Conclusions
Advocacy is currently underway to develop and promote a system for delivery of ICC. Development of a knowledge base of the barriers to interconceptional preventive care is critical and timely to inform the process of building this preventive service. Careful attention must be paid to ensuring that barriers do not impede any vulnerable population group's access and participation. Health promotion strategies must not only increase demand for ICC service, but must also proactively identify individual, contextual and structural barriers, then develop structures and processes for delivery of care that facilitate equitable access for all women. Individual behavioral strategies tend to be divorced from the contextual or structural mediators of health care utilization. Marketing, for example, is an individual-focused behavioral strategy that may disproportionately benefit higher income and higher educated women because these women are less likely to face social or economic barriers to participation once they are informed of the need and availability of the service. We showed that other factors, above and beyond traditional barriers to care, possibly contextual or structural factors, continue to impact on participation in ICC care for urban women. The challenge remains for new paradigms to be developed to capture the full range of barriers affecting interconceptional preventive health care participation, particularly for vulnerable population groups. Once these factors are identified, inter- and preconceptional care can be structured and delivered to ensure equitable access and will only then hold promise to reduce disparities in preterm-related mortality.