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Recommendations for Contraceptive Use |
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Elements of Informed Choice |
Report of the Cooperating Agencies
Task Force on Informed Choice: Executive Summary
The Cooperating Agencies (CA) Task Force on Informed Choice, consisting of
representatives of 17 organizations working in international family planning programs, met
in April and November 1988 and in February 1989. The following recommendations represent
the consensus of the CA Task Force members regarding the most important actions needed to
promote informed choice in developing countries:
Recommendation No. 1
Expanded Definition of Informed Choice
Informed choice is effective access to information on reproductive choices and to
the necessary counseling, services and supplies to help individuals choose and use an
appropriate method of family planning, if desired. The Cooperating Agencies Task Force
broadened the definition of informed choice from a choice of family planning methods to
encompass various reproductive choices, including the possibility of choosing pregnancy.
Thus, informed choice begins prior to the choice of a particular method, at the time when
a person first learns that there is a way to control his or her fertility.
Recommendation No. 2
Continual Process
Informed choice should be seen as a continual process as new acceptors try out
one method and then shift to other methods or nonuse as their needs or preferences change.
Recommendation No. 3
Method Choices
Within each given service area, an appropriate range of contraceptive methods
should be available to meet the needs of various types of contraceptive users. Available
methods should include male and female methods, some reversible methods which are
temporary as well as long-acting ones, and permanent methods. Program administrators
should strive for "effective access," which means that, at a minimum, major
groups of contraceptive methods are available in each regional area of a country.
Recommendation No. 4
Referrals
Providers that offer only one or a limited range of family planning methods
should tell clients where alternative methods are available, regardless of how distant
they may be. Referral systems should be established and coordinated with providers at the
local level, using written materials as appropriate.
Recommendation No. 5
Clinic Education
To complement counseling, service providers should seek to improve client
education by using waiting areas for visual displays, lectures and audio-visual
presentations and by providing client counselors with visual aides and audio-visual and
print materials. Client education materials should be accurate, appropriate to their
intended audience, and understandable.
Recommendation No. 6
Client Counseling
Each local institution should ensure that client counseling is done sensitively
and effectively. The goal of counseling is to have the client arrive at a choice that
he/she is satisfied with and, if the choice is to use contraception, to prepare the client
to use his/her chosen method effectively. Counseling should be a two-way interaction,
based on a positive relationship.
Recommendation No. 7
Monitoring and Evaluation
CAs and local institutions should build information needed for monitoring and
evaluation of informed choice into their standard reporting requirements. Such information
might include indicators that client counseling guidelines have been followed and service
statistics on method mix and referrals (as appropriate). Evaluations should look at the
structure of services, the actual delivery of services and service outcomes to assess the
extent of informed choice. While CAs can provide technical support, local institutions
must take primary responsibility for promoting informed choice and for monitoring service
delivery sites to ensure that the appropriate steps are being taken.
Recommendation No. 8
Public Outreach
Family planning agencies should make more use of culturally sensitive mass media
to reach not only potential and current contraceptive users but also others who influence
reproductive decisions such as spouses, other relatives, and policy-makers. All modes of
public education such as television, radio, press, magazines, group meetings, exhibits,
cultural events, folk theater, all types of entertainment, field worker visits, inserts in
contraceptive packages and point-of-purchase displays should be expanded. Whenever
feasible, they should include information about specific methods.
Recommendation No. 9
Protocols for Service Delivery
Both public and private agencies in developing countries should develop national
or regional guidelines on family planning methods and the client education process.
Emphasis should be placed on continuous support of clients, not simply the first contact.
Recommendation No. 10
Training
Service delivery staff need to be trained in client counseling and interpersonal
communication, since good counseling and a positive relationship with the client are
essential to informed choice. Counseling staff should receive on-site training,
assistance, supervision, and periodic evaluations. Each agency should develop or adapt
from other agencies a portion of a training module specifically on informed choice.
Trainers should encourage service providers to be attentive to the client's needs and life
situation.
Recommendation No. 11
Male Involvement
Family planning programs need to pay more attention to the role of men in
reproductive decisions andto expand male outreach programs. Many programs focus mainly on
women, even though men have a major role in making family reproductive choices in many
countries.
Recommendation No. 12
Family Planning and STDs, Including AIDS
The prevention and treatment of sexually transmitted diseases (STDs) is important
to reproductive health. Family planning providers should offer basic STD services. In view
of the widespread concern regarding acquired immune deficiency syndrome (AIDS), family
planning providers should seek assistance from various sources for programs to prevent
transmissions of the virus that causes AIDS. These programs may include staff training,
counseling, peer group activities, condom promotion and distribution, the development of
communication strategies and materials, and human immunodeficiency (HIV) testing (where
appropriate).
Recommendation No. 13
Research Needs
More research should be conducted on various elements of informed choice,
including method availability, referrals, counseling, public and clinic education, and
training. Operations research can be useful to assess the most effective ways of promoting
informed choice.
Recommendation No. 14
Informed Consent Requirements
While clients should make informed decisions for any contraceptive, written
informed consent should be required only for voluntary sterilization, because it is
intended to be (and effectively is) permanent.
Recommendation No. 15
The Role of Cooperating Agencies
CAs should review their policies and procedures in regard to informed choice,
provide adequate staff training, and adopt appropriate monitoring and evaluation
procedures. CAs preparing international guidelines should seek input from service
providers in developing countries.
Recommendation No. 16
Agency for International Development (AID) Support to CAs
AID should provide CAs with up-to-date, accurate information pertaining to
informed choice, especially in key areas such as contraceptive safety and efficacy and
AIDS prevention.
The Task Force concluded that much progress has been made in promoting informed
choice and that future initiatives may depend upon correcting erroneous assumptions about
informed choice. In fact, the stereotypical activities associated with informed
choice-boring lectures, lengthy forms and rigid guidelines-may have little to do with
helping the client to make and implement choices, to understand and remember pertinent
information, and to feel comfortable seeking additional information or services, as
needed.
Family planning and health care professionals need to understand that
implementation of programs to promote informed choice will make their job easier, not
harder. Satisfied users are not only the key to high continuation rates, but also the most
effective promoters of family planning. |
