Background: Preconception care (PCC) is highly recommended evidence-based intervention to optimize women’s health in particular and in so doing reduce the incidences of adverse pregnancy outcomes (APO). PCC targets modification of risk factors to APO occurring before and just at early weeks of conception. Nevertheless, in Ethiopia, the need to implement PCC as part of the continuums of the comprehensive Maternal, Neonatal and Child Health Care services is not yet studied. Purpose/Aim of the study: This study aimed to develop a guideline to assist the incorporation of PCC in Ethiopian health system thereby reduce the highly incident APOs in the country, which is the purpose of the study. Methodology: This study applied the explanatory sequential mixed method to determine the determinants to the non-implementation PCC in Ethiopia. In addition, a policy document analysis was conducted to identify the existence of policy guiding the implementation of PCC in Ethiopia. Finally, the study applied a Delphi technique to increase the utility and acceptance of the guideline developed. The study was guided by a theory based framework called a Framework for Determinants of Innovation Processes (FDOIP). RESULT: Nearly all (84.7%) of the healthcare providers (HCPs) never ever practiced PCC. Even among those who ever practiced, the majority (74%), practiced it poorly. More than two third (68.6%) had poor PCC knowledge. HCP’s with good PCC knowledge had likely hood of practicing PCC by four times greater than those with poor PCC knowledge (AOR=4.4, 95% CI: 2.5-7.6). The policy document analysis identified the absence of policy guiding the practice of PCC in Ethiopia. The HCP’s curriculums also didn’t include PCC. The determinants to non-implementation of PCC, as perceived by the qualitative study participants include absence of national PCC policy , absence of PCC guideline, lack of institutional PCC plan, presence of other competing demand, lack of laboratory facilities and setup, lack of accountable body, absence of Individual or organization introduced PCC to the country, absence of trained manpower on PCC, absence of known expert in PCC, Poor public awareness about preconception health and PCC, Unplanned Pregnancy and poor health seeking behaviour. CONCLUSION The study revealed the absence of a standard and complete PCC practices by the HCPs. Nearly all HCPs never ever implement PCC. Even those very few practitioners were found practicing PCC poorly that is in a substandard, incidental, and in an inconsistent way. There is no formal policy document guiding the implementation of in Ethiopia. The HCPs training curriculum didn’t include PCC. The guideline developed base on the study findings of the study recommended to incorporating PCC in Ethiopia health system. / Health Studies / D. Litt. et Phil. (Health Studies)

The aim of the study was to develop strategies to reduce the unmet need for modern contraception among agro-pastoral women. The objectives of the study were to determine the prevalence of unmet need for modern contraception, determine the factors associated with unmet need for modern contraception, and explore the barriers that hindered agro-pastoral women from using modern contraception. A mixed-method research design was used to conduct the study. Data were collected from agro-pastoral women and family planning service providers. Questionnaire and individual in-depth interviews were used to collect the data. The validity and reliability of the quantitative data and trustworthiness of the qualitative data were ensured. Use of standard data collection tools, employing method and data triangulation, and documenting all the procedures of data collection and analysis were among the ways employed to do so The quantitative data were analysed using simple descriptive statistics and multivariate logistic regression. Thematic analysis was employed to analyse the qualitative data. Ethical principles of research such as beneficence, justice, informed consent, respect for persons, privacy and confidentiality and scientific integrity were considered to conduct the study. The study revealed an unmet need of 29.2% (n=112) for modern contraception among agro-pastoral women. The unmet need for birth spacing constituted 21.1% (n=81), whereas the unmet need for birth limiting was 8.1% (n=31). The age of the women, the number of living children, knowledge of modern contraceptive methods, and knowledge of FP service centres were found to be associated with women‘s unmet need for modern contraception. Lack of time and money, lack of knowledge about modern contraception, and fear of side effects were the major individual-level barriers. There were also culture-related factors such as the need for many children that hindered agro-pastoral women from using modern contraception. Moreover, the study disclosed that religious unacceptability and husband‘s and relatives‘ opposition were also among the mentioned barriers. The quality of FP service provision in terms of the competence and behaviour of health service providers, unavailability and inaccessibility of FP service, were also indicated as barriers. The findings informed the development of strategies to reduce agro-pastoral women‘s unmet needs for modern contraception in Eastern Ethiopia. The study further recommended that the health bureaus of the region, zone and district collaborate in ensuring that agro-pastoral women realise the significance of the provision of accessible, equitable, quality modern contraception. It is also essential to equip health facilities with qualified health service providers and necessary facilities. Religious leaders should be involved in disseminating vital, relevant and empowering FP information. / Health Studies / Ph. D. (Public Health)