Developing internationally agreed core indicators for surveillance of preconception health: protocol for a consensus study

Background: Interventions and policies to optimise preconception health are increasing internationally. This stems from growing recognition that improving preconception health can improve maternal and child health outcomes and advance equity by reducing inequalities and address inequities for people of reproductive age and any children they may have. Interventions and policies should be evaluated through population-level surveillance of preconception health to inform the development of new initiatives, monitor effectiveness, and support advocacy for international adoption of successful strategies. However, there is currently no internationally agreed set of preconception health indicators available and suitable for international surveillance. The International Core Indicators for Preconception Health and Equity (iCIPHE) Alliance was established to address this gap. Aim: To prioritise core indicators that can be used in low-, middle- and high-income countries for surveillance of preconception health and equity. Methods: We held two workshops with the iCIPHE Alliance (multi-sectoral stakeholders from low-, middle- and high-income countries) to inform the design of this international consensus study. The development of core indicators will consist of three steps: (1) identifying an initial long-list of candidate surveillance indicators, and defining principles for scoring the importance of each indicator, through a literature review, public involvement, and workshops with iCIPHE Alliance members; (2) scoring each candidate indicator in terms of its importance for surveillance through a two-round Delphi survey among study participants; and (3) agreeing on the final core indicators through a series of consensus meetings with a selected group of study participants. We will recruit study participants from all World Health Organization (WHO) regions across four stakeholder groups: people of reproductive age (who do not belong to any of the other stakeholder groups); health and social care professionals; policy and programme professionals; and researchers. Dissemination: We will disseminate the priority core indicators through peer-reviewed publication, lay summaries, policy briefs and presentations. An implementation strategy, to enable monitoring of inequalities, inequities, and changes in preconception health over time within and between countries, will be developed with relevant national and international organisations to inform next steps.