implementation comprises opportunities, risks and needs Some midwives stated they had all the information they needed to use the RLP, whereas others believed they needed more knowledge and wanted more information before starting to use the RLP. It was suggested that more in-depth preparation for all midwives through role-plays and group discussions could have facilitated the introduction of the RLP. Suggestions for the future included incorporating the concept into midwifery education, translating the booklet into different languages, and developing internet resources that midwives could refer to for further information. It is obvious that we should continue, that’s what it feels like. This is fun and exciting [FGI1] 4.1. Making the RLP mandatory might be a double-edged sword The midwives considered it would be advantageous if all midwives used the RLP, but stated that some kind of guideline needed to be developed to make this happen. However, there was some concern about making the RLP mandatory, as this could mean the RLP lost its attraction and that the questions would be posed in an indifferent way. For everyone to do this, then something needs to come from higher up... now we are going to start with this and everyone will do it ... otherwise it will just be for those that think it is... fun [FGI4] This is fun to work with and great to work with, but if it comes as a must... then it would not be as much fun anymore. [FGI3] 4.2. Facilitating and problematic documentation The midwives wanted an easy and quick way to register the RLP counselling in the records, but disagreed on whether the woman’s individual RLP should be included in the documentation. If the woman’s answers were noted, it would create a possibility for follow-up and avoid what they felt would be an unprofessional repetition of the question. On the other hand, it was perceived as unethical to document plans that could change over time and it could also lead to the midwife not daring to ask again. It was also suggested that the woman ought to decide for herself whether her RLP should be documented or not. If you don’t document it anywhere then you have to start afresheach time and then it might well be perceived as a bit, I don’t know... Repetitive Unprofessional somehow... a bit repetitive [FGI1] 4.3. Expanding RLP usage The midwives considered the RLP needs to follow the women from an early age through their fertile life, and that arenas other than midwifery should be involved to reach all women. It was suggested the concept would also be appropriate for men and that the booklet could be distributed on its own, without the counselling to reach a broader target group. Schools, youth clinics, student health centres and primary health care centres were suggested as possible arenas. Other professionals such as teachers, school nurses, health nurses, doctors, dieticians, counsellors and sexologists might also benefit from using the RLP. Not everyone comes to us! So there must certainly also be another forum. [FGI1] Discussion The RLP is potentially a relevant tool for reproductive counselling globally. This study provided the first exploration of its adoption in clinical practice, for which Swedish midwifery care served as an exemplary setting. A majority of the midwives approached adopted the RLP in their contraceptive counselling and their experience of the RLP was predominantly positive. They considered the RLP as a health-promoting tool suitable for, but not limited to, contraceptive counselling. The most common reasons for not using the RLP were related to practical matters, such as lack of information, rather than the concept itself. Both qualitative and quantitative data were used to gain a deeper understanding of the adoption of the RLP. The study was conducted among midwives, as they are the main providers of contraceptive counselling in Sweden. The survey response rate was high, but it is possible non-responders had different reasons for not using the RLP or different experiences and opinions of using it. One large private clinic dropped out due to heavy workload and those midwives did not return the questionnaire. Except for type of workplace, we have no further information about those who did not respond to the questionnaire. The follow-up was conducted 3 months after the midwives received the RLP material. Although a longer test period might have generated Midwives’ adoption of the reproductive life plan 1153 Downloaded from https://academic.oup.com/humrep/article/30/5/1146/590484 by guest on 02 February 2022 a broader range of experiences and slightly different opinions about the RLP, it was considered valuable to capture the midwives’ first impressions and identify any immediate potential hindrances; therefore, a 3-month test period was chosen. A registered nurse and two registered midwives, both known to the midwives but not acquaintances or colleagues, conducted the FGI with the midwives. To help create an open discussion climate, it was emphasized that the interview did not aim to evaluate the midwives as professionals, but their experiences and opinions about the RLP, and that positive and negative aspects were equally important. The mixed method of the survey and the FGIs was a strength and a way of confirming the findings through triangulation. We undertook several measures to ensure trustworthiness