Tashinka and Layan recently ‘tied the knot’ and are now looking forward to becoming parents. They went for a preconception assessment at the Homagama Medical Officer’s Clinic, just outside Colombo.
"The process was easy to follow, and what made it even more special was the personal care and attention from the midwife. She made us feel heard, supported and truly cared for."
Thanks to a well-organised Maternal and Child Health programme, Sri Lanka has emerged as a leader in South Asia for improving maternal and child health. Since 2011, the Government, supported by UNICEF and partners, has been offering newly married couples, such as Tashinka and Layan, free preconception assessments. These sessions equip couples with the knowledge they need about health and nutrition before pregnancy, as well as helping them better understand the emotional and lifestyle changes that come with becoming parents.
Nutrition during preconception - the period before pregnancy - has a critical role in shaping the health of women and their future children. For women who are about to become mothers, good nutrition in preconception helps establish the nutrient reserves they need for a healthy pregnancy[1]. Poor preconception nutrition, on the other hand, has the power to alter the way babies’ genes are expressed, affecting how their bodies store fat, regulate metabolism and respond to food later in life. These changes can increase their risk of obesity, diabetes, and other health issues[2].
In South Asia, too many women start pregnancy already at risk. A recent Lancet paper, found that one in three married, non-pregnant women is overweight, while one in ten is underweight. Half of these women have anemia, and micronutrient deficiencies are widespread. Interventions during pregnancy are important, but they often come too late to make a difference.
Despite its importance, preconception nutrition often gets overlooked in women’s health, especially in South Asia. Policies exist in all eight countries but limited budgets and resources mean these programmes don’t always reach the women who need them.
One of the biggest challenges is simply reaching women at this stage. Pregnancy has well-established health services but preconception care is harder to embed. Women may not actively seek healthcare before pregnancy, and traditional systems often miss them entirely. This calls for fresh thinking, not just in how we design programmes but in how we connect with women in their everyday lives.
Sri Lanka’s Service Package for Newly Married Couples is a great example of innovative thinking. Launched in 2011 and scaled up nationwide by 2018, it is built into the country’s existing health systems.
When couples register their marriage, they’re connected to a team of trained midwives, nurses and doctors who offer support as they begin their journey towards parenthood. They attend two preconception care sessions where they’re assessed for nutritional risks and receive tailored counselling, management and referrals.
“We see this as a unique aspect within our public health system. Within the community this program for newly married couples has greatly helped us to improve the quality of care for pre-pregnant women and, thereby, for pregnant mothers.”
The results are encouraging. About 60 per cent of newlyweds sign up for the programme. Half of them get folic acid supplementation, and 91 per cent report having planned pregnancies. By working within systems such as marriage registration, these programmes deliver critical services and create opportunities for women to take charge of their health.
Tashinka and Layan’s experience is a reminder of what’s possible when women are given the knowledge and resources they need to prepare for healthy pregnancies.
"As a newly married couple, we learned a lot from this programme, and it also helped us to focus on our future in a more meaningful way,” said D. Layan Madhuranga upon finishing the pre-assessment visit.
Sri Lanka's successes show that targeted nutrition offers a rare opportunity to break the cycle of malnutrition. However, without concerted action, women in the region will continue to face these risks. To address this, governments in the region must commit to investing in and prioritising this crucial stage of life.
