Table 2 Identifying the intervention messages for family planning for the BornFyne PNMS v2.0

1. Timing of use of family planning, removal, and when to get pregnant

Participants’ discussion revealed that they knew about family planning, but some areas were of concern to them especially when to start using family planning and after removing the family planning when to get pregnant or how soon they can get pregnant. Most were ignorant of how each method works and limited knowledge and understanding of some of the methods.

“I was scared that it could happen and that I could no longer give birth. I practically bled for 2 weeks like a woman had just given birth. My mother kept talking because I gave birth at 16yrs. The first injection normally disturbs, but we never know about the 2nd one. I took the 2nd one and after 3 months, I was dry for almost 1 year/ I stopped menstruating for almost one year I had transformed. After 2 years, I had sex, that’s how pregnancy came along” [FGD Women Akonolinga.]

A woman who was teaching walked past my door and told me about family planning. She told me that when I removed the family planning, I was still very fertile and wasn’t supposed to sleep with my partner. I didn’t know and the person that removed it also didn’t tell me anything. Once I removed it, in less than a month I got pregnant. That’s all about the family planning (FGD women Tiko)

The implant can be removed at any time (maximum 3 years after placement). On the day of removal, a new implant can be placed in the same place [1].

Ideally, young women and men should not have children before the age of 18, or before they have completed their studies and are ready to do so [1].

2. Post family planning removal what to do?

It was understood during the discussion that women were ignorant of how some of the methods should be administered and what to do after removal.

They told me, that if I wanted to get pregnant, I needed some antibiotics to clean my system. A nurse approached me and advised me to take antibiotics to ‘clean’ my system before I got pregnant, and if I didn’t want to take antibiotics, I should wait for the family planning to finish my system, so that way I could get pregnant. I waited for it to finish in my system until I got pregnant. (Tiko) For 5 years it disturbed me a lot. I was pale, wasn’t eating, I looked white as though I didn’t have blood. They advised me to remove it because it was disturbing me (FGD Women Tiko).

You can become pregnant as early as one week after taking an implant. After implant is withdrawn, and if you do not wish to become pregnant at this time, you must immediately start using another method of contraception, such as condoms. Women may experience mild discomfort and some bruising after implant removal [2].

There are no medical problems caused by a delay in the removal of long-acting methods such as implants or IUDs. Do not attempt to remove the contraceptive method yourself; wait until you have access to health care from a qualified provider [3].

3. What type of family planning method is best?

Generally, both men and women across all districts were interested in knowing what type of family planning is best and how to go about it. They were very eager to get answers to specific questions on specific family planning methods, some saw condoms as the best method especially as it also could prevent STIs but at the same they did not understand why a condom should burst Some women saw the natural method as ideal.

we just go and get it done when we haven’t done blood tests to know if it is compatible with us. I’m speaking for myself, If I want to use it once I’ve given birth, I need to go get checked at the hospital first to know which I will be compatible with before I can take it.

I’m interested, particularly on the part of choice, since there are many side effects there may be a method that suits your wife. It seems many women have that issue so you may need another method but which? (Akonolinga)

All modern methods of contraception help prevent pregnancy. Women and their partners can choose any modern contraceptive method that is acceptable and safe for them. There is a wide variety of modern methods, one of which may suit you best. Condoms, when used consistently and correctly, are the only method of birth control that helps prevent unwanted pregnancies and protect against sexually transmitted infections, including HIV. They can be used with other birth control methods to protect against both unwanted pregnancy and sexually transmitted infections.

Emergency contraceptive pills can prevent up to 95% of pregnancies when taken within five days of having sex, and they can be taken by anyone with or without a medical condition [3].

4. Steps to considered before using family planning

It is only later that a woman explained family planning to me. She said they usually check the person before knowing which one is good for them. The one for 1 month may have not been good for me, but I could try the one for 3 months or 5 years. Family planning is good, just that it wasn’t good for me, that’s why I stopped. [ Women FDG Tiko]

The adoption of a contraceptive method may depend on several factors: age, education, physical health, parity, profession, intervention of spouse or partner, rumour, quality of information received on the method [4].

5. Potential side effects

Concerning infertility, when I had the first plan A in implanting, we took a break, and then we went on. When we went on we had my woman conceive. However, she had a stillbirth during delivery, and that’s when we started asking questions. Since I saw so many advantages, I had to keep using it, I’m still wondering whether I should go on after taking on this one or I should carry on with implanting. I’m wondering whether that stillbirth was caused by that family planning or something else, as the diagnosis did not show the cause of it [Tiko men FGD]

• it can wake up acne problems,

• it can promote weight gain in certain predisposed women,

• it can lead to menstrual disorders (bleeding between periods, irregular periods, absence of periods) [5],

6. Who to talk to and when?

Most respondents expressed challenges in communication especially when and who to talk to. Some men also expressed challenges in communicating with the women. Some women also find it challenging to communicate with men and sometimes engage in family planning practice without informing the husband or partner. When they start experiencing side effects, they will want to involve the husband so some men didn’t see it as the right approach because they believed family planning should be discussed as a family and not only the woman.

Other methods can change your menstrual cycle in a way that disturbs you a lot and causes you to spend a lot of money. If you meet a doctor that is not experienced, he may insist you took some tablets, when you didn’t take them.

It’s also difficult for that type of woman to talk about what they’re experiencing if you as a man don’t ask her what is bothering her.

If you notice any other type of side effect not mentioned above, you should either contact a qualified health care professional, or go to the nearest health facility[ref].

7. Silo decision making

Some men are particular about the way some women make decisions without consulting their husbands and they believe this is not right when there is a negative outcome that is when the women will be aware of what they have engaged in and sometimes they have to tendency to blame it on cultural aspects.

However, in today’s world, many women are making the discussion to undertake family planning by themselves. When a problem arises, they blame it on an elder (ancestors) in the family saying that they are the ones that have blocked them. Though she is the one that has implanted or injected family planning at a young age. (FGD men Tiko)

Women should talk with their husbands and the husband talk with their women to discuss about family planning for their household

8. Family and household education and communication

I will add in the same light by saying that it is in our customs in Africa generally when 2 people get together, it should automatically result in making children. There is this education that Africans receive, a woman who does not have children in her home is not considered a woman. On top of that, we Africans have received an education that a child represents wealth, so the one who has more children has an abundant workforce that can allow him to become someone well-positioned in life, which makes it difficult to ask Africans to go to a family planning because it is in the education. This vision will come with time because it is necessary to advise people a lot, and it is necessary to raise awareness. I think that awareness will come much more from the man’s side because it is the woman who carries the child, it is the woman who undergoes everything, but the man is the one who puts the child, he only waits for the day and this is why in couples it is necessary to raise awareness among men. Because the real difficulty is at the level of men, women do it without telling their husbands and the consequence is that many of them do not manage to conceive in a short time. This means that when they stop using this method to conceive again, it becomes difficult [FGD Men Akonolinga/Tiko]

Family planning allow young girls and boys, women, men and couples to determine the number and timing of pregnancies through the use of a method of contraception.

9. Youths and adolescent girls and boys

Nowadays, what we notice is that most youngsters don’t use condoms. Maybe the boy will want to use the condom but the girl will refuse saying that the condom reduces the pleasure. So, when the girl says that, you the guy must obey because you want to satisfy your partner. They usually say “We don’t eat bananas with its skin”. So, to eat a banana you must remove the skin. If you insist, she will refuse. And that is how we go on for it.

Parents should really emphasize the education of their children, especially young girls. They are vulnerable. We should prompt parents to discuss with their children, boy or girl, we don’t know where the problem can come from

For the girl, from the onset of menstruation. Parental consent is mandatory. But ideally from 15 years old

10. Post-partum period for women after given birth

After giving birth I went for them to place it. It really disturbed me and in less than 2 months I went back for them to remove it. As I removed it, in less than a month I got pregnant. (The woman that was giving it to me didn’t explain it to me. She just said it’s good as it prevents me from getting pregnant. (Tiko)

For the woman who has just given birth, it is advisable, immediately after childbirth, to use a method of family planning to avoid pregnancy. If you do not practice exclusive breastfeeding immediately after delivery, it is advisable to use another form of contraception.