Family Planning Module: 3. Counselling for Family Planning

Study Session 3  Counselling for Family Planning

Introduction

The primary objective of counselling in the context of family planning is to help people in your village decide on the number of children they wish to have, and when to have them. You can help them to choose a contraceptive method that is personally and medically appropriate. Through your counselling sessions with them, you will make sure that they understand how to use their chosen method correctly, to ensure safe and effective contraceptive protection.

In this study session, you will learn about the general concepts and principles of family planning counselling, the steps for conducting family planning counselling, and the factors affecting counselling outcomes.

Learning Outcomes for Study Session 3

When you have studied this session, you should be able to:

3.1  Define and use correctly all of the key words printed in bold. (SAQ 3.1)

3.2  Discuss the general principles of counselling for family planning and describe the contexts in which counselling can take place. (SAQs 3.1 and 3.2)

3.3  Explain the special nature of family planning counselling. (SAQ 3.3)

3.4  Describe the steps of family planning counselling. (SAQ 3.4)

3.5  Describe the factors influencing family planning counselling outcomes. (SAQ 3.5)

3.1  Concepts of counselling

In Study Session 11 of the Health Education, Advocacy and community Mobilisation Module, you learnt that counselling is a face-to-face communication that you have with your client or couple in order to help them arrive at voluntary and informed decisions. It is somewhat different from advice, in which you try to solve a client’s problem by giving information and your personal opinion.

Family planning counselling is defined as a continuous process that you as the counsellor provide to help clients and people in your village make and arrive at informed choices about the size of their family (i.e. the number of children they wish to have).

Informed choice is defined as a voluntary choice or decision, based on the knowledge of all available information relevant to the choice or decision. In order to allow people to make an informed choice about family planning, you must make them aware of all the available methods, and the advantages and disadvantages of each. They should know how to use the chosen method safely and effectively, as well as understanding possible side-effects.

Always remember that family planning counselling is not a type of lecture from you to those who have come to you for help. In the process of family planning counselling there should be mutual understanding. You should show respect to the client who has come to see you, and deal with their problems and concerns about contraception in a straightforward way. There are a variety of approaches for different types of family planning counselling. For example, the way you would approach a session with a group would be different from the way you would work with an individual. The most common settings in which family planning counselling can take place are described below.

Figure 3.1  A Health Extension Practitioner giving individual counselling.

3.1.1  Individual counselling

You will find that in most cases individuals prefer privacy and confidentiality during communication or counselling with you. It is important to respect the needs and interests of a client by finding a private room or place where you can talk with them (Figure 3.1).

3.1.2  Couple counselling

Couple counselling is when you give a counselling service to a couple or partners together (Figure 3.2). This is particularly common when they are thinking of using irreversible family planning measures, such as voluntary surgical methods.

Figure 3.2  A Health Extension Practitioner counselling a couple.

3.1.3  Group information sharing

Figure 3.3  Group counselling and information sharing.

Group information sharing is used when individual counselling is not possible, or if there are people in your village who are more comfortable in a group (Figure 3.3). In this situation, after greeting everyone in a friendly manner, you would explain to them the benefits of family planning, discuss briefly common myths and mistaken beliefs about family planning, and then inform the group about how to obtain appropriate contraception. It is a cost-effective way of information sharing and answering general questions, but people are not likely to share their more personal concerns with you in this setting.

3.2  General principles of counselling and counsellor characteristics

You have already learnt about the general principles of counselling in the Health Education, Advocacy and Community Mobilisation Module, and about what characteristics and skills you need to display to ensure a successful outcome to your counselling sessions. In this section, you will check your understanding of these principles and characteristics before considering the additional requirements for successful family planning counselling.

3.2.1  General principles of counselling

You need to remember these guidelines when you are counselling for family planning, but there are additional considerations because family planning is a particularly sensitive issue. You will learn about these in Section 3.3.

3.2.2  Skills and characteristics of a counsellor

Once again, remind yourself of the general skills and characteristics you need to be a successful counsellor.

3.3  The special nature of counselling for family planning

Many people have strong ideas about family planning, but some of the ideas they have may be based on myth or mis-information. You need to be respectful and welcoming when sharing ideas, and demonstrate commitment to the necessary values and principles of family planning.

Try to find out your clients’ views by encouraging them to talk. Do not ask them direct and judgmental questions such as: ‘Are you one of those people who believe that modern family planning is forbidden for religious people?’ Such questions sound critical and can make people feel inferior, or may make them mistrust you because they may ask themselves, ‘Why should I believe this person when all my relatives share my belief?’

Always try to understand, and be sensitive to, cultural and psychological factors that may affect clients in your village adopting and using family planning methods. For example, there may be opposition to the idea of controlling the size of the family from some cultures and religions. Some methods may be unpopular with clients, for example a woman might not like the idea of having to insert a contraceptive into her body before having sex, or a man may think that a condom will take away the pleasure of sex.

This means that you should have good scientific knowledge of all the contraceptive methods, and understand the practical part of family planning methods. Also, you should be prepared to answer questions comfortably and without embarrassment in relation to contraceptive myths, rumours, sexuality, sexually transmitted infections (STIs), reproductive and personal concerns.

3.4  Overview of the stages of counselling for family planning

3.4.1  General counselling

The first contact usually involves counselling on general issues to address the client’s needs and concerns. You will also give general information about methods, and clear up any mistaken beliefs or myths about specific family planning methods. All this will help the client in your village arrive at an informed decision on the best contraceptive method to use. During this session you would also give information on other sexual and reproductive health issues, like sexually transmitted infections (STIs), human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) and infertility.

3.4.2  Method-specific counselling

In method-specific counselling, you give more information about the chosen method. In this case, you can explain the examination for fitness (screening), and instruct on how and when to use the given method (see Box 3.1). You will also tell the client when to return for follow-up, and ask them to repeat what you have said on key information.

3.4.3  Return/follow-up counselling

Follow-up counselling should always be arranged. The main aim of follow-up counselling is to discuss and manage any problems and side effects related to the given contraceptive method. This also gives you the opportunity to encourage the continued use of the chosen method, unless problems exist. Also use this opportunity to find out whether the client has other concerns and questions.

3.5  Steps in family planning counselling: the GATHER approach

When you counsel a new client in your village about family planning, you should follow a step-by-step process. GATHER is an acronym that will help you remember the 6 basic steps for family planning counselling (see Box 3.2). It is important to know that not every new client in your village needs all the steps — you need to use the GATHER approach sensitively so that it is appropriate to each client’s need. Within your community you may need to give more attention to one step than another.

It is important to give more emphasis to the points under each counselling step.

3.5.1  G — Greet the client

• In the first case, give your full attention to your clients.
• Greet them in a respectful manner and introduce yourself after offering seats.
• Ask them how you can help them.
• Tell them that you will not tell others what they say.
• If the counselling is in a health institution, you have to explain what will happen during the visit, describing physical examinations and laboratory tests if necessary.
• Conduct counselling in a place where no-one can overhear your conversation.

3.5.2  A — Ask the clients about themselves

• Help them to talk about their needs, doubts, concerns and any questions they might have.
• If they are new, use a standard checklist or form from your Health Management Information system to write down their name and age, marital status, number of pregnancies, number of births, number of living children, current and past family planning use, and basic medical history.
• Explain that you are asking for this information in order to help you to provide appropriate information, so that they can choose the family planning method which is the best for them.
• Keep questions simple and brief, and look at her/them as you speak.
• Many people do not know the names of diseases or medical conditions. Ask them specific questions. Say, ‘Have you had any headaches in the past two weeks?’, or ‘Have you had any genital itching?’, or ‘Do you experience any pain when urinating?’ Do not say, ‘Have you had any diseases in the recent past’.
• If you have seen the client(s) previously, ask if anything has changed since the last visit.

3.5.3  T — Tell them all about family planning methods

• Tell them which methods are available.
• Ask which methods interest them and what they know about the methods.
• Briefly describe each method of interest and explain how it works, its advantages and disadvantages, and possible side-effects.

3.5.4  H — Help them to choose a method

• To help them choose a method of contraception, ask them about their plans and family situation. If they are uncertain about the future, begin with the present situation.
• Ask what the spouse/partner likes and wants to use.
• Ask if there is anything they cannot understand, and repeat information when necessary.
• When the chosen method is not safe for them, explain clearly why the method may not be appropriate and help them choose another method.
• Check whether they have made a clear decision and specifically ask, ‘What method have you decided to use?’

3.5.5  E — Explain how to use a method

After a method has been chosen:

• Give supplies if appropriate.
• If the method cannot be given immediately, explain how, when and where it will be provided.
• For methods like voluntary sterilisation the client will have to sign a consent form. The form says that they want the method, have been informed about it, and understand this information. You must help the individual understand the consent form.
• Explain how to use the method.
• Ask the client to repeat the instructions.
• Describe any possible side-effects and warning signs, and tell them what to do if they occur.
• Ask them to repeat this information back to you.
• Give them printed material about the method to take home if it is available.
• Tell them when to come back for a follow-up visit and to come back sooner if they wish, or if side-effects or warning signs occur.

3.5.6  R — Appoint a return visit for follow-up

At the follow-up visit:

• ask the client if she is, or they are, still using the method, and whether there have been any problems.
• ask if there have been any side-effects.
• reassure the client/s concerning minor side-effects. Explain that the side effects are not dangerous and suggest what can be done to relieve them.
• refer for treatment in the case of severe side-effects.
• ask the client if they have any questions.

If the clients want to use a different method, tell them about other methods and help in this choice. It is important to remember that changing methods is not bad. The main thing is that they can choose a method which is acceptable and appropriate. If the clients now want to have a child, help them to discontinue the use of their current method of family planning. Make sure the clients know when and where to go for prenatal care when the spouse becomes pregnant.

3.6  Factors influencing family planning counselling outcomes

There are different factors that affect the quality and effectiveness of communication in counselling. You should identify and address these factors in order to have successful family planning counselling sessions. These factors are divided into three broad categories.

3.6.1  Factors related to you

As a provider of family planning services, your ability to engage in effective communication, your technical knowledge, skills, attitudes and behaviours can influence the effectiveness of the counselling process. You will have your own values and beliefs on specific methods, and you must try not to let this show or you can affect the other person’s choice.

Respecting the rights of the client is essential to the quality and continuity of family planning services, including counselling. Box 3.3 below summarises the principles of the client’s rights in all aspects of family planning services.

3.6.2  Factors related to the client

The client’s level of knowledge and understanding may affect their choice. What they choose to do may also be affected by the extent to which they trust and respect you (Figure 3.4). Their personal situation may make it difficult for them to choose some methods, for example if their spouse or another family member has a different preference to them.

Figure 3.4  Handing out contraceptives in a village; success depends on trust between clients and the provider. (Photo: Marie Stopes International)

3.6.3  External/programmatic factors

In most developing countries like Ethiopia, reproductive health services in general, and family planning programmes in particular, are limited and cannot be accessed by everyone. You may learn about some methods that you cannot offer to people in your community because of its unavailability. Moreover, the supplies of the family planning materials may not be regular and reliable.

In most health facilities the space or room for the provision of family planning is integrated with other reproductive health programmes. This can make it really difficult for you to find a place where privacy and confidentiality can be maintained.

You may have to work hard to overcome these various difficulties and provide an effective family planning service for your community, but the benefits of success will have a huge impact on future generations.

Summary of Study Session 3

In Study Session 3, you have learned that:

1. Family planning counselling is the process whereby you help clients and people in your village to make informed and voluntary choices about the number of children and the spacing of the children within their family.
2. There are different ways of providing effective family planning counselling. You may work with individuals, couples or with a group. Usually working with an individual works best.
3. At the first contact meeting, focus on general counselling to establish trust, and address the needs and concerns of reproductive health and family planning.
4. Method-specific counselling is provided once a person has chosen a specific family planning method. Use the BRAIDED approach to help you remember what to say when you counsel clients on specific methods.
5. Follow-up counselling is given to discuss and manage any problems or side-effects, and to discuss alternatives if the original method has not been satisfactory.
6. GATHER is an acronym to help remember the 6 basic steps in the counselling process:
   • G  Greet
   • A  Ask
   • T  Tell
   • H  Help
   • E  Explain
   • R  Return.
7. Factors which can affect counselling outcomes can be viewed from different perspectives: yours, your clients, and the reproductive health services in your country. Thinking about potential problems can help you to work around them to deliver an effective service.

Self-Assessment Questions (SAQs) for Study Session 3

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.