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Impact of Preconception Folic Acid Education on Folic Acid Use among Women Planning Pregnancy in Nigeria

Abstract

Folic acid use before conception and during the early stages of pregnancy is an important component of preconception and maternal health because adequate folate intake helps reduce the risk of neural tube defects and supports healthy fetal development. Despite the importance of folic acid supplementation, some women planning pregnancy in Nigeria may have inadequate knowledge of its benefits, appropriate timing, recommended use, and dietary sources. Limited access to preconception counselling, misconceptions about supplements, financial constraints, poor awareness of pregnancy planning, and inconsistent healthcare utilization may contribute to inadequate folic acid use before conception. Preconception folic acid education provides an opportunity to improve women's knowledge of the importance of folic acid, recommended timing of supplementation, appropriate sources, and the consequences of inadequate folate intake. Improved education may encourage women planning pregnancy to initiate and consistently use folic acid before conception. Against this background, this study investigates the impact of preconception folic acid education on folic acid use among women planning pregnancy in Nigeria. The study will be anchored on the Health Belief Model, Theory of Planned Behavior, and Social Cognitive Theory. The Health Belief Model explains how women's perceptions of the risk of neural tube defects, perceived severity, perceived benefits of folic acid use, perceived barriers, and cues to action may influence supplementation practices. The Theory of Planned Behavior explains how attitudes toward folic acid use, subjective norms, perceived behavioural control, and behavioural intentions may influence women's decisions to use folic acid before pregnancy. Social Cognitive Theory emphasizes the roles of knowledge, self-efficacy, social support, observational learning, and environmental influences in developing and maintaining preventive health behaviours. Collectively, these theoretical perspectives provide a suitable framework for explaining how preconception folic acid education may influence folic acid use among women planning pregnancy in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women of reproductive age who are planning pregnancy and reside in selected communities or attend selected healthcare facilities across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible women. Preconception folic acid education will be assessed using indicators such as exposure to folic acid education, frequency and duration of educational sessions, information on the benefits of folic acid, recommended timing of supplementation, recommended dosage according to applicable national or clinical guidance, dietary sources of folate, information on neural tube defects, counselling by healthcare professionals, educational materials, and follow-up support. Folic acid use will be assessed using indicators such as initiation before conception, frequency of use, consistency of supplementation, duration of use, appropriate use according to healthcare guidance, access to folic acid supplements, and self-reported or documented use where available. Data will be collected using structured questionnaires, validated knowledge and supplementation assessment tools where appropriate, antenatal or preconception clinic records, supplement records, and relevant maternal health programme documents. Descriptive statistics will be used to summarize participants' characteristics, exposure to folic acid education, knowledge, and supplementation practices. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the impact of preconception folic acid education on folic acid use. Where a quasi-experimental design is adopted, folic acid knowledge and use before and after exposure to structured preconception education may be compared, while relevant demographic, socioeconomic, reproductive, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that preconception folic acid education has a significant positive impact on folic acid use among women planning pregnancy in Nigeria. Women exposed to structured and evidence-based folic acid education are expected to demonstrate greater knowledge of the benefits and appropriate use of folic acid and higher rates of supplementation before conception than women with limited or no exposure to such education. Education provided through healthcare facilities, community programmes, reproductive health services, and other appropriate channels may improve women's understanding of the importance of beginning folic acid supplementation before conception and maintaining recommended use during the early stages of pregnancy. However, financial constraints, limited availability of supplements, poor access to healthcare, misconceptions, inconsistent pregnancy planning, low health literacy, and inadequate follow-up may limit the translation of education into sustained supplementation. The study therefore expects accessible, culturally appropriate, evidence-based, and continuous preconception folic acid education to contribute significantly to improved folic acid use among women planning pregnancy in Nigeria. The study is expected to contribute to the literature on preconception folic acid education, folic acid supplementation, neural tube defect prevention, maternal nutrition, reproductive health, pregnancy planning, women's health, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, primary healthcare centres, hospitals, reproductive health programmes, nutrition programmes, healthcare professionals, women's health organizations, development partners, and policymakers regarding strategies for improving folic acid use before pregnancy. The study will also provide evidence-based recommendations for integrating folic acid education into routine preconception and reproductive healthcare, improving access to affordable folic acid supplements, strengthening community-based nutrition education, increasing healthcare-provider counselling, improving awareness among women planning pregnancy, and linking preconception education with broader maternal nutrition and neural tube defect prevention programmes across Nigeria.

Keywords: Preconception folic acid education, folic acid use, women planning pregnancy, folic acid supplementation, maternal nutrition, neural tube defect prevention, preconception care, reproductive health, women's health, Nigeria, public health.