education. In spring 2014, the county had 68 midwives in 21 clinics with 20 000 visits/year for contraceptive counselling. All midwifery activities within the county’s primary health care system are led by a co-ordinating midwife and a chief physician, who regularly convene educational meetings. The average time allocated for contraceptive counselling is 30 min and electronic medical records are used. Procedure and participants The co-ordinating midwife and the senior consultant in antenatal care supported the study. During an educational meeting in autumn 2013, the midwives were informed about the RLP and invited to participate in the study. All 51 midwives present were offered the opportunity to use the RLP in their counselling, and 36 midwives from 16 clinics volunteered. After the meeting, telephone contact was made with all clinics to invite additional midwives who had not attended the meeting. Out of the 68 midwives, 53 midwives volunteered to use the RLP. After receiving the RLP material, they were invited to a focus group interview (FGI) 3 months later. Materials given to the midwives Participating midwiveswere provided with an RLP guide and a booklet.The RLP guide (Fig. 1) aims to assist the midwife in operationalizing the RLP in contraceptive counselling. The booklet was study-specific and consisted of 28 pocketsized and colour printed pages in Swedish to be handed out during the counselling. An overview of the content of the booklet is presented in Fig. 2. FGIs Midwives who had experience of using RLP in contraceptive counselling were invited to participate in a FGI. Focus groups are used with the intention to better understand people’s views of a subject. It creates a non-judgemental environment and can encourage participants to share their views without the need for consensus (Krueger and Casey, 2009). Five FGIs with 22 midwives were conducted in spring 2014 with a moderator and an observer. Each group consisted of 4 – 5 midwives and took place in conference rooms at Midwives’ adoption of the reproductive life plan 1147 Downloaded from https://academic.oup.com/humrep/article/30/5/1146/590484 by guest on 02 February 2022 the workplaces. A study-specific interview guide with open-ended questions was used, which covered the areas: (i) overall experiences, (ii) recall of specific experiences, (iii) the overall concept of the RLP, (iv) the materials (RLP-guide and booklet), (v) reactions from women, (vi) the future and (vii) the RLP for partners and/or for men. Both positive and negative aspects were probed, and when needed, follow-up questions were asked to clarify the statements. The interviews lasted on average 91 min (range 64 – 118 min), and were recorded and transcribed verbatim. The midwives received a gift voucher for their participation. Questionnaire All midwives in the county (n ¼ 68) received a study-specific questionnaire with questions about their background and overall experience and opinions on different aspects of the RLP. The background questions covered age, years of experience of contraceptive counselling, type of workplace (public/ private health care provider; family planning/youth clinic), number of visits for contraceptive counselling/week, and number of visits where the RLP was used. Questions about the RLP were posed as Likert items on the overall concept (range of five scores on a continuum from very good to very bad), their general practical experience (very positive—very negative), the booklet (very useful—very unusable), the RLP-guide (very useful— very unusable) and intended RLP usage in the future (always—never). Participants who had not used the RLP were asked to state their reasons, through the following alternatives: not received information about RLP; did not have time/energy to engage in a new project; the information was insufficient; do not like the idea of the RLP in contraceptive counselling; time constraints/special circumstances at the clinic; sick leave/parental leave; or Figure 1 The reproductive life plan (RLP) guide developed to assist the midwives during counselling. 1148 Stern et al. Downloaded from https://academic.oup.com/humrep/article/30/5/1146/590484 by guest on 02 February 2022 other. Midwives participating in the FGI completed the questionnaire before the interview, and the remainder of the midwives received a postal questionnaire at their workplace. One reminder was sent to non-responders after 2 weeks. The response rate was 78% (n ¼ 53). Data analysis The interviews were analysed with qualitative content analysis, as described by Burnard et al. (2008). To obtain an overall picture of the data, transcripts were read several times. In the open coding, notes were made in the margins to summarize the relevant data according to the aim of exploring midwives experiences and opinions of the RLP. After deleting duplications, all initial codes were collated and compiled into subcategories and finally into categories. The analytic process involves back and forth movements to the text, and categories were traced back in the transcripts to ensure validity. The initial analysis was carried out by three of the authors and was validated by two of the others. Examples of the analytical process are presented in Table I. The questionnaire data were entered and analysed with the Statistical Package for Social Sciences