Table 5 Factors that influence the scaling up of post pregnancy family planning

People

Family involvement, accompaniment, and tradition

[38]

Fear of judgment

[38]

Lack of interest

[45]

Knowledge regarding lactational amenorrhea and suitable contraceptive methods

[50]

Loyalty toward the religious doctrines in religious based hospitals in post abortion contraceptive counselling instead of applying national family planning guidelines

[36]

Male partner:

Integration of men

[45]

Partner sharing in decision making

[47]

Myths and misinformation, Misconceptions about modern contraception

[38, 50]

Perceived quality of facility services

[38]

Factors related to postnatal care

Prioritization by women of scheduled postpartum visits

[50]

Opportunities to encourage continuity of care, especially for PPFP

[38]

A contraception-dedicated six-week postpartum

[50]

Religious and traditional norms:

Sexual abstinence for up to three to six months postpartum

[50]

Social pressure to closely space pregnancies

[38]

Traditional views on the consequences borne by closely spaced children and their mothers

[50]

Cultural and religious objections to family planning and lingering misconceptions

[48]

Service delivery

Access to facility services

[38]

Factors related to counselling

dedicated PPFP counseling materials

[50]

privacy within the health facility

[53]

time necessary to fully counsel women on all available and appropriate methods

[45]

Time required for One-to-one counseling

[55]

Limited availability of clinic days and scheduled visits dedicated to contraception

[50]

Extent of antenatal care (ANC) coverage

[48]

Medical products

Available equipment and supplies

[48]

Availability of readily accessible methods and plans for stock-outs in health facilities

[50]

Financing

Challenges with Engaging private insurance companies

[27]

Financial risk intolerance

[30]

LARC device cost/reimbursement

[27, 30]

Administrative infrastructure and financial flexibility

[30]

Out-of-pocket payment of contraceptives

[50]

Cost/Fund to buy or to purchase the instruments or LARC by health facilities

[27, 49]

Health information systems

Challenges in acquiring data use agreements between public health and medicaid

[27]

Difficulty analyzing raw medicaid claims data

[27]

Long duration for resolving technical billing issues

[27]

Technical complexity of information technology system for claims processing

[27]

Pre-existing strong collaborations across agencies with respect to data

[27]

Leadership and Governance

Leadership stability

[30]

Support from high-level leadership

[27]

Clinical champions

[27, 30]

Co-location of health department and financial agency and/or strong pre-existing working relationship between agencies

[27]

Connecting with rural birthing facilities

[27]

Translating what works across various contexts

[27]

Effect of political sensitivity around contraception on team’s ability to work on increasing LARC access

[27]

Political commitment to post abortion and postpartum FP programs

[49, 50]

Process changes for coders and pharmacy staff members

[27]

Health workforce

Ability to work with other teams in the learning community and share resources

[27]

Continued support and guidance from trainers in informal follow-up visits and phone calls

[48]

Judgmental treatment from health providers

[38]

Inability to perform the procedure or Lack of knowledge/skills about all contraceptive methods

[45, 48]

Lack of live clinical insertions

[45]

Lack of supervision throughout practice insertion sessions

[45]

Pre-existing personal connections of team members

[27]

Shared culture and language facilitated the training, reduced miscommunication between teams, and built engagement and mutual support

[48]

Spill over: hearing about process from others in the learning community

[27]

Team members long and continuous involvement with immediate postpartum LARC initiative

[27]

Turnover in team members

[27]

Uncertainty about goal for immediate postpartum contraceptive use

[27]