title: Midwives' adoption of the reproductive life plan in contraceptive counselling: a mixed methods study.
abstract: OBJECTIVE
  How is the reproductive life plan (RLP) adopted in midwifery contraceptive counselling?
  
  
  CONCLUSIONS
  A majority of midwives adopted the RLP in their counselling, had predominantly positive experiences and considered it a feasible tool for promoting reproductive health.
  
  
  BACKGROUND
  The RLP is a health-promoting tool recommended by the Centers for Disease Control and Prevention in the USA for improving preconception health. It was recently used in a clinical setting in Sweden and was found to increase women's knowledge about fertility and to influence women's wishes to have their last child earlier in life.
  
  
  METHODS
  An exploratory mixed methods study among 68 midwives who provided contraceptive counselling in primary health care to at least 20 women each during the study period. Midwives received an introduction and materials for using the RLP in contraceptive counselling. Three months later, in the spring of 2014, they were invited to complete a questionnaire and participate in a focus group interview about their adoption of the RLP.
  
  
  METHODS
  Data collection was through a questionnaire (n = 53 out of 68; participation rate 78%) and five focus group interviews (n = 22). Participants included both younger and older midwives with longer and shorter experiences of contraceptive counselling in public and private health care in one Swedish county. Quantitative data were analysed for differences between users and non-users, and qualitative data were analysed by qualitative content analysis to explore the midwives experiences and opinions of using the RLP.
  
  
  RESULTS
  Sixty-eight per cent of midwives had used the RLP in their contraceptive counselling. Four categories emerged through the focus group interviews: (i) A predominantly positive experience; (ii) The RLP-a health-promoting tool; (iii) individual and societal factors influence the RLP counselling; and (4) long-term implementation comprises opportunities, risks and needs. The most common reason for not using the RLP was lack of information.
  
  
  CONCLUSIONS
  There was general lack of experience of using the RLP with women from different cultural backgrounds, with non-Swedish speaking women and, when a partner was present. Due to the non-random sample, the limited knowledge about non-responders and a short follow-up period, results apply to short-term implementations and might not fully apply to long-term implementation.
  
  
  CONCLUSIONS
  The use of RLP in contraceptive counselling appears a feasible way of promoting reproductive health. Results from the USA and Sweden indicate it is a promising tool for midwives and other health professionals involved in reproductive counselling, which deserves to be explored in other nations.
  
  
  BACKGROUND
  Grants were received from the Medical Faculty at Uppsala University and the European Society of Contraception and Reproductive Health. There are no competing interests.
  
  
  BACKGROUND
  N/A.
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, SE-751 22 Uppsala, Sweden jenny.stern@pubcare.uu.se.
authors.forename: J
authors.initials: J
authors.lastname: Stern
authors.affiliation: Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Bodin
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, SE-751 22 Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Grandahl
authors.affiliation: Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Segeblad
authors.affiliation: Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
authors.forename: L
authors.initials: L
authors.lastname: Axén
authors.affiliation: Department of Women's and Children's Health, Uppsala University, SE-751 85 Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Larsson
authors.affiliation: Department of Public Health and Caring Sciences, Uppsala University, SE-751 22 Uppsala, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Tydén
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003267:Contraception / Q000379:methods* / Q000523:psychology; D003376:Counseling / Q000379:methods*; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D017144:Focus Groups; D006176:Gynecology / Q000379:methods; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008875:Middle Aged; D008880:Midwifery; D011320:Primary Health Care / Q000458:organization & administration; D060728:Reproductive Health; D011795:Surveys and Questionnaires; D013548:Sweden; D014481:United States
keywords: contraceptive counselling; family planning; planned pregnancy; preconception care; unplanned pregnancy