Table 2 Applying the COM-B model to explore the barriers, facilitators and recommendations to uptake of immediate postpartum LARC

Capability

Psychological

• Lack of knowledge

• Misconceptions (need to wait for menses, effect of birth trauma on use of LARC, perceived body fragility immediately after birth)

• Religious beliefs

• Accurate knowledge on LARCs

• sensitization by health workers while in health facilities

• community sensitization by health workers and VHTs.

Opportunity

Physical

• Lack of health worker-initiated family planning services,

• overburdened health workers,

• Shortage of equipment used to offer LARCs

• stock outs of LARCs .

• health workers do not have skills in offering LARC services.

• Availability of PPFP LARC

• Health workers have skills to offer the LARCs.

• Lobby for LARC from other health facilities.

• Training Midwives to enhance their skills in PPFP.

Social

• Men do not accept LARC if the decision is made without them

• No time to attend health facilities

• health workers appear stressed or harsh

• Good attitude of health workers

• Joint decision-making with partner to take up FP:

• Partner support

• Provision of privacy and confidentiality to women

• Offering both individual and couples’ counselling about PPFP during ANC visits and at postnatal units.

Motivation

Automatic

• Social norms

• Negative influence of family and friends about use of LARCs.

• Desired family size

• lack of sexual intimacy after delivery

• Resuming sexual activity after delivery

• Educated mothers

• Positive attitude towards couple counselling and FP use,

• Positive influence by partners, family members, and health workers.

• Having attained a desired family size

• male involvement in ANC and other health services, sensitization by expert clients.

Reflexive

• Discomfort of insertion and removal of LARC methods

• Fear of infidelity

• Side effects

• Negative experience

• Differing fertility goals

• Desire to space births / avoid conceiving too soon

• Long duration of action

• Approval to the utilization of LARC

• Preference for LARC

• Sensitization, need for individualized FP

• Sensitization by use of poster images about PPFP and media.