Exploring University Women’s Perspective on Pre-Pregnancy Health: A Qualitative Study on Behaviors, Challenges, and Information Needs

1. Introduction

Planning for pregnancy and the pregnancy period itself are unique opportunities when women are often motivated to enhance their health and make lifestyle changes [1,2]. These positive changes can significantly benefit women's and the next generation's health [3]. Behavioral modifications such as improving nutrition, engaging in physical activity, as well as quitting smoking, drugs, and alcohol before pregnancy can lead to better outcomes for both mothers and babies [4,5]. Managing excess weight and preventing obesity during reproductive years can also improve women’s long-term health and provide intergenerational health benefits [6]. Thus, enhancing the delivery and dissemination of pre-pregnancy health information offers numerous advantages [4].

Despite these benefits, pre-pregnancy health remains an under-emphasized aspect of women’s health promotion. In the United States (U.S.), approximately 41.6% of all pregnancies are unintended [7], meaning conception frequently occurs without prior planning. Moreover, women aged 20 to 29, an age group that includes many college students, account for over half (56.5%) of abortions in the U.S., indicating the frequency of unplanned reproductive outcomes during young adulthood [8]. Many women do not recognize pregnancy until several weeks after conception, with one in four recognizing pregnancy after 5.5 weeks of gestation [9]. During this early and often unrecognized stage, women may continue engaging in behaviors such as smoking, alcohol use, or poor dietary practices that can adversely affect fetal development. Unmanaged preexisting conditions such as diabetes or hypertension may further elevate risk [10]. These factors highlight the importance of encouraging women to consider their health prior to conception [4,11].

Given that nearly half of women experience a birth by age 25, college and university settings provide a critical yet underutilized opportunity to promote pre-pregnancy health among young women [11,12]. These settings are uniquely positioned to provide access to health education, preventive services, and social support that can foster lifelong healthy behaviors [13]. Additionally, enrollment in U.S. degree-granting institutions has risen steadily, from 16.9 million in 2003 to 19.8 million in 2017 and is projected to exceed 20 million by 2028 [14]. Because these years coincide with important developmental transitions, integrating wellness initiatives into college settings can shape health trajectories that extend into adulthood and future reproductive life. However, the transition to college life often disrupts established routines, negatively impacting students’ health behaviors. Research shows that college students frequently skip meals, consume high-calorie fast food, snack excessively, and engage in lower levels of physical activity, all of which contribute to poor dietary quality and weight gain [15,16]. Increased consumption of alcohol and other substances further compound these risks [17,18].

Given that many women may become pregnant during or soon after their college years, understanding how they interpret and prioritize health behaviors in regard to their future pregnancy is essential. Yet, little is known about how traditional university-aged women perceive pre-pregnancy health, whether or how they prepare for a potential pregnancy, and what barriers they face in adopting healthy behaviors. This study addresses this gap by exploring university women’s knowledge, attitudes, and experiences related to pre-pregnancy health. Through a qualitative lens, this aimed to capture the lived experiences of emerging adult women, providing insights that can inform the design of targeted educational and health promotion programs within university settings to support healthier pregnancies and long-term well-being.

2. Results

2.1. Sociodemographic Characteristics of the Participants

Fifteen women participated in the study (mean age = 21.67 ± 3.39 years). Most identified as White (80%) (Table 2). Slightly more than half of women were partnered (53.3%). Participants were primarily juniors (33.3%) or graduate students (26.7%). Family income levels varied, with the largest proportion reporting $30,000 - $49,999 (26.7%). Most participants were employed part-time (73.3%), and all reported having health insurance (100%).

2.2. Qualitative Findings

The interview analysis revealed four emerging themes: (1) Importance of pre-pregnancy health for university women, (2) Behaviors and actions during pre-pregnancy, (3) Challenges experienced in maintaining pre-pregnancy health, and (4) Preferences and sources of information related to pre-pregnancy health (Supplemental file 1).

Theme 1: Importance of pre-pregnancy health for university women

Almost all participants (93.3%) revealed the importance of pre-pregnancy health, with many (73.3%) considering it crucial for ensuring a healthy pregnancy and creating a supportive environment for their child. One participant noted, "Planning for pregnancy feels a bit overwhelming, but I believe it’s important to be well-prepared to ensure a healthy pregnancy and a good environment for the baby.” Participants also recognized the importance of early proactive health behaviors such as taking supplements, eating healthily, and staying physically active, even if not planning to become pregnant soon. Additionally, there was an awareness of the need to avoid potentially harmful behaviors like smoking and drinking.

Theme 2: Behaviors and actions during pre-pregnancy

Importance of discussing pregnancy intention with healthcare providers and family

Almost half of the participants (46.6%) highlighted the importance of discussing pregnancy intentions with their healthcare providers and family members when thinking about or preparing for a future pregnancy. Many participants (46.6%) emphasized the role of medical professionals in guiding their pre-pregnancy health decisions. One participant stated, "I would look at information, probably with my doctor and gynecologist." Many participants (93.3%) acknowledged their reliance on health professionals for comprehensive advice on pre-pregnancy diet, physical activity levels, and genetic testing, especially when there were potential hereditary concerns. Family influence was also significant in shaping pre-pregnancy health behavior. Participants frequently mention parents (26.6%), particularly mothers, as sources of guidance and support. One woman noted, "My mom like she always told me, growing up that, like, I'll have to think about having kids in the future. But she always told me that, like, we'll worry about that when we get there. But now that I'm in my 20s, she's kind of starting to bring it up more ...”

Reliance on online sources for pre-pregnancy health information

In addition to discussing pregnancy intentions with healthcare professionals and family members, over half of the participants (53.33%) described different ways they gathered information about pre-pregnancy health. Many participants (86.6%) mentioned relying on social media platforms like Instagram and TikTok as popular sources of information, while participants were cautious about the legitimacy of information received through these platforms as one participant noted, “… you can't always trust social media, I'll try and do like a secondary search [if] I am interested in, like, looking at it further, [or] I'll reach out to, like a healthcare professional.” For correct information, some participants (20%) consulted trusted websites, such as those run by the government or universities. For example, one participant commented, "I will probably go to Google and then click on links that have like.gov, like.edu, or something."

Behavior changes and lifestyle modifications before pregnancy

Participants expressed that preparing for pregnancy requires intentional adapting of healthier lifestyle habits, including improving diet, being physically active, avoiding substance use, and prioritizing mental well-being.

A more nutritious diet. All participants (100.0%) highlighted that dietary changes were a key behavior modification that would need to be made before becoming pregnant. They emphasized the importance of eating healthier, incorporating more fruits and vegetables, and avoiding processed foods. One participant stressed, “I would probably try to eat more food with more protein, or like vitamins, or like anything that is healthy, and …avoiding fast food or junk food.” Some participants (26.6%) also wanted to reduce sugar intake and excessive caffeine consumption.

Being more physically active. Approximately 94.0% of interview participants highlighted physical activity as the second most important component of behavior modification for pre-pregnancy health. Participants acknowledged the need to maintain or increase their physical activity levels to ensure better health outcomes. One participant emphasized, "I would probably want to increase my physical activity … before trying to get pregnant." Many women (73.3%) emphasized the importance of regular exercise, particularly strength training and flexibility, in preparing their bodies for pregnancy. Furthermore, a few participants (20%) intended to maintain their present physical activity levels while decreasing intensity throughout the later stages of pregnancy.

Avoiding substance use. Quitting substance use, such as smoking and drinking, was the third most important component of behavior modification for pre-pregnancy health, mentioned by women. Many participants (80.0%) emphasized the importance of avoiding these habits to ensure better health outcomes for both them and their future children. Reflecting a common sentiment, one participant mentioned, "100% substance use is out.” Others (15.0%) highlighted that while they already do not smoke or drink, they recognize the importance of maintaining these habits, as one stated, "I’ve also considered the need to quit smoking and drinking, even though I don’t smoke." Several participants (60%) also noted that quitting these habits before pregnancy makes it easier to maintain a healthy lifestyle afterward.

Maintaining optimal mental health status. Approximately three-fourths (73.3%) of interview participants highlighted mental health as a crucial factor in pre-pregnancy behavior and lifestyle modification. Participants mentioned stress management, positivity, and mental preparation for pregnancy changes. One participant said, "Taking care of your mental health comes with taking care of your physical health.” Others (26.6%) noted strategies such as the importance of mental health and stress-reduction methods, like reading books and listening to podcasts. However, one participant emphasized the importance of addressing mental health issues like intergenerational trauma to guarantee a healthy mentality for themselves and their future children.

Theme 3: Challenges experienced in achieving pre-pregnancy health

Most participants (86.6%) revealed a wide range of challenges related to planning for a future pregnancy and optimizing their pre-pregnancy health, including personal health issues, financial stability, career concerns, environmental factors, family health history, personal health issues, and the taboo nature of pre-pregnancy discussions.

Past family health history and personal health

Family health history and personal health issues added layers of complexity to planning for a future pregnancy. Among participants who discussed family or personal health concerns, many (73.3%) expressed worry about a family history of fertility issues or genetic conditions, such as heart defects, expressed concern about their potential impact on pregnancy. One participant shared, “I have a history of fertility issues,” while another mentioned, “I think about my family history with substance use.”

Financial constraint

Financial concerns were prevalent among participants. Over half of women (53.3%) were worried about the costs associated with having a child, including medical expenses, childcare, and general financial stability. One participant noted, " I think that [money] is a huge barrier as well as being able to financially afford to have the kid, or even plan to have a kid.” Another highlighted the high costs of daycare as a concern.

Environmental factors

Some participants (33.3%) also cited environmental factors such as living conditions and relocation as obstacles. One participant planning to move to a new city for graduate school noted, "Moving to a different city means that I don't know any of the people there or my surroundings." Another participant mentioned the unsuitability of dorm living for starting a family, emphasizing the need for a permanent residence before having children.

Cultural challenges

Lastly, the taboo nature of discussing pregnancy planning in some communities further complicated preparation efforts. A few participants (20.0%) reported that topics like safe sex practices and pregnancy planning were not adequately covered in educational settings. One participant stated, "It's a very taboo subject to approach…. [school curriculum] doesn’t really go into many details...how to practice safe sex, and how to prepare to get pregnant."

Theme 4: Preferences and timing of information related to pre-pregnancy health

Preferred topics for pre-pregnancy health

Participants suggested a wide range of information on topics related to pre-pregnancy health. Many (80.0%) emphasized the need for better education on prenatal care, including the importance of prenatal vitamins and understanding what needs to be done to maintain their health during pregnancy. Dietary guidelines and food safety (100%) were also critical, with participants wanting to know what foods to eat and avoid. Participants sought advice on staying physically active (94%) and managing stress (73.3%) during pregnancy, with a focus on coping strategies for overall well-being. Participants also requested healthcare resources, financial planning advice, and education on basic hygiene and sexual health practices. One participant stated “…planning for pregnancy and maintaining reproductive health, even if it’s not something we’re considering immediately.” Additionally, a few participants (26.6%) expressed a desire for community and professional support, such as more resources and educational programs for college students delivered by campus health services, reproductive health educators, and/or trusted health healthcare providers.

Preferred timing to receive health behavior information

Participants revealed a strong preference for receiving information on optimizing their health before actively planning for pregnancy, allowing time for lifestyle adjustments. Most participants (73.3%) emphasized the importance of being informed well in advance about strategies to improve pre-pregnancy health behaviors to allow for necessary lifestyle adjustments and to ensure a healthier pregnancy. One participant noted, "I think before I get pregnant is definitely when I would want to know these things." Others echoed this sentiment, emphasizing that understanding pregnancy information beforehand helps in forming healthy habits and reducing anxiety. However, a few participants (20.0%) preferred gathering information during pregnancy, feeling that they would have specific questions as if situations would arise.

3. Discussion

This qualitative phenomenological study explored university women’s perspectives on pre-pregnancy health, including perceived importance; behaviors and intentions; challenges; and information needs. Overall, participants recognized pre-pregnancy health as important and identified multiple lifestyle behaviors, such as improving diet, increasing physical activity, avoiding substance use, and attending to their mental health, as central to preparing for a future pregnancy. At the same time, participants described multiple contextual barriers embedded in the realities of young adulthood, including structural, financial, cultural, and informational barriers that complicated acting on this knowledge. These findings add to the growing body of literature on pre-pregnancy health by focusing specifically on young adult women in a U.S. university setting. This population is at high risk for unplanned pregnancy and rapid weight gain, yet it is often underreached by pre-pregnancy health interventions [2,19].

Most participants viewed pre-pregnancy health as foundational to both their own well-being and the health of a future child, showing a sense of personal responsibility for preparation. This aligns with Khan et al. (2019), whose qualitative work found that women valued lifestyle changes such as improving diet, physical activity, alcohol reduction, and vitamin supplementation prior to conception [20]. Similar patterns have been documented in other studies showing that women frequently identify nutrition, weight management, and substance avoidance as central to preparing for pregnancy [21,22]. Importantly, participants in this study also described pregnancy planning as emotionally overwhelming, particularly while navigating academic transitions and evolving adult identities. This sense of uncertainty indicates that pre-pregnancy health may not only be behavioral, but also tied to women’s lived experiences of timing, readiness, and future responsibility [23]. Similar to findings from Musgrave et al. (2023), women in our study demonstrated strong awareness of healthy habits but limited understanding of more clinical components of pre-pregnancy care, such as screening for chronic disease, reviewing medications, or ensuring vaccinations are up to date [24]. This gap is noteworthy considering that many pregnancy-related risks originate before a woman realizes she is pregnant. For example, neural tube closure occurs early and is sensitive to preconception folate status [25]. Thus, understanding pre-pregnancy health solely through lifestyle lens may leave critical clinical needs unaddressed. The current findings therefore support research suggesting that women require not only knowledge but also a broader conceptualization of pre-pregnancy care as a preventive health service encompassing screening, counselling, and risk assessment [19,21].

Participants expressed intentions to improve dietary quality, increase physical activity, eliminate substance use, and support mental health before pregnancy. These intentions parallel results from quantitative and qualitative studies demonstrating that women are motivated to adopt healthier behaviors when contemplating pregnancy [20,24]. However, our findings indicate specific contextual barriers unique to university women, including financial insecurity, relocation or environmental transitions (e.g., moving away to a new city for graduate school), and sociocultural discomfort surrounding discussions of pregnancy planning. These findings reflect a pattern observed among university-aged populations, who experience declines in diet quality, increased fast-food intake, and reduced physical activity when transitioning to independent living [26,27]. Likewise, alcohol use among college students remains prevalent and is shaped by peer influence and campus culture [18]. These challenges may contribute to the well-documented “intention-action gap,” wherein participants express strong health goals yet face difficulty translating intentions into sustained behavior change [28].

A notable contribution to this study is the emphasis participants placed on mental health as integral to pregnancy readiness [29,30]. While guidelines refer to mental health as one dimension of pre-pregnancy care, participants in this study described stress, emotional readiness, healing from trauma, and concerns about inherited mental health conditions as relevant considerations when thinking about preparing for pregnancy [31]. This extends prior research by demonstrating that university women may conceptualize mental health not simply as stress management, but as emotional and intergenerational preparation for parenthood [32]. Further, our findings and others consistently revealed that women rely mostly on digital platforms such as TikTok and Instagram for initial information about fertility and pre-pregnancy health [33]. While such platforms increase access to health content, participants in this study expressed skepticism due to misinformation, leading them to verify information through healthcare professionals or trusted websites (e.g., university or government domains) [34,35]. These patterns suggest that interventions leveraging digital platforms should prioritize credible, culturally appropriate messaging and clear pathways to validated resources, rather than simply increasing online content volume.

Despite women identifying clinicians as their most trusted source of comprehensive pre-pregnancy guidance, many noted that they had not been offered practical counselling or reproductive life planning during routine healthcare encounters. This aligns with U.S. data showing that only a minority of women receive preconception counselling despite demonstrated interest [36,37]. Previous intervention research, such as Schuldt’s educational project, has shown that targeted instruction can significantly improve women’s knowledge, attitudes, and intentions to seek pre-pregnancy care [38]. Our findings specifically highlight missed opportunities in routine primary care visits, where students felt discussions about reproductive planning, fertility concerns, or mental health history would have been beneficial but rarely occurred.

Beyond informational barriers, participants reported structural and cultural barriers influencing financial constraints, relocation challenges, lack of supportive living environments, family history of health conditions, and taboo attitudes towards discussing pregnancy. These observations align with previous work showing financial strain, limited reproductive education, and sociocultural stigma shape pre-pregnancy health behaviors [37,39]. Importantly, our study adds evidence that these barriers manifest differently in college settings, where students often lack stable housing, steady income, or family proximity, all of which affect readiness for pregnancy planning. Participants further emphasized wanting to receive health behavior information well before planning for pregnancy, aligning with international recommendations for early engagement in reproductive planning [2,23]. Notably, participants expressed a need for content specifically adapted to university life, considering academic pressures, transitional living situations, and limited financial stability. This suggests that standard pre-pregnancy materials may not fully meet the needs of emerging adults in the university settings.

Strengths and Limitations

This study offers novel insight into how university-aged women conceptualize pre-pregnancy health, including their behavioral intentions, structural barriers, and preferred sources and timing of information. A key strength is the use of a phenomenological qualitative design, which allows participants to describe their lived experiences in depth rather than responding to predefined assumptions. By focusing on women enrolled at a Midwestern U.S. university, this study adds needed evidence from a population and setting that have been less represented in prior preconception or pre-pregnancy phase health research. Recruitment across multiple academic departments and degree levels also enabled the inclusion of students with varied socioeconomic backgrounds, living situations, and future reproductive intentions. Additionally, the integration of rigorous analytic procedures, including peer debriefing, audit trail documentation, and systematic team-based coding, enhanced the study’s credibility and trustworthiness.

Several limitations must also be acknowledged. First, the sample was drawn from a single Midwestern university, potentially limiting transferability to other settings with different demographic or cultural characteristics. Although participants represented varied academic levels, the majority identified as White, which may not reflect the perspectives of racially and ethnically diverse student populations who may experience distinct reproductive health challenges. Self-selection bias is possible, as students interested in women’s or reproductive health may have been more likely to participate. Finally, while interviews captured perspectives and intentions related to pre-pregnancy health, they did not assess actual behaviors or health outcomes. Future research incorporating more diverse samples, longitudinal follow-up, and mixed-methods approaches may be necessary to examine how intentions translate into sustained health behavior change over time.

4. Materials and Methods

4.1. Study Design

This study is a part of a larger sequential explanatory mixed-method project consisting of both a web-based survey and semi-structured interviews designed to further understand college women’s pre-pregnancy knowledge and behaviors, as well as factors they may consider for future pregnancy planning [40]. While the larger study included both quantitative and qualitative components, the present study presents findings from the qualitative interview phase, which aimed to provide a deeper understanding of university women’s perspectives and contextual experiences related to pre-pregnancy health and factors influencing preparation for future pregnancy. For the semi-structured interviews, a qualitative phenomenological approach was used to explore how university women perceive and interpret pre-pregnancy health and preparation for future pregnancy. Phenomenology focuses on understanding how individuals make meaning of their lived experiences within their social and cultural contexts [41]. This orientation allowed the study to capture participant’s perspectives regarding health behaviors, knowledge, and perceived barriers related to pre-pregnancy health [42]. The current study has been reported following the Reporting Qualitative Research (SRQR) framework [43].

4.2. Sampling and Recruitment

A convenience sample of college women was recruited from a public university in the Midwest. Eligibility criteria included: (1) identifying as a woman, (2) being at least 19 years of age (age of majority in the study location), (3) currently enrolled as an undergraduate or graduate student at the university where the study took place, and (4) being proficient in English.

Recruitment was conducted using a multifaceted strategy to maximize reach and participation. Digital flyers containing a study description and QR code to an online survey assessing participant eligibility were distributed across social media platforms such as Facebook and Twitter (X), specifically targeting university-affiliated student and professional groups. Additional methods included word-of-mouth and posting flyers on bulletin boards in key locations across campus. Further, faculty members were contacted via email and provided an overview of the study and instructions to share the flyer with their students through email or Canvas announcements. Eligible participants who completed the survey and expressed interest in further participating in an interview were contacted by the lead author (PC) using their preferred method of communication (i.e., text, email, or phone call) to schedule an interview at a time and date convenient for them.

4.3. Data Collection

Data were collected during the spring and summer sessions, from the third week of April to the second week of June 2024, through semi-structured interviews via Zoom and/or telephone, based on participants’ preferences. Verbal informed consent was obtained before each interview. All interviews were conducted by a fourth-year PhD student (PC) with more than five years of qualitative research experience. The interviewer was trained by a senior faculty mentor (DD), who has extensive expertise in qualitative research and women’s health. To minimize bias, the interviewer maintained a neutral stance and avoided leading questions. A total of 51 students expressed interest, 17 scheduled interviews, and 15 completed them. Interviews lasted approximately 15-20 minutes (M = 17.5 minutes). Each participant received a $25 Amazon gift card as compensation.

4.4. Semi-Structured Interview Guide

A semi-structured interview guide was developed to explore participants’ perceptions on pregnancy planning and their knowledge of pre-pregnancy health behaviors. The interview guide was developed by the lead author (PC), in collaboration with the senior author (DD) who has extensive expertise in qualitative methods and women’s health.

Questions were informed by an iterative review of the literature on key health behaviors known to impact pre-pregnancy health [24,44] and were developed to explore participants’ perspectives on these items. While this qualitative study was conducted as part of a larger mixed-methods project, the interview guide was designed to expand upon broad survey domains rather than replicate specific survey items. The qualitative component aimed to deepen understanding of how university women interpret and experience pre-pregnancy health within their developmental and social context. Questions were open-ended and prompts addressing perceived importance of pregnancy planning, anticipated changes prior to conception, sources of health information, social and cultural influences, and challenges related to preparing for a healthy pregnancy. Probing questions were used to clarify responses and explore emerging concepts in greater depth. During interviews, participants were informed that “pre-pregnancy health” referred to health behaviors and conditions that can influence pregnancy outcomes even before conception [44]. Sample questions are presented in Table 1, and the full interview guide is provided in Supplemental file 2.

4.5. Ethical Considerations

The study received approval from the University of Nebraska Medical Center (UNMC) Institutional Review Board (IRB:0200-24-EX). All participants provided informed consent before participating.

4.6. Data Analysis

Interviews were audio-recorded and transcribed verbatim. Initial automated transcripts were generated using Otter.ai©, followed by manual review by the lead author (PC) while listening to audio recordings to correct inaccuracies. Transcripts were then imported into QSR NVivo 12 software version 25 for qualitative data analysis.

Data were analyzed using a directed content analysis approach [45,46]. Directed content analysis approach is an approach in which existing theory, prior research, or predefined domains are used to guide the initial coding framework while allowing new concepts to emerge from the data. This systematic process involved multiple steps. First, the lead author familiarized with the transcripts, reading through each transcript multiple times. Next, a deductive codebook was developed following the semi-structured interview guide and from the study aims (e.g., perceived importance, behavior intentions, barriers, information source/needs). The senior author (DD) reviewed the codebook, and disagreements were resolved through discussion until consensus was reached before coding. Then, the lead author coded all transcripts, using analytic memos to document emerging themes applying structured codes, organizing data into thematic categories, and interpreting patterns across participants. During coding, the lead author also used inductive coding to capture new ideas not adequately represented by the initial deductive framework. Codes were then reviewed and combined as needed to reduce overlap and ensure internal consistency across transcripts. Themes were refined through iterative review and discussion between PC and DD, with attention to representativeness, coherence, and alignment with the research questions. Final themes were defined and named, and illustrative quotations were selected to support each theme.

To enhance credibility and trustworthiness, several established qualitative rigor strategies were applied including peer debriefing, maintenance of audit trail documenting decisions and revisions, and use of analytic memos to support reflexivity and transparency [47,48]. Peer debriefing occurred through frequent discussions between the lead author (PC) and senior author (DD), during which emerging codes, theme interpretations, and coding discrepancies were reviewed and refined. An audit trail was maintained within NVivo and research notes to document coding decisions, codebook revisions, and theme development throughout the analytic process. Analytical memos were written during transcript review and coding to capture reflections on emerging patterns, potential interpretations, and relationships across participant’s responses. Data saturation was reached after 12 interviews [49]; however, the remaining three participants had already scheduled appointments and were interviewed to honor their time and commitment. These interviews were used to confirm thematic consistency.

5. Conclusion

This study suggests that university women value pre-pregnancy health and intend to make positive lifestyle changes, such as improving diet, increasing physical activity, avoiding substance use, and supporting mental well-being. However, they face financial, cultural, and information barriers that may limit their ability to act on these intentions. While many rely on social media for initial guidance, healthcare professionals remain the most trusted source of accurate information, though preconception counselling in this context was rarely offered in routine care. Because college life coincides with both heightened risk of unplanned pregnancy and major lifestyle transitions, universities represent a key setting to deliver accessible, evidence-based preconception health education and support. Strengthening campus-based resources such as reproductive health programming, counselling, and tailored health promotion initiatives may better support young women in preparing for future pregnancy and promoting long-term reproductive well-being.