We interviewed 39 participants. 20 of these were in-depth interviews ( nine postpartum mothers, three male partners, one ANC mother, four health workers and three VHTs) and three FGDs where one was with six antenatal mothers, another with seven postpartum mothers and one with six men whose partners were in the postpartum period. Among the indepth interviews, we interviewed 3 couples. None of the participants declined to enroll in the study. The age range of the most participants was 20 to 35 years(n = 31), while the majority were of formal education (n = 37) and were peasants (n = 20). Most of the participants were of the Bagisu ethnic group, had one to three children (n = 14) and delivered from a health facility (n = 31).
Table 1
Characteristics of participants
Characteristics | Postpartum Women (N = 16) | Antenatal women (N = 07) | Men (N = 09) | Health workers (N = 4) | Village health teams (N = 3) |
Age | | | | | |
< 20 | 01 | 00 | 00 | 00 | 00 |
20–35 | 15 | 07 | 06 | 03 | 00 |
¬ 35 | 00 | 00 | 03 | 01 | 03 |
Marital Status | | | | | |
Single | 00 | 00 | 00 | 01 | 00 |
Married | 16 | 07 | 09 | 03 | 03 |
Education level | | | | | |
No education | 02 | 00 | 00 | 00 | 00 |
Formal education | 14 | 07 | 09 | 04 | 03 |
Occupation | | | | | |
Peasant | 12 | 04 | 04 | 00 | 00 |
Housewife | 03 | 01 | 00 | 00 | 00 |
Teacher | 01 | 00 | 00 | 00 | 00 |
Self employment | 00 | 02 | 03 | 00 | 00 |
Motorcyclist | 00 | 00 | 02 | 00 | 00 |
Nurse/ Midwife | 00 | 00 | 00 | 04 | 00 |
Village health team | 00 | 00 | 00 | 00 | 03 |
Ethnic Group | | | | | |
Bagwere | 04 | 00 | 04 | 02 | 03 |
Bagisu | 03 | 06 | 05 | 02 | 00 |
Baganda | 00 | 01 | 00 | 00 | 00 |
Place of Delivery | | | | | |
Home | 01 | 00 | 00 | 00 | 00 |
Health facility | 15 | 07 | 09 | 04 | 03 |
Parity | | | | | |
1–3 | 10 | 05 | 03 | 02 | 01 |
4–6 | 04 | 02 | 06 | 02 | 02 |
> 7 | 02 | 00 | 00 | 00 | 00 |
Enablers and barriers to uptake of immediate postpartum LARC
We identified 3 themes which were enablers, barriers, and recommendations. These had sub-themes which were structured around the COM-B model. The enablers and barriers were aligned into capability, opportunities, and motivation of behaviour.
Table 2
Applying the COM-B model to explore the barriers, facilitators and recommendations to uptake of immediate postpartum LARC.
Com-B domain | Sub-domain | Barriers | Enablers | Recommendations |
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). • lack of sexual intimacy after delivery • Differing fertility goals, | • Knowledge on LARCs • Need to resume intimacy with their partners • having attained a desired family size, conceiving too soon, | • sensitization by health workers while in health facilities • community sensitization by health workers and VHTs. |
| Physical | • Unaware and unskilled health workers in offering LARC services. | • Health workers have skills to offer the LARCs | • Training Midwives to enhance their skills in PPFP. |
Opportunity | Physical | • Lack of health worker-initiated family planning services, • overburdened health workers, • Shortage of equipment used to offer LARCs and stock outs of LARCs . | • Availability of PPFP LARC. | • Lobby for LARC from other health facilities. |
| Social | • Harsh workers • Lack of partner support • lack of agency to ask for health education. | • Good attitude of health workers • Joint decision-making to take up FP • Partner support | • Provision of privacy and confidentiality to women • Offering FP counselling during ANC visits and at postnatal units. |
Motivation | Automatic | • Negative influence of the care taker about use of LARCs. • Lack of male involvement. | • Positive attitude towards couple counselling and FP use, • Positive influence by partners, family members, and health workers. • Male involvement in ANC couple counselling on FP. | • Recruitment of male VHTs • male involvement in ANC and other health services, sensitization by expert clients. |
| Reflexive | • Fear of infidelity, • side effects, • Discomfort of procedures of LARCs • Negative experience | • Educated mothers • Long duration of action, approval to the utilization of LARC, • preference of LARC. | • Sensitization, need for individualized FP, • Sensitization by use of poster images about PPF and media. |
Theme 1: Capability
Women`s capability to take up immediate PPFP was hindered psychologically and physically.
Sub-theme A: Psychological capability
The following factors psychologically impeded the women`s capability to uptake of immediate PPFP; 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), lack of sexual intimacy after delivery, Differing fertility goals.
Limited Knowledge and misconseptions
Due to limited knowledge on PPFP, many participants developed misconceptions about PPFP methods. This therefore would affect their psychologically capablilty of deciding to take up the PPFP. We identified misconceptions and fear of side effects, differing fertility goals, need for menses to return, lactation amenorrhea, birth trauma after delivery, inexperience in use if the IUD, perceived body fragility, perceived women`s role in the family and fear of side effects as hinderances to uptake of PPFP.
Misconceptions
The utilisation of LARC especially IUD was hindered by the misconceptions surrounding IUD use. The misconceptions regarding the use of IUDs and implants included interference with sexual intercourse, disappearance in the body, causing weight gain, excessive bleeding and infertility. Women thought that insertion of the IUD required measurement of the length of partners’ penis.
“Yes, women always complain. That if they insert that coil, it disappears in your body; that it kills off eggs (ova) in a burnt manner….that it …goes up to the heart. (23year old postpartum woman).
“if it( the IUD) starts to harm me during sexual intercourse, then I feel pain, I start to ask myself that what is it? Or sometimes then we divorce” (53 year old Male partner)
“That coil me I hear the people who go for it say that they measure the length of your husband’s penis and they say that if you go for that coil you do not have to cheat, that when you cheat you get problems because men are not the same (in terms of the length of the penis) and that the coil is not good.” ( 27year old postpartum woman)
Misconception for the need to wait for menses and lack of sexual intimacy
The use of LARC in the immediate postpartum period was perceived to be irrelevant since the menstrual periods had not yet returned. Women thought that absence of menses meant that they could not conceive, while others thought that LARC uptake in the immediate postpartum period was only relevant for those whose menses had returned early. Return of menses was also key for women who thought that LARC would cause amenorrhea. Some women wanted to know when their menses would return after birth, and so, were reluctant to use family planning methods which would interfere with the return of their menses.
“Yes I cannot accept because if you do not see the period and you get like that family planning injection, you will be without having your periods you will not understand yourself. It needs you first menstruate and see that period. I first see the menstrual blood before (getting a method)” (27 year old postpartum woman).
The idea of using postpartum LARC immediately after childbirth was foreign to some women and male partners because of the lack of intimacy at this period.
“…as the husband I cannot be with her intimately immediately after birth…. So, at least I wait for her to return to her normal way. When she bleeds following birth, time comes and she is dry [lochia stops], but even if she is dry as the partner you can give her another one week before you can resume your game [sex]” (38 year old male partner).
Misconception for the need to recover and body fragility after delivery
Immediate postpartum LARCs, especially the intrauterine device, were perceived to add more pain to those who experienced a traumatic delivery. Women, therefore, preferred to first recover from the birth trauma before taking up any method.
“ there for me, basing on what(having a painful vaginal tear repair after birth) i went through, I feel that you be adding me more pain(if you insert a coil immediately after child birth). Yes, in the process of putting it. You be when you are still fresh, like there they have vaginally repaired them, those one who are vaginally repaired. Ok the stitches be still painful then you add” (30year old postpartum woman)
The capability to use LARC was crippled by the nearly universal disapproval of its use in the immediate postpartum period. Women and male partners were reluctant to use LARC immediately after birth because of the perceived need for the woman to fully recover from the after-effects of childbirth including that the woman was still weak to use LARC. Women thought that their bodies were still fragile to use family planning immediately after birth. The fact that women were still bleeding made women to be more hesitant to use IUD as it was thought to make bleeding worse. This was especially important given that women lacked enough blood during this postpartum period. The associated pelvic pain during postpartum, and still fresh vaginal tears and repairs hindered the insertion and use of IUD during the immediate postpartum period.
“At least six weeks after birth. Immediately after birth I see she is still bleeding because she has just given birth, the “way” is still very wide,... So, if you put when the way is still wide, when it goes back to normal it might affect her” (38 year old Male partner)
“…I cannot accept. the uterus can be when it has not yet gone back to its original position. And you are still over bleeding. And you do not know when that bleeding is going to stop, in what period. You may say that you insert it in then you bleed over and over. And you say, this thing is the one causing the bleeding. yes, so for me I cannot accept it(the IUD). (35 year old Pregnant woman attending ANC)
Desire for a large family size
The use of postpartum LARC was hindered by a desire for a large family size. Some women wanted to give birth until their ova were exhausted which hindered the use of postpartum IUD
“There those who do not listen even if you tell them to (take-up FP), they just want to continue producing. Some, say let me produce the children until they get finished in the womb” (27year old postpartum woman)
Sub-theme B: Physical capability
Unaware and unskilled health workers in offering LARC services
The unaware and unskilled health workers in offering PPFP services made women to be physically incapable to takeup PPFP. The reluctance of health workers to initiate postpartum LARCs contributed to skills and knowledge deficiency on postpartum LARC among men and women. Additionally, some midwives, nurses and village health teams were unaware of PPFP and unskilled in offering PPFP services.
“I have always known that after birth, you wait for some time, they don’t give it to you immediately. I didn’t know that you could get it.” (22-year-old postpartum woman)
Around me l have them (other nurses and midwives) but they are not confident (skilled). Me I feel there is a way they are not confident because every time a mother comes for IUD, when I am not there they wait for me (40 year Midwife ).
Theme 2: Opportunity
Sub-theme A: Physical
Phyiscally, women lacked the opportunity to receive PPFP methods due to lack of health worker-initiated family planning services, overburdened health workers, shortage of equipment used to offer LARCs and stock outs of LARCs
Lack of Health worker-initiated family planning services.
All the mothers attended antenatal care, and only one of them delivered at home. The rest (n = 14) delivered from a health facility. Postnatal care was poorly attended except for the purpose of bringing the child for immunization. Despite skilled birth attendance in a majority of the study participants, the majority of them were not counselled for postpartum LARC during antenatal care and postnatal care. There was no mention of postpartum LARC in the majority of cases (n = 9) during antenatal and postnatal care, while in isolated cases, postpartum family planning was mentioned unintentionally and perfunctorily during history-taking in antenatal care. Most of these women who witnessed lack of initiated family planning services during their postpartum period lacked the opportunity to take up postpartum LARC methods.
“No, she (health worker) didn’t talk about it at all. And still they just discharged us” (38 year old Male partner whose wife delivered from Busiu HC1V).
“They don’t give it [family planning] to you immediately. I didn’t know that you can get it. After some time then you can go and get it. The health workers had never 22-year-old postpartum woman)
Consequently, some women had never heard that family planning in general can be used in the immediate postpartum period. Paradoxically, healthcare workers misguided some women that they were not eligible for immediate postpartum LARC.
“I have never heard that they put immediately after birth,…Yes, the health workers…then said, “but we cannot insert it (Implanon) in you right now [after abortion], go home and spend one month then you come back here and then we insert it in you.” ” (35 year old Pregnant woman attending ANC at Nakaloke HC III)
Despite the lack of initiative to counsel and provide postpartum LARC on the part of the healthcare workers, women and male partners expressed palpable demand and interest to receive information and counselling regarding postpartum LARC. Participants thought that informing them about postpartum LARC would help them decide on whether to use LARC in the immediate postpartum period.
“It is good [to receive health education during ANC] because I [will]know as a mother when I give birth, I need to go to the health worker and they give me family planning to use” (Postpartum mother currently user of implant)
“Now there it needs when you… maybe teach us and we might also be happy or get responsible
to see that we join family planning” (32 year old Postpartum mother with 12 children)
Overburdened healthcare workers and lack of agency to demand for health education
There was reluctance of women and their families to engage the healthcare providers regarding receiving information related to postpartum LARC. The healthcare workers were perceived to be so busy, very tired and unavailable to provide postpartum LARC, while the fear of burdening the authoritarian healthcare workers with need for postpartum LARC services further discouraged conversations regarding the utilisation of postpartum LARC.
“Now, sometimes, the health workers may be busy…, she might be tired. So, you may fear to talk to them because they have worked the entire night, they are tired and they want to go and rest…..I fear to talk to them that is why I just keep quiet, .” (, 27year old postpartum woman).
Lack of FP equipment and shortage of LARCs
Stock outs of the postpartum LARCs hindered health workers from offering PPFP services. This was also associated with unavailability of equipment used to offer PPFP such as lignocaine, autoclave, and procedure couches.
“here I cannot insert an IUD where there is no couch. There should be a couch because you have to put this mother in lithotomy position then you do it.” (38-year-old midwife)
“Only that sometimes when we have stock outs and maybe a mother has come, we don’t have lignocaine. We don’t have the gloves, we don’t have even syringes, no cotton, and sterility is a problem. Usually that’s what affects us as a facility.” (35-year-old Nurse)
Sub-theme B: Social
There were factors that socially denied women an opportunity to takeup PPFP. These included; harsh workers, lack of partner support, lack of agency to ask for health education.
Harsh health workers
Women missed the opportunity of taking up LARCs because some health workers communicated harshly to them and disrespected client rights to remove a method which was causing them significant side effects such as excessive bleeding, loss of appetite and losing weight.
“Just she [health worker] became harsh. When she became harsh I saw ah-ah that I am not managing [to wait for family planning counselling].” ( 30 year old postpartum woman)
Lack of partner support:
The use of LARC immediately after childbirth was negatively affected by the male partner disapproval. The lack of involvement of male partners in the consenting and decision-making processes in addition to the misconceptions of the side effects of LARC made male partners reluctant to allow the use of LARC.
“yes, what will you do? Now when the important thing you have to hide yourself (meaning to get implanon and not inform partner) and when you tell him, he does not accept.(30 year old postpartum mother)
Receiving counselling and a method of postpartum LARC without the knowledge and approval of the husband highly caused marital conflicts. Women reported that some husbands disliked family planning services to the extent that they could divorce their wives if they took up any method.
“When they reach there sometimes the health workers sensitize them and they get courage. Then she decides to take it. So, from there then she gets back, others [women] even divorce when the husband doesn’t agree with what she has done [taking up postpartum LARC].” (ID402, 23 year old postpartum woman)
Failure to return for family planning services.
Unavailability of men for male companionship during ANC visits
Women noted that failure to receive family planning while in the hospital after delivery meant, they could not get time to come back because of their busy domestic duties at home. Additionally, having to wait long hours at the health facility in order to receive services also causes most mothers to not to seek or to delay seeking family planning services. Most men were not able to accompany their wives to health facilities due to their busy work schedules which reduced their opportunities to receive family planning counselling services.
“For us we have a lot of work as mothers so you decide to go home and I will come back another day. Now when you reach home, you may be caught up with work, you say you will get time and go back to the health facility.” ( 27 year old postpartum woman)
Me, I am a motorcyclist. I can wake up early morning and say let me go to work, I will come back and we go with my wife for the ANC appointment. Then time reaches when I have not yet come back from work, perhaps I might be still very far, therefore my wife comes alone to hospital. (61 year old FGD Male partner)
Theme 3: Motivation
Sub-theme A: Automatic;
Women were automatically motivated not to utilize PPFP due to negative influence of the care taker about use of LARCs, lack of male involvement.
Sub-theme B: Reflexive
Fear of infidelity, side effects, Discomfort of procedures of LARCS, Negative experience reflexively motivates women not to take up PPFP were reflexive motivators to hinder uptake of PPFP.
Fear of infidelity
Women especially those with men having long distance jobs perceived that their husbands thought that the use of postpartum LARC would encourage them to have sexual relations with other men.
“Now he might be thinking that if I go for family planning and yet he is not always around, I might cheat on him, you know how men can be, they might think you are here doing different things yet in actual sense you are doing your work and he thinks you are cheating that is why he does not want.” (ID103, 27 year old postpartum woman)
Discomfort of procedures of LARCs methods:
Barriers such as discomfort of the LARCs methods were discovered and these had code such as invasive removal of implants, side effects, and discomfort on insertion of the IUD, and implant.
Women felt discomfort due to the invasive mode of removal of implants. Some women thought that inserting IUD immediately after birth was difficult, painful and uncomfortable for them. The mode of insertion of the IUD in the context of per vaginal bleeding made it more discomforting for the woman.
“ Because of the way they insert it in down there. Yes, I see it is difficult/uncomfortable to be with…..Yes, in the process of putting it.” (30 year old postpartum woman)
“The fear is during removal as you know some of us drink alcohol so they may give the drug to reduce pain and may not work so when they cut to remove you feel the pain”(28 year old FGD pregnant woman).
Side effects
Over-bleeding was the most common side effect reported to be experienced by women. They reported that they became dizzy whenever they over-bled especially using the implant method. Other side effects that were commonly experienced with implants included gaining weight and weight loss
“Now I gave birth to him in 2018,(by then) that is when I used it but I did not use it to the end. It would make me bleed a lot, I would always feel dizzy so I used it for one and a half years after I came and it was removed.” (22 year old postpartum woman)
“If they fit in you, it might accept(or work in) your body and then you fatten. The whole of you fattens and then someone thinks that you’re pregnant yet not. The second one, there is finishing two “weeks” while “bleeding” when you go to the hospital and they give some tablets then it stops..”(, 23 year old postpartum woman)
However lack of sexual drive was reported by some women and associated it with feeling like a pregnant woman.
“My wife was not having sexual desires. Then I asked her, “how come when we are in one bed when I want to have sexual relations you say you don’t have the sexual desire”,,, Then I said, “what can we do, we go and remove the method”(30 year old FGD Male partner).
Enablers to utilisation of postpartum LARCs.
Theme 1: Capability:
Sub-theme A: Pyschological
Knowledge on LARCs, need to resume intimacy with their partners, having attained a desired family size and conceiving too soon were factors that made women psychologically capable of taking up PPFP.
Need to resume intimacy with their partners
The recovery process also enabled return of menstrual periods which indicated to women the possibility of conception and the need for family planning. The return of menses was also accompanied by sexual resumption which women thought would put them at risk of pregnancy.
“Now I knew that I was becoming fine/ fine and my husband could want to be intimate [have sexual relations]. So I knew I might conceive accidentally.” (22 year old postpartum woman)
Having attained a desired family size
Men and women whose marriages were old or had lasted long with evidence of grandchildren present were automatically motivated to take up postpartum LARCs due to having attained a desired family size.
“Ok, for family planning, I want and I want it 100% because even the number of children is that one(enough), I have even started having grandchildren.” (, 32 year old postpartum woman with parity of 12)
Conceiving too soon
Willingness to and use of postpartum LARC was related to the need to promote child spacing and promote proper recovery from childbirth especially women who had complications during child birth.
“She told me that it is true when you use family planning, you will space your children and even if you get pregnant again, these other children will not be sickly. If you do not space children they disturb you because they are always sickly and you will not be able to take care of them.” ( 22 year old postpartum woman).
Sub-theme B: Physical
Afew health workers had skills to offer the LARCs and this capability enabled them to offer PPFP.
Theme 2: Opportunity
Sub-theme A: Physical
Physical opportunities such as availability of PPFP methods enabled women to take up PPFP.
Sub-theme B: Social
Good attitude of health workers, Joint decision-making to take up FP and partner support were social opportunites that facilitated uptake of PPFP.
Joint decision making with a partner about family planning.
Most women who received health education after birth regarding the importance of using postpartum LARC, the six weeks period enabled women to share the new information with their male partners, a step which was critical in joint decision making. Partner approval following joint decision as a couple was thought by both women and men to promote utilisation of LARC after six weeks, rather than immediately after birth, since women needed to first seek guidance and approval from their husband when they go back home after being discharged This motivated women to take up postpartum LARC. Relatedly, the utilisation of LARC in the six weeks was facilitated by the postnatal care services especially immunization which was thought to be suited for postpartum LARC.
“So, if they give me something [health education] and then I come back after one and a half month, I come back and sit with my partner and explain to him that and we agree with each other. Then there is no problem.” (, 23-year-old postpartum woman)
“The one and a half months (starting contraception 6 weeks after delivery) would be better for us the women….there on going back at one and a half month [for immunization], it’s better you receive it because you would have agreed with your partner.” (, 23-year-old postpartum woman).
Theme 3: Motivation
Sub-theme A: Automatic
Positive attitude towards couple counselling and FP use, positive influence by partners, family members, and health workers with male involvement in ANC couple counselling on FP automatically motivated women to take up PPFP.
Positive attitude towards couple counselling and family planning use
Women and male partners expressed palpable demand and interest to receive information and counselling regarding postpartum LARC. Participants thought that informing them about postpartum LARC would help them decide on whether to use LARC in the immediate postpartum period. Positive attitudes towards family planning use were related to receiving health education as a couple during antenatal care, positive nudging from grandmothers, and not experiencing the side effects purportedly reported among family planning methods.
“Me it looks better if we are counselled when we are all together me and my wife, because we shall decide on one issue. And the questions that will be asked, we; my wife and I will be able to answer together. (30 year old FGD Male partner).
“That one (Implant) is good I can put it, it does not have any problem. Okay there are those who say that when they put they bleed a lot but I have never tried it. But I see as if it is good.” ( 27 year old postpartum woman)
Influencers for postpartum LARCs
The subjective norms relating to recommendation to use of family planning in the postpartum period among the peers encouraged some women to use postpartum LARC. The healthcare provider had a strong influence to utilisation of postpartum family planning methods especially among women with childbirth complications. The family social circles, the grandmothers and other senior women further influenced women on the use of postpartum LARC.
“Considering how the health workers explained to me that I should not conceive soon since my uterus is now very weak. I should take some time before producing again.” (ID102, 22-year-old postpartum woman)
“I have seen from my sister, she delivered by C/S. She gave birth to twins and my mother looked at their income as a couple and it was not good so she told her if you do not space, you will not be in good conditions. So do not produce again soon..” ( 22-year-old postpartum woman)
The society perceived that women`s primary role was to give birth while that of men was to provide for the family. This negatively influenced mothers by preventing them from taking up postpartum LARCs. They reported saying;
“Some men say that they leave their women to produce because they(men) take care of the family.” (, 35year old Antenatal woman)
Sub-theme B: Reflexive;
We uncovered factors such educated mothers, long duration of action, approval to the utilization of LARC and preference of LARCs as reflexive motivators for utilization of PPFP.
Long duration of action
Women were motivated to take up postpartum LARCs because of their long duration of action and perceived effectiveness when used. Women reported that in cases of stockouts for short-acting reversible contraception methods at health facilities, those who already received the LARCs methods are already protected from conceiving and will not be affected by stock outs.
“Because for the short acting methods, it's difficult. You might go to the hospital and…then that we are out of stock…And sometimes because of unavoidable issues the dates might reach when you’re not around….But with the other method (implants& coils) when they say that it’s 5 years it will be 5 .” (ID402, 23 year old postpartum woman)
Preferences for contraceptive implants.
The utilisation of LARC in the postpartum period was related to covert preferences for contraceptive implants. Some women were opposed to the use of the IUD and indicated that they would be willing to use contraceptive implants instead. The preferences for contraceptive implants were related to perceptions that the side effects were less for contraceptive implants especially those related to vaginal bleeding, interference with sexual intimacy with the male partner, and the effect on fecundity.
Similarly, the misconceptions surrounding the use of implants were less for the IUD which provided a positive subjective norms and ambience favourable for use of postpartum contraceptive implants. Some of the women had used contraceptive implants before which promoted its use in the immediate postpartum period. The method of inserting contraceptive implants was also thought to be compatible with the immediate postpartum period as it was thought not to interfere with the healing and recovery process after childbirth.
For the arm, it is also not bad. I see it does not cause difficulty….it is not like the coil….for it just, they put on the arm, then they treat you for just a short time. Few days it can be ok. You will be healed. Not like the other one (IUD), when you will be in pain.
However, a few women preferred using the IUD due to its long term effectiveness compared to the implant.
“ok, for me if they are to give me a method, truth they have to give me the IUD, I would want it; the one for the opening of the uterus (IUD). Why? Because it’s similar to the other one (implant - in being long acting compared to short acting methods). Reason being if they have fitted it (IUD) in you, for it, you have enough protection in your body and if you’re to be wherever. ( 23 year old postpartum woman)
Women and men recommended sensitization by health worker, experienced clients and community outreaches on Postpartum Family Planning as ways to increase their capability to take up PPFP. Healthworkers reported that training on Postpartum Family Planning and borrowing PPFP methods from other health facilities during stockouts or shortages medical supplies would increase physical opportunities for women receive Postpartum Family Planning. Provision of privacy and confidentiality to women and offering Family Planning counselling during ANC visits and at postnatal units were recommendated as social opportunities for women to take up Postpartum Family Planning. Recruitment of male VHTs, male involvement in ANC and other health services were suggested to be automatic motivators for uptake of Postpartum Family Planning. Women were recommended not to take advice from negative peers and first try to take up a family planning method to get their own experience. This makes them exercise autonomy in using a method of family planning. The need for individualized FP, sensitization by use of poster images about PPF and media would reflexively motivate women to take up PPFP. Offering individualized counselling helps shy or fearful or low esteemed women to freely open up to health workers about their concerns on family planning.