Counseling is a vital part of family
planning. It helps clients to:
- arrive at an informed choice of reproductive options,
- select a contraceptive method with which they are satisfied, and
- use the chosen method safely and effectively.
Good counseling focuses on the individual client’s needs and situation. Good
counselors are willing to listen and respond to the client’s questions and concerns.
Keys to Good Counseling
A good counselor:
- Understands and respects the client’s rights.
- Earns the client’s trust .
- Understands the benefits and limitations of all contraceptive methods.
- Understands the cultural and emotional factors that affect a woman’s (or a
couple’s) decision to use a particular contraceptive method.
- Encourages the client to ask questions.
- Uses a nonjudgmental approach which shows the client respect and kindness.
- Presents information in an unbiased, client-sensitive manner.
- Actively listens to the client’s concerns.
- Understands the effect of nonverbal communication.
- Recognizes when s/he cannot sufficiently help a client and refers the client to
someone who can.
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To be effective, counseling must be based on the establishment of trust
and respect between the client and counselor.
In serving clients, it is important to remember that they have:
- the right to decide whether or not to practice family planning,
- the freedom to choose which method to use,
- the right to privacy and confidentiality, and
- the right to refuse any type of examination.
Also, while many contraceptive methods are highly effective, method failure can occur.
In the case of method failure, the client should be counseled, informed about the
available options and referred for appropriate services.
Counseling Process
In discussing contraceptive options with clients, service providers should briefly
review all available methods, even if a client knows which method s/he wants.
Service providers should be aware of a number of factors about each client that may be
important, depending on the method in question. These are:
- reproductive goals of the woman or couple (spacing or timing births);
- personal factors including the time, travel costs, pain or discomfort likely to be
experienced;
- accessibility and availability of other products that are necessary to use the method;
and
- the need for protection against STDs (e.g., HBV, HIV/AIDS).
Steps in Family Planning Counseling
Counseling can be divided into three phases:
- initial counseling at reception (all methods are described and the client is
helped to choose the method most appropriate for her/him),
- method-specific counseling prior to and immediately following service provision
(the client is given instructions on how to use the method and common side effects are
discussed), and
- follow-up counseling (during the return visit, use of the method, satisfaction
and any problems that may have occurred are discussed).
The provision of counseling, however, should be part of every interaction with
the client.
Who Should Provide Counseling?
Information and counseling commonly will come from more than one source. Therefore, all
staff should be knowledgeable about all available contraceptive methods.
Range of
Pregnancy Rates per 100 Women During the First Year of Use.
METHOD |
PREGNANCY RATES
(TYPICAL USE) |
Vasectomy |
0.1–0.15 |
Tubal Occlusion |
0.2–0.4a |
Progestin-Only
Implants |
0.2–1 |
CICs |
0.1–0.4 |
PICs |
0.3–1 |
IUDs (copper- and
hormone-releasing) |
0.5–1 |
POPs |
0.5–10 |
COCs |
0.1–8 |
LAM |
1–2b |
Condoms |
2–12 |
Spermicides |
3–21 |
Withdrawal (Coitus
Interruptus) |
4–18 |
Diaphragms with
Spermicides |
6–18 |
NFP |
9–20 |
a Recent data suggest that failure rates at 5 and 10
years are higher depending on the woman’s age at the time of the procedure and the
method of sterilization used.
b If fully breastfeeding, no vaginal bleeding and infant less
than 6 months old.
Adapted from: Labbok, Cooney and Coly 1994; Trussel 1990; WHO 1993.
 
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