Table 1 Overview of themes, subthemes, and key points

1. Factors that contributed to acceptability of the intervention

 1.a. The intervention improved access to UPT and reproductive healthcare services

  •Home visits by CHVs eliminate costs and time spent traveling to a clinic for UPT, which is particularly beneficial for women who experience stigma in pregnancy or whose freedom to travel is limited

  •Early identification of pregnancy supports early initiation of ANC, and negative pregnancy tests support timely initiation of FP

  •CHVs support links to downstream reproductive care and act as liaisons between women and other healthcare providers

 1.b. The intervention supported more informed choices about pregnancy and reproductive health, but not necessarily for women with unwanted pregnancies interested in abortion

  •UPT supports women’s and families’ abilities to plan for birth, for example, by saving money

  •UPT opens up opportunities for women to make major life choices that are affected by pregnancy status, for example, leaving a marriage

  •Some participants expressed concerns that women would “misuse” the information from UPT to make choices they did not think were acceptable, for example, around abortion

  •Some CHVs and non-CHV participants thought counselling by CHVs should be directed towards preventing abortion

 1.c. Acceptability of the intervention depends on trust between CHVs and the community

  •CHV-delivered UPT and counselling was acceptable because CHVs were generally trusted and respected

  •Concerns about CHVs’ confidentiality, and that CHVs’ biases and conflicts would affect access to UPT, are barriers to acceptability

  •Post-UPT counselling with a study staff member is an acceptable way to address concerns about confidentiality with a CHV

  •CHVs themselves described a sense of great value from delivering UPT, a service which provides a diagnosis, and may have enhanced trust in CHV’s skills

2. Factors that contributed to or detracted from the feasibility of the intervention

 2.a. It is feasible for CHVs to provide UPT, counselling, and referrals if the appropriate supplies are provided

  •Appropriate supplies included enough test kits, transportation or remuneration of transportation costs for CHVs, and a carrying bag

 2.b. It may not always be feasible for women to access reproductive healthcare services even if a CHV successfully delivers UPT, post-test counselling, and a referral

  •This intervention does not address downstream barriers to accessing care at distant clinics (costs, distances, mistreatment)

  •Some men in the community’s negative attitudes toward FP might limit women’s access to FP services

3. Spanning both acceptability and feasibility: adequate financial, educational, and professional support for CHVs

 3.a. The additional work involved in providing UPT, counselling, and referral exacerbated pre-existing financial strain on CHVs

  •CHVs live with economic insecurity, and volunteer work infringes on their time for income-generating work

  •UPT, which was extremely popular, exacerbated the demands on CHVs

  •Participants thought financial strain on CHVs could be addressed by providing financial support, as a stipend or in-kind

 3.b. CHVs requested additional educational and professional supports

  •CHVs requested additional training for counselling around unwanted pregnancies, adolescent pregnancies, and infertility

  •CHVs described fears that they might be blamed for miscarriages, abortions, or breaches of confidentiality