useless 0 Missing 0 In the future, I will use the RLP... Always/often 19 Sometimes 16 Seldom/never 0 Missing 1 . Table II Characteristics of midwives responding to the questionnaire, n 5 53. Characteristics Midwives who used the RLP n 5 36 Midwives who did not use the RLP n 5 17 P-value Age (years), mean+SD (range) 52+10 (31–65) 48+10 (34–65) 0.116a Years of experience of contraceptive counselling, mean+SD (range) 13+11 (1–40) 9+9 (0.5–30) 0.222a Workplace 0.130b Public health care provider 30 11 Private health care provider 6 6 Type of clinic 0.882b Midwifery clinic 25 12 Both midwifery and youth clinic 11 5 Number of visits for contraceptive counselling/week, mean+SD (range) 15+7 (6– 30) 11+6 (3– 25) 0.024a a P-value for comparison between the two groups, analysed with Mann –Whitney U-test. b P-value for comparison between the two groups, analysed with Pearson’s x2 test. 1150 Stern et al. Downloaded from uest on 02 February 2022 1.1. Rewarding and easier than expected The midwives expressed the RLP gave the discussion a different angle when actively posing the question about intentions of having children. They also experienced the RLP as interesting, exciting, and fun, and that it refreshed and updated their knowledge. Initially, they were concerned it would be more complicated and difficult to get started, but found it easier the more they used it. There is a difference, now I take this up... otherwise you would just talk about it if the patient has taken up the issue of children. [FGI4] 1.2. Good start for broadening the counselling Both the RLP-guide and the booklet were considered good conversation starters. Questions were easy to pose, and helped them raise the topic with specific individuals. The RLP was experienced as a structured and systematic way of working that broadened the counselling, gave it a context, worked as an eye-opener and made the women think about their plans. Consequently, there was a more reflective interaction. However, there was a risk of being stuck with detailed questions from the woman, for example about the kind of vegetables containing the highest concentration of folic acid. You get it in a context, such as why do we talk about BMI, why do we talk about smoking... that you see the bigger picture [FGI3] 1.3. Time efficient or time consuming: different experiences The midwives considered other competing tasks, such as antenatal care and cervical cancer screening, a hindrance to using the RLP, but had diverse experiences of time spent on the RLP. Some expressed it took extra time and only raised the questions when they felt they had time Figure 3 Overview of the results from the qualitative analysis. Midwives’ adoption of the reproductive life plan 1151 Downloaded from https://academic.oup.com/humrep/article/30/5/1146/590484 by guest on 02 February 2022 for it. Others described the RLP as less time consuming than expected, and some stated it to be time efficient or even take less time than standard care. The RLP was experienced as less time consuming and more efficient than other routine questions. Although I am surprised at how little extra time it took [FGI3] 1.4. Predominantly positive reactions from women The midwives considered women reacted more positively than they had expected; most women were interested and were happy to be asked. The midwives experienced a need for, and wish, to discuss this topic, and that most women were receptive to the information. Still, some women were not interested and one even expressed that it was a rude question and her own business. Even though many women had not reflected over their plans, the midwives were surprised by individual women’s answers and that many had a clear vision. The midwives described that many women had unrealistic plans and wanted to keep all options open and many women were surprised when they realized how little they knew about reproduction. I think some light up... they are actually glad that you take this up... [FGI4] 1.5. Informing without intruding requires tactfulness and professionalism The midwives felt that the RLP was disarming; it does not presuppose anything about the woman, but enables the midwife to provide information without intruding. Still, it was discussed whether it was appropriate to pose these questions; if a woman’s plan for childbearing is not after all a private matter. The midwives emphasized the importance of tactfulness in adapting the information to the individual woman and the particular conversation. It was also considered important to be professional and non-judgmental, and to pose the questions with interest rather than indifference. Some stated that just asking the questions could never be harmful, whereas others were concerned about the risk of applying pressure and initiating unwanted processes. Some groups were perceived as more difficult to counsel in a good manner than others were, such as very young women and single women. There is a risk that you ask the question wrong... that it is not a natural question... so... I think the patient feels you are interested... if you ask the question honestly [FGI4] 2. The RLP: a health-promoting tool The midwives considered the RLP as a health-promoting concept that gives additional value to the contraceptive counselling. I think