40 years in whom pregnancy was possible were included. Women age <15years>40years those in whom pregnancy was not possible, cases of hysterectomy, total ligation, menopausal etc and not willing, though there were none, were excluded.

The study revealed that, of 2400 study subjects, only 1396 (58.2%) had some scatchy awareness, [423 (30.3%) said they knew about right age for pregnancy, 477 (34.2%) possibility of diseases running in family and 496 (35.5%) essentiality of knowing the last menstrual date (LMD)]. Relationship of awareness with different variables like age, education, profession, economic status and previous birth is in table I (Table I). There was significant difference in number of women with awareness between illiterate and secondary school educated (p-value <0>(Table II). There was significant difference between number of women knowing the need of prepregnancy good health with age (p-value <0>(Table III). Also there was significant difference in numbers of illiterate and even primary school educated women (p-value <0> Overall of 2400 study subjects, 1240 (51.7%) were aware of need of extra micronutrients during pregnancy, [517 (41.7%) by blood improving tablets and 723 (58.3%) by extra energy providing diet]. Relation of awareness with age, education, profession, economic status, and number of births is in table IV (Table IV). Also there was significant difference with better education in women knowing need of extra micronutrient during pregnancy (p-value <0>

Table I: Prepregnancy Awareness About Needs for Safe Maternity

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table II: Prepregnancy Awareness of Essentialities During Pregnancy

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table III: Awareness of Prepregnancy Anaemia

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table IV: Advantages of Prevention and Treatment of Anaemia Prepregnancy

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table V: Awareness Of Extra Micronutrients In pregnancy

*Small Scale, (Food, Shoes making, Bamboo itoms) Industry, Welding Workshop, Brick furnace

Table VI: Awareness About Hygiene During Pregnancy

Discussion

Preconception care (PCC) refers to things, women could do before and between pregnancies for safe pregnancy, safe birth and safe future of the mother as well as the baby. Unfortunately, millions of women in the world have no access to getting pre-pregnancy information and care and both are essential. Antenatal care is too late to reduce the harmful effects of many preexisting disorders and undesired happenings preconception, periconception and during early pregnancy. Raising awareness of women about right age of pregnancy, right interval between two pregnancies, good health at onset of pregnancy and during pregnancy and clean hygiene, all are essential. Also protection from ill effects of pre-existing disorders and environmental issues is essential. There are modest additional requirements for energy and protein during pregnancy and women need to know. Martine  [2] also reported that awareness of anaemia, a public health problem responsible for a big proportion of maternal deaths was very essential. In the present study only 1247 (52%) women were aware of essentiality of treatment of anaemia pre-pregnancy. Mason [3] opined that there was convincing evidence that health problems and nutritional problems, contributed to poor pregnancy outcome and it was essential that women were aware. Stephenson et al [4] from USA reported that despite a high level of pregnancy planning, awareness of preconception health among women and health professionals was low. However, many women were motivated to adopt healthy behaviour preconception. Doke et al  [5] also reported that very few countries including India implemented comprehensive packages of PCC. In their study, PCC was rolled out among all women, who desired to be pregnant in a year. Their study in central India revealed that only 50% pregnancies were planned. The decision about first pregnancy was influenced more by the mother-in-law. Women knew that pregnancy should not occur in teen age and inadequate weight had adverse impact on the health of new-born. Women had some knowledge about adverse effects of tobacco and alcohol use in pregnancy. Most of them did not practice behaviour or accessed services of PCC. In the present study, of 2400 study subjects, only 1396 (58.2%) had some scatchy awareness of prepregnancy issues which affected pregnancy. Of them, only 423 (17.7%) women talked about right age for having pregnancy, 477 (19.8%) talked of possibility of diseases running in family, and 496 (20.6%) women said it was essential to know LMD. No one talked of preexisting disorders in the mother, interval between two pregnancies and so many other issues. Only 549 (22.87%) women were aware of necessity of prepregnancy good health, 340 (14.16%) said stress free life was essential and only 87 (3.6%) said for remaining healthy it was essential to avoid heavy work during pregnancy. However women did not talk of protection from environmental issues or medication, specially periconception and in early pregnancy. Umar et al [6] from North-Western, Nigeria reported poor awareness but good perceptions and acceptability of PCC by women, and opined that there was a need to create awareness and it needed to be incorporated into maternal health services. Akinajo et al 7 reported high awareness of PCC (76%) in many, but practice was low (34.2%) before index pregnancy and reported a huge disconnect between awareness and practice in Nigeria. Ojifinni et al [8] reported that in Nigeria participants stated that there were neither defined PCC services in the health system nor guidelines. PCC services were however provided when health workers perceived a need or when clients demanded health information, treatment modification, medical check-up, screening or education and counselling. Alemu et al [9] from Ethiopia reported significantly low knowledge and utilisation of PCC. Educational status and antenatal care were shown to affect PCC knowledge. Age and sound knowledge of PCC had significant association with utilisation of PCC. It has been opined that although it remains unclear how awareness translated into appropriate actions, chances of better outcome are there. Ayelew et al 10 from Ethiopia reported that overall knowledge of PCC was in 27.5% women with secondary school education and more 25 to 34 years, were having knowledge of PCC than their other counterparts. In the present study also, of 850 women with primary school education, 34.4% had some scatchy awareness and of 91 with women who had higher secondary school education, 64.8% were aware, significantly more (p-value 0000.1). Of 105 women who had no birth, 73 (3.04%) were aware about essentiality of prepregnancy good health and only 12 (0.5%) talked of stress free life, 12 (0.5%) avoidance of heavy work and 49 (2.04%) talked about need of regular check up during pregnancy. Of 275 home makers, 201 (73%) were aware of need of micronutrients.  Of 147 women from upper economic class, 101 (68.7%) were aware and of 864 from lower economic class, 429 (49.65%) were aware of need of micronutrients, significant difference (p value <0>Summary and Conclusion
Over all it was revealed only some women had scatchy prepregnancy awareness. No one talked of appropriate interval, existing disorders, effects of environment, or medication, although the health care before pregnancy and during pregnancy was talked by some. Only 30.1% women knew disorders needed treatment before pregnancy, and 51.67 % women were aware of the extra micronutrient required in pregnancy, 48.50% women were aware about hygiene during pregnancy. Awareness was directly proportional to variables like age, literacy, economic status and occupation. Overall there seems a real need of creating prepregnancy awareness, provide PCC services for promoting maternal and new-born health and preventing maternal and new-born mortality.

Conflict of Interest – Nil