Introduction In 2013, the World Health Organization (WHO) pointed out that preconception care is relevant for all women of reproductive age. In highincome countries many women postpone childbearing until ages when their fecundity has decreased, whereas many women in low-income countries would benefit from delaying their first pregnancy and space subsequent pregnancies (WHO, 2013). Preconception care is defined as a set of interventions that aim to identify and modify biomedical behavioural and social risk to a woman’s health or pregnancy outcome through prevention and management (Moos et al., 2008). Since the most critical period for organ development occurs before many women even know they are pregnant, the first contact with antenatal care is often too late for advice about healthpromoting changes in lifestyle. The reproductive life plan (RLP) is a health-promoting tool recommended by the US Centers for Disease Control and Prevention (CDC) for improving preconception health and decreasing unintended pregnancies and adverse pregnancy outcomes. CDC recommends health professionals to use the RLP to screen women and men for their intentions to have or not to have children in the short and long term and their risk of conceiving (CDC, 2006). The RLP has the potential for use in many areas of the world. The RLP consists of a set of nonnormative questions on having or not having children (Moos, 2003), and aims to encourage women, men, and couples to reflect on their reproductive intentions and find strategies for successful family planning within the context of personal life goals and values (Moos et al., 2008). This includes having the desired number of children, avoiding unwanted pregnancies, and avoiding ill health that may threaten reproduction. Women with diabetes, hypertension and obesity were the target group when physicians at a Family Health Center in the USA tested the RLP concept. The intervention increased women’s knowledge about reproductive health, especially among those with the lowest precounselling test scores and among women without children. The authors concluded that the RLP was a brief, cost-effective counselling tool for women with chronic diseases (Mittal et al., 2014). Another study from the USA among low-income, African-American and Hispanic females and males attending publicly funded clinics showed that more female than male primary care patients viewed questions about patients’ reproductive plans as important (Dunlop et al., 2010). Also young healthy and well-educated women can benefit from a discussion about their RLP. In a RCT (Stern et al., 2013), the RLP concept was used in contraceptive counselling among female university students in Sweden, a group who tend to postpone childbearing until the age when their reproductive capacity has started to decrease and overestimate the chances of having a child with IVF (Lampic et al., 2006; Peterson et al. 2012).Women receiving RLP-based counselling increase their knowledge about fertility and intend to have their last child earlier in life, and nine out of ten state midwives should routinely discuss a RLP with their patients (Stern et al., 2013). The adoption and implementation of new methods of prevention and health promotion in the health care system is a complex process. According to Fleuren et al. (2004), determinants that may impede (or facilitate) an innovation within a health care organization can be categorized into: characteristics of the socio-political context, characteristics of the organization, characteristics of the adopting person, characteristics of the innovation and characteristics of the innovation strategy. Although the CDC has recommended the use of RLP in health care settings for many years, there is a lack of information on the adoption of the RLP in routine care and how health care personnel experience the RLP. The aim of this study was to investigate midwives’ adoption of the RLP in contraceptive counselling in one county in Sweden. Methods Design Exploratory mixed methods study among midwives in primary health care with questionnaires and focus group interviews. Context and setting Contraceptive counselling in Sweden is free of charge and mainly offered by nurse-midwives at antenatal/family planning clinics and youth clinics within the primary health care system. Midwives are responsible for healthy women and refer women with chronic diseases to gynaecologists. Until spring 2014, the national guidelines for contraceptive counselling focused solely on medical history and information about advantages and disadvantages of different contraceptive methods, but they now state that discussions about future reproduction can be included in the counselling (The Medical Products Agency, 2014). The study was conducted in mid Sweden, in a county that covers both rural and urban areas. The county has 345 000 inhabitants, 14% are born outside Sweden, and the mean income is 215 000 SEK/year for women and 288 000 SEK/year for men. The education level is similar to the Swedish average, i.e. 27% of the population have postgraduate