Co-designing postpartum contraceptive services with and for immigrant women in Sweden: lessons learned from the IMPROVE-it project

Abstract

Background and aim Immigrant women in many high-income countries including Sweden, report unmet need of sexual and reproductive health and rights, and face worse pregnancy outcomes and higher risk of unintended pregnancies. Postpartum contraceptive services are often inadequate to meet their needs. Co-design has shown to reduce health inequities, yet little is known about using this method for postpartum contraceptive service development and even less in collaborating with immigrant populations. The aim of this paper is to describe the co-design process and the strategies that were developed to help develop tailored and acceptable postpartum contraceptive services for immigrant women in Sweden. Methods The paper describes a co-design process that took place during 2022–2023, including the cyclical digital consultations with Arabic and Somali speaking immigrant women, midwives and researchers, as well as the outputs from the process. The theoretical framework for the co-design process was the ‘Double Diamond’ Design Process Model. Data analysis included qualitative content analysis. Results The co-design process led to the joint development of intervention materials and strategies to improve postpartum contraceptive services. Specifically, the process revealed ideas on how to improve contraceptive counseling within three pre-identified areas of change: improve physical access to contraceptive services; improved communication strategies using visual aids and information charts; and empowerment strategies that focus on reflective practice without assumptions about what a group of women might expect. We found that participants contributed actively to the process with ideas and suggestions, and that the co-design process facilitated positive reflections on ongoing counseling practices. Conclusion The co-design process resulted in the successful and participative development of innovative tools and activities to improve contraceptive counseling services. This approach is original because it involves both immigrant women, often left behind, and midwives delivering the services. Whilst this interplay allowed for careful refinement of services and tools by using an iterative process, it also facilitated reflective midwifery practice.