Background:
In order to improve the knowledge, attitudes, and behaviors of women related to preconception health, more must be understood about the idea of planning as related to pregnancy and conception. For the clinical or public health professional, “planned pregnancy” is a term commonly used with clients, yet it is unclear if women's perceptions and understanding of family planning coincide with those of professionals.

Objectives:
This study endeavors to further elaborate information that is vital to
our understanding of preconception issues in two ways: 1) by generally evaluating women's understanding of the concept of planned pregnancies, and by 2) interpreting those findings through the experiences of African American women who are especially at risk for poor pregnancy outcomes.

Methods:
In the summer of 2005 the Michigan Department of Community Health conducted 16 focus groups with 161 African American women across 9 counties identified as having the highest African American infant mortality rates in the state of Michigan. Since African American women are nearly twice as likely to experience a poor pregnancy outcome as white women, the focus groups were intended to build understanding of pregnancy experiences of African American women in order to make needed changes in the health care system to support better outcomes.

Results:
Five major themes were drawn from the analysis of focus group
transcripts:
Theme 1: The concept of seeing any health care provider BEFORE a pregnancy occurs is foreign to many women; a point that directly contradicts the current preconceptional goals of health care providers and agencies.
Theme 2: “Planning” was not unilaterally viewed as a definitive act but rather as a continuum. Theme 3: Planning as an event vs. a process: Many women expressed a level of fatalism or resignation about their ability to influence pregnancy planning.
Theme 4: It takes two to plan a pregnancy. Often preconception care is focused on women.
Theme 5: Contextual issues affecting preconception care. Preconception care is more than physical, it has social, psychological and spiritual components

Conclusion and implications for practice:
It is imperative that nurses recognize the role of race and economics in understanding women's beliefs and attitudes about pregnancy planning and preconception care. Enhancing the cultural commitment of practicing nurses and nursing workforce diversity is critical. Through partnerships and advocacy, nurses can become a vehicle for social justice while playing a key role in advancing the preconception health needs of African American women.