Implementability of contraceptive implant insertions during midwife postnatal home visits: an exploratory qualitative study

Abstract

Many women lack access to contraception information and services during pregnancy and postnatally and are at risk of unintentionally falling pregnant again soon after birth. Contraception enables women to attain their desired number and spacing of births. Better access to postpartum contraception is critical for informed decision-making, higher uptake and improved health outcomes. Home-based provision of the contraceptive implant may contribute to increasing access. To explore the views of midwives on the implementability of midwives providing contraceptive implants during postnatal home visits METHODS: We conducted an exploratory qualitative interview study with 21 midwives. Reflexive thematic analysis was used to construct themes. Home implant insertions were seen as generally acceptable and potentially feasible. Midwives' primary concerns related to workload and scheduling, although most felt this could be manageable, particularly in continuity models. Two factors to promote implementability included i) enhanced 'contraception conversations' in maternity settings, and ii) strong leadership and support, including a policy and training framework, opportunities for practice, and consideration of workload. Midwives felt home insertions would be well-suited to continuity care models. Although this may be a beneficial starting point, it means key groups of women who would also benefit from contraception may be missed. Midwives viewed provision of home implant insertions as generally acceptable and potentially feasible, in the context of early and ongoing contraception conversations and proper planning and support. Further research trialling implant insertions during midwife postnatal home visits is warranted to determine feasibility and acceptability in real settings.