“One counselling strategy does not fit all”: Midwives’ experiences of providing contraceptive counselling to girls and young women with ADHD - a Swedish qualitative interview study

Abstract Background Despite accessible services, unmet contraceptive needs persist among young women in Sweden. Young women with ADHD may have diverse sexual and reproductive health needs, and previous research has identified challenges related to healthcare access, communication, and contraceptive use. However, less is known about how midwives experience providing contraceptive counselling to girls and young women with ADHD. This study aimed to describe midwives’ experiences of providing contraceptive counselling to girls and young women with ADHD in Swedish youth clinics. Methods A qualitative exploratory study design using Braun and Clarke’s reflexive thematic analysis of interviews, including ten midwives providing contraceptive counselling to young women with ADHD. The average interview time was 34 min. Results The participating midwives were aged 31 to 62 years and had between six months and 24 years of experience working in youth clinics across four of Sweden’s six healthcare regions. Their experiences were captured by the overarching theme, Adapting contraceptive counselling to individual needs despite limited ADHD-specific support , which encompassed three themes: Striving to provide person-centered counselling , Navigating counselling in response to increased support needs , and Recognizing the importance of ADHD-specific knowledge and resources to support counselling. Conclusions Midwives described adapting contraceptive counselling to perceived individual needs through changes in communication, consultation structures, access to care, and interprofessional collaboration. They also described a need for stronger ADHD-specific education and evidence-informed professional guidance. Support for counselling should provide a structured professional foundation while allowing flexibility to respond to individual circumstances and preferences.