Arabic speaking women's experience of postpartum contraceptive counselling in Sweden

Immigrant women living in Europe report lower use of contraceptives compared to native born women. The postpartum period is a key opportunity to provide high quality contraceptive counselling to support birth spacing, but little is known on how the counselling could be adapted to meet the needs and preferences of immigrant women. Approximately a third of all women giving birth in Sweden have an immigrant background, whereof Arabic speaking women constitutes one of the largest groups. Hence, the aim of this study was to explore Arabic speaking women's perspectives of contraceptive counselling postpartum.  METHOD: Five focus group discussions (FGDs) were conducted with 23 Arabic speaking women. The FGDs were conducted in Arabic and translated to English. Data was analysed using reflexive thematic analysis.

Four main themes were created: 1) Adapting to new circumstances influence reproductive intentions:raising children in a new setting was described as a double burden and birth spacing was seen as essential for the family's wellbeing. 2) Reproductive decision-making - the women's choice but partner's support is important: inviting the partner to the contraceptive counselling was thought to enhance both his knowledge of contraceptives and his understanding of the woman's entire life situation postpartum. 3) Conflicting information about contraceptives creates hesitancy: navigating opposing information on contraceptives from the woman's home country and midwives in Sweden was confusing and fears of negative side effects from contraceptives were deep-rooted. 4) Trust and mistrust in antenatal and postpartum contraceptive services: trust included experience of emotional support and an open-minded attitude from the midwife. Mistrust involved scarce support in handling side effects, limited decision support and a feeling of breached privacy.

To provide person-centred and equitable contraceptive counselling postpartum, health care services need to shift attention from individual barriers to how the counselling can be improved. Key elements include integrating the concept of birth spacing in the postpartum contraceptive counselling, ensuring accessible follow-up services and to provide comprehensive information in the native language to support informed choices. An open-minded engagement with patients is also central to provide contraceptive counselling that is inclusive for all women.