Globally, low- and middle-income countries (LMICs) carry a disproportionately heavy burden of maternal and neonatal mortality and morbidity [1]. Too many women haemorrhage to death peripartum, develop acute stroke, renal failure, or pulmonary edema from uncontrolled hypertension, or are affected by severe sepsis, including after unsafe abortion [2]. And when bad things happen to a pregnant woman, the same is likely to be true for her fetus or newborn [3], which can include neonatal sepsis or preterm entry into a world that lacks the facilities to deal with a baby’s immature organ system [4]. Indeed, among adolescent mothers and women who deliver in rural or sprawling peri-urban areas, the flagrant persistence of inequitable health outcomes has beckoned experts to generate priorities for action [2], yet preconception care has somehow been neglected. Until now.