Table 2 Codebook

Contraceptive knowledge

Accurate information (deductive)

Expressed factually correct information about contraceptive methods (or where to get it) and pregnancy

"It helped because he helped, right, he explained to me, I went and advised my husband, and he accepted that actually the children are little. If you don’t you won’t be in good health, you should rest and let the children grow up, then let’s have another child later." (20-year-old female, Inhassunge)

"They told us we can use a condom when we have sex outside, yes." (39-year-old male, Gilé)

Misinformation (deductive)

Expressed factually incorrect information about contraceptive methods (or not knowing where to get it) and pregnancy

"No, she’s only a year and three months, she’s still very little for her mother to get pregnant again. And she is still breastfeeding, it will only be when she weans from breastfeeding….We haven’t weaned her so this helps the mother avoid pregnancy, and also, right, right we didn’t start having sexual intercourse because the baby is still breastfeeding" (27-year-old male, Mocubela)

"I usually see women doing planning while the children are still in their belly, if they don’t comply with health’s law they will die.” (38-year-old male, Pebane)

New information (deductive)

Any reference to new information that either member of the couples learned from any of the HoPS+ sessions about contraception, birth spacing, or reproduction

"It’s because where we come from we didn’t know there were pills you could take to decrease the number of children. So now that there is medication, if you want to have 2 or 3 then you just go to the hospital. When you go to the hospital they give you medication so those children can grow up. That’s what I think now." (36-year-old male, Quelimane)

"Helped me by saying that you need to give good medication for the child, medication for you too, so that you’re well. If you don’t give medication to the child, and if you don’t take it the child will also not have good health. I memorized that…They said that in order to having children you need… if you see that you already gave birth and the child is already 2 years old and I don’t give it a break, you ought to go to the hospital to ask for medication and wait for the child to grow up a little. After you see the child is at a good age, you can have another, you can stop [family] planning to have another." (20-year-old female, Inhassunge)

Partner motivation

Individual fertility desires (deductive)

Rationale for why an individual wants children (take care of them when they are old, child mortality, financial difficulties with many children, etc.) or why they want to delay or stop having children

"I would like to rest first." (20-year-old female, Mocubela)

"I want to have a maximum of four (4) because if you give birth to many is not a bad thing to get old, right?" (28-year-old male, Maganja Da Costa)

"May be twenty I would like (smiles), because it’s good to have children at home." (20-year-old female, Gilé)

"The reason I want ten children, for example, my mother only had me, only me alone, yes, the brothers all died, the mother died, and just left with dad. So is the reason I ask and say at least ten." (39-year-old male, Gilé)

"They [the children] can take care of each other, welcome each other." (19-year-old female, Pebane)

Health considerations (inductive)

Expressing that improved health has changed how an individual or partners think about having additional children or that health limits future fertility goals

"If I feel like I have good health, maybe I will think about having more children." (23-year-old male, Mocubela)

"My health was very weak before taking the medication. It was health hour by hour. Now I see that it is different from what it was before. Now I go a month without feeling sick." (20-year-old female, Inhassunge)

Economic considerations (deductive)

Any reference to economic considerations in making fertility decisions

"It could be four… but even having four in the times we’re living in, I don’t know, if it was old times where you had a lot of food for children to eat, people would have 7 even 10…Now, the way I see it, these days if someone has 4 or 3 it is already too much." (27-year-old female, Inhassunge)

"I used to think I could have a maximum of 3 or 4. Because here in Mozambique, to have 9 or 10 children, ehhh, poverty will add to poverty, hmm." (28-year-old male, Gilé)

Religiosity (deductive)

How an individual considers religious preferences in fertility decisions

"Those [children] who God wants to give us, according to his will." (19-year-old female, Gilé)

"Since our religion says that planning is a sin, that’s why I say that it will depend on the number God wants to give me. Even if it’s 1 we will thank this God who gave us 2, 3… hm." (27-year-old male, Mocubela)

Social norms/motivations (deductive)

Expressed social norms surrounding fertility in couples' community

"There are people who gave birth to 10 and people they say gave birth too much. Some give birth to 5 and they also say it was too much. There are people who birthed 4, 2 girls and 2 boys and they say that one birthed well…Girl pounds flour, fetches water. Boy will also take you to the hospital when you’re sick, talks to the nurses, that’s what a boy does. So you don’t say it’s not good to have a boy." (20-year-old female, Mocubela)

"It depends on each person’s wishes. They agree between the couple, the husband along with his wife will say, “I want these many children”, the women will give birth until they reach the number they agreed on. Afterwards you just need to do family planning." (27-year-old male, Mocubela)

Barriers to contraceptive uptake

Paternalism (deductive)

If the female partner reports that the male partner wants control family planning or the male partner reports wanting to control family planning

"Yes, she has been saying that “when the day comes for me to go do (family) planning, I will go to do (family) planning”. So I told her that she can’t do planning alone without discussing with me. We should agree first and then do the planning. That’s all.” (19-year-old male, Quelimane)

Gender norms (deductive)

Examples of partners acting in ways that would be expected of them given their gender

"I don’t know [how many children I would like] since my husband isn’t here." (23-year-old female, Maganja Da Costa)

Surreptitious contraceptive use (deductive)

References to hiding contraceptive use from partner (e.g., reporting using injectables so partner does not know)

"We didn’t agree [on using family planning]. She did it and when I found out about the idea, I liked it. She said she wanted to rest. “I don’t want to have another child while this one is little,” I said alright." (22-year-old male, Mocubela)

"When I talk he won’t listen. So I want to try to “steal” by myself." (30-year-old female, Inhassunge)

Facilitators of contraceptive uptake

HoPS+ Engagement (deductive)

References to partner’s engagement to HoPS+ intervention components, includes attendance at counseling/skills sessions or peer sessions as well as references to what a partner shared at or after any sessions

"It helped because he [the couples counselor] helped, right, he explained to me, I went and advised my husband, and he accepted that actually the children are little. If you don’t you won’t be in good health, you should rest and let the children grow up, then let’s have another child later." (20-year-old female, Inhassunge)

"Yes, my relationship with my wife really did change. I can tell you how it changed, it changed a lot because we didn’t understand each other before, we would each accuse the other. So then this phase arrived, we are established, no one accuses the other, everything is normal, it’s normal. We live without any problems, no arguments, we are able to talk and get over problems." (34-year-old male, Maganja Da Costa)

Trust in providers (deductive)

Expressed trust in providers, counselors, or peer support couples to give advice/information on contraceptive decisions

"When they arrived and gave me advice, and explained everything to me, I was free to feel that emotion, with that happiness. Yes, I like those people that were coming to the house, yes, I can’t speak ill of them." (39-year-old male, Gilé)

Partner respect (deductive)

Expressed respect or examples of listening to or following partner's desires (or, conversely, not doing so)

"We help each other. Sometimes when I’m sick, or even my son, or I went to another place, I say, “husband go get mine for me,” and if it was him, he also says, “wife go get it for me too and bring it home.” We haven’t argued at our home yet…It helped us because when we get home we respect each other as husband and wife, we don’t fight because of this disease." (20-year-old female, Gilé)

Shared decision making (inductive)

References to talking to partner (or avoiding talking to partner) about using contraception

"It depends on each person’s wishes. They agree between the couple, the husband along with his wife will say, “I want these many children”, the women will give birth until they reach the number they agreed on. Afterwards you just need to do family planning." (27-year-old male, Mocubela)

"We have said that, “oh my friend, we have to let this child grow a little. We do the planning and when it grows up, we leave the planning.”” (19-year-old female, Quelimane)

Paternalism (deductive)

If the female partner reports that the male partner wants control family planning or the male partner reports wanting to control family planning

“Yes… my husband forced me [to have an implant]…He’s the one who forced me." (18-year-old female, Maganja Da Costa)

Postpartum contraceptive use

Current contraceptive use (inductive)

Reported current contraceptive use in female partner (or by male partner)

"I put in an implant." (18-year-old female, Maganja Da Costa)

"She’s using contraceptives, it’s an implant.” (23-year-old male, Maganja Da Costa)