Background:
Information about risk factors and preventive measures provided before conception is estimated to prevent 15-35 % of adverse pregnancy outcomes. To actually achieve this goal, it is crucial that preconception counselling (PCC) becomes available to all prospective parents. In a Dutch project ‘Parents to be', general practitioners routinely offered PCC to all women of childbearing age. Of all women who were invited 55% did not respond. Unfortunately, a quarter of pregnancies in the following year occurred in this group.

Objectives:
We aimed to identify women's motives for not responding to an invitation for PCC from their general practitioner.

Methods:
A purposive sample of 11 women who did not respond to an invitation for PCC and who became pregnant within one year was interviewed. We aimed to include women with a variety of characteristics that were expected to influence motives for non-response, such as parity, age and education.

Results:
Three key themes influencing non-response emerged from the data: perceived knowledge, perceived lack of risk, and a misunderstanding of the aim of PCC.
Several women assumed they already knew enough about healthy living and pregnancy. All women were concerned about their health and the health of their babies, but many felt that their risk of having a child with a congenital abnormality was very small. The majority said that they had changed their behaviour during pregnancy to promote health. Some women associated PCC with information on how to become pregnant.


Conclusion and implications for practice:
For successful future implementation of PCC a more tailored approach may be necessary for certain (groups of) women, specifically addressing potential reasons why women may mistakenly not consider themselves part of the target group for PCC. Including information on fertility and focussing on personalized rather than general information in the invitation may improve uptake rates.