Experience of contraceptive care by midwives for nonpostpartum individuals in the Netherlands: a mixed methods study

Abstract

Since 2015, Dutch midwives have been authorised to prescribe all contraception. Initially providing contraceptive care to postpartum clients, they are increasingly offering it to anyone. It remains unknown how this broader population experiences this care. Therefore, this mixed methods study aims to explore experiences of nonpostpartum individuals receiving contraceptive care from Dutch primary care midwives.At 13 midwifery practices in the Netherlands, participants were recruited to fill out a survey and participate in an in-depth semi-structured interview, both based on Levesque’s Conceptual Framework of Access to Health. Univariate and multivariate logistic regression analyses were applied to survey data (n = 91) and thematic analysis to interview data (n = 10).Most survey participants (87.8%) received an intrauterine device during their appointment. A majority (58.2%) rated their care a 10 out of 10. Giving full marks was significantly associated with a higher perceived income (adjusted OR = 3.19, 95% CI = 1.21-8.81, p = 0.021), adjusted for appointment type and time since appointment. Participants reported receiving understandable information, being taken seriously, and having enough time during their appointment. Interviews revealed that participants especially appreciate how midwives make them feel at ease, midwives’ expertise, and the convenience of access.To conclude, given the positive experiences reported by nonpostpartum individuals with contraceptive care from midwives, efforts should be made to improve task sharing and to increase awareness of midwives as contraception providers. Future research should compare care experiences across all types of providers and include a more representative population.PLAIN LANGUAGE SUMMARYDutch midwives have been allowed to prescribe contraception since 2015. They have mainly offered contraceptive care to people after giving birth. Recently, they started to provide contraceptive care to a broader population. However, it is unclear how these people feel about contraceptive care provided by midwives.That is why we studied the experience of accessing contraceptive care at midwifery practices in the Netherlands. 91 participants completed a survey and 10 people took part in interviews.Of the survey participants, 58.2% rated their care experience a 10 out of 10. People with higher incomes were more likely to rate the care a 10. Interviews showed that participants valued the midwives’ skills and knowledge. Participants also mentioned that they felt at ease and that it was easy to access contraceptive care at midwives. However, many thought midwives only provided care related to pregnancy.To conclude, participants reported very positive experiences with contraceptive care from midwives. To improve access to contraceptive care, it is important to raise awareness that midwives can also provide contraception. Future research should compare contraceptive care experiences across all providers and include a more diverse population.