The economic burden of perinatal mortality due to inaction on preconception health in low and middle-income countries:A population attributable fraction and economic impact analysis

Background: Poor preconception health has been associated with several pregnancy and childbirth-related complications, including perinatal mortality. Yet, the health and economic burden that inaction on preconception health places on societies remains under-researched, hindering efforts to address these issues effectively. This study aimed to quantify the economic burden of perinatal mortality attributable to five preconception risk factors in fifteen low and middle-income countries (LMICs). Methods: We used a population-attributable fraction analysis to estimate the proportion of perinatal deaths in 2020 attributable to adolescent pregnancy, short birth intervals, intimate partner violence before pregnancy, pre-pregnancy overweight and obesity, and female genital mutilation. We then performed an economic impact analysis to quantify the foregone productivity and the societal costs due to these perinatal deaths, using both the human capital and the value of a statistical life-year approach. Findings: More than 230,000 (20.7%) perinatal deaths were attributable to the five selected risk factors in the fifteen LMICs in 2020. The productivity losses were estimated at $INT21.3 billion, representing 0.7$INT51.0 billion. Interpretation: Our findings indicate that inaction on preconception care potentially contributes to a substantial proportion of the burden of perinatal mortality, which, in turn, generates profound and long-term economic and societal losses in LMICs. These results highlight the need for effective preconception strategies and relevant policies, and further research is needed to explore the economic value of preconception care in these settings