Learning Outcomes Explain how to support informed choice and maintain confidentiality Discuss sexual health without embarrassment Demonstrate how to help clients discuss and negotiate FP use with partners Identify beliefs and attitudes that may interfere with effective counseling Describe the four stages of FP counseling and factors that affect FP method choice
Demonstrate how to use a counselling tool and other job aids effectively Demonstrate effective communication and counselling skills Demonstrate competence in providing informed choice FP counselling Explain the counselling needs of women who are postpartum and post abortion Explain how traditions or beliefs may limit a woman’s ability to freely choose and use FP
Personal Goals for FP Counselling What motivated you to become a health worker? Why do you think FP counselling is important? What are your goals for counselling community members or clients about FP? What do you hope will happen? What community problems will good FP counselling help with?
What is Informed Choice? All family planning clients have the right to informed choice: Opportunity to freely choose among options and Complete, accurate information that is easy to understand about appropriate, available options
Clients Have a Right to Freely Choose Whether to: Have children, and how many to have Use FP or not Be tested for STIs/HIV Use condoms Have one or more sexual partners Talk with partner about condoms or FP Reveal their HIV status
Maintaining Confidentiality Confidentiality is a client’s right All sessions with FP clients must be kept confidential Do not tell anyone what client has told you or show client records to anyone except a health provider Assuring clients of confidentiality helps them to relax and share more openly
Effective FP Counselling Communication and counselling skills, including skills of giving focused information Ability to guide the client through the counselling process FP methods information
How Do We Communicate? Interpersonal communication is: Nonverbal communication: Face-to-face exchange of information, ideas or feelings through facial expressions, gestures and body positions Verbal communication: Face-to-face exchange of information, ideas or feelings through use of the voice
Effective Non-verbal Communication Paying full attention—listening Relaxed and accepting body postures facing the client Facial expressions that show interest, acceptance and concern (smiling) Encouraging gestures (nodding the head) Avoiding checking watch or looking away Help establish a good connection
Effective Verbal Communication Active Listening: Giving verbal encouragement Using appropriate tone of voice Paraphrasing what the client says Reflecting feelings
Paraphrasing and Reflecting Feelings Purpose: Lets client know you are listening Checks that you have understood Reflects the client’s feelings about situation Summarizes or clarifies what client says
Using Simple, Clear Language Use words and explanations that clients can easily understand If clients do not understand, they may not: –Ask for clarification –Make good decisions –Follow instructions
Other Key Counselling Skills Remain nonjudgmental and avoid using judgemental words Discuss sexuality and sexual practices comfortably Help clients prepare to talk with partners about FP Ask questions effectively
Purpose of Asking Questions Assess client’s needs and concerns Involve client in conversation Help client express feelings and attitudes Show interest and concern Determine what client already knows Identify misinformation or myths to correct
Types of FP Counselling Questions Two types: Do you wish to have children in the future? How may I help you today?
How can I help you today? Are you using a family planning method now? Are you worried you might be pregnant? Would you like to choose a method? Do you have a question or problem about a method? Do you have any concerns about sexually transmitted infections (STIs) or HIV/AIDS? Other needs?
Tips for Asking Questions Effectively Use a tone of voice that shows interest Ask one question at a time, wait for answer Ask questions that encourage client to express needs Avoid leading questions Avoid judgmental questions or questions starting with “Why” or “Why didn’t you?” Repeat a question in different way if client has not understood If asking a delicate question, explain why
Negotiating Family Planning Use “What are some reasons a woman’s partner may give her for not using FP or why he doesn’t like FP?” How can you help a client prepare to negotiate FP use with a partner?
Counselling is Not … Solving a client’s problems Telling a client what to do or making decisions for client Judging, blaming, or lecturing a client Interrogating a client Imposing your beliefs Pressuring a client to use a specific method Lying to or misleading a client
Beliefs and Attitudes Be aware of your beliefs and attitudes Clients may not return if they feel judged or pushed Remain neutral and nonjudgmental Respect the rights of your clients Practice helps
Communication and Counselling Skills Success of FP counselling depends on ability to establish and maintain a good connection: –Builds trust –Helps client relax –Helps client communicate openly Good communication and counselling skills are keys for maintaining good connection throughout the counselling session
Communicating Effectively and Maintaining Rapport Show respect Be relaxed, friendly and attentive Use simple, clear language Use open-ended and probing questions appropriately Listen carefully to client Ask client about feelings Encourage client participation Explain what will occur during visit and procedures Ensure client understanding and correct misunderstandings Use job aids appropriately Correctly record information on data-collection forms
Stages of FP Counselling 1 2 3 4 Establish rapport and assess client’s needs and concerns Provide information to address client’s needs and concerns Help client make an informed decision or address a problem Help carry out client’s decision
Assess Client’s Needs and Concerns Greet client appropriately Ensure privacy, confidentiality, and client comfort Ask about reason for visit Ask about partner(s), home life, family, health, sexual behavior, HIV status Ask about plans to have children, desire for FP Explore STI risk and what client does to avoid STIs 1
Questions About the Client Ideal family size Home life Partner(s) Health Sexual behavior HIV status
No method in mind? We can discuss: Protection from sexually transmitted infections (STIs) or HIV/AIDS Your experiences with family planning What you have heard about family planning methods Your plans for having children Your partner’s or family’s attitudes Other needs and concerns Provide Information to Address Client’s Needs and Concerns Now let’s discuss how a method can meet your needs 2 Part 1
Provide Information to Address Client’s Needs and Concerns Part 2 Inform client when needs or concerns are beyond provider’s capability Advise on how to prevent STIs Advise on how to have a healthy pregnancy (if client wants to become pregnant) 2
Provide Information to Address Client’s Needs and Concerns Part 3 Explain benefits of FP and healthy spacing If client wants FP, help client identify methods suited to her needs Give information on methods of interest Respond to other client questions or concerns 2
Provide Information to Address Client’s Needs and Concerns Part 4 Ask these 4 questions to identify methods suited to client’s needs and goals: 1.Do you wish to have children in the future? 2.Are you breastfeeding an infant less than six months old? 3.Do you have the cooperation of your partner in FP? 4.Are there any methods that you do not want to use or have not tolerated in the past? 2
Effectiveness How long client wants protection from pregnancy Ease of use Health benefits and possible side effects Safety How Clients Choose Methods
Ask client if she or he has any questions about methods you discussed Ask client to choose a method Use pregnancy checklist or method screening checklist to determine if client can use method Agree on decision or plan in partnership with client 3 Help Client Make An Informed Decision
Vasectomy or Female Sterilization Condoms (Male or Female) Vaginal Methods LAM Fertility Awareness-Based Methods What method are you using? IUD The Pill The Mini-Pill Long-Acting Injectable Monthly Injectable Implants
Help Carry Out Client’s Decision Give FP method and condoms, if needed Explain/demonstrate correct use Ask client to explain/ demonstrate Remind client about side effects, reasons to return Role-play or rehearse skills to talk to partner Arrange follow-up, resupply, or referral, as needed 4
Family Planning Counseling Optional Session Session III
Serving Diverse Groups Different client’s have different needs What are some of the special needs of these groups? – male vs. female, –adolescents vs. adults, –postabortion or postpartum women How would you address each of these client’s needs?
Counselling Needs of Adolescents Young people deserve nonjudgmental and respectful care Show them that you enjoy working with them Use terms that suit young people Try to make sure that a young woman's choices are her own Speak without expressing judgment Take time to fully address questions, fears, and misinformation
How can I help you? Anything you want to discuss? For example: Will parents or partner find out? Need contraception? HIV/AIDS worries? Partner problems? Pregnancy? About sex? About the body? You are welcome here any time
Counselling Needs of Men How to talk with their partners about family planning and STIs. Encourage men to make decisions about sexual and reproductive health jointly with their partners. Encourage women to bring their partners to see clinical providers for joint counselling, decision-making, and care. Suggest to female clients that they tell their partners about health services for men. Give female clients informational materials to take home, if available. Correct men’s misperceptions and give them information to inform their decisions and opinions.
Counselling Needs of Postpartum Women Discuss the importance of birth spacing Explain the rapid return to fertility for women who are not breastfeeding Discuss return to sexual activity Explain benefits of LAM and exclusive breastfeeding Discuss family planning options and when each method can be started Integrate family planning within maternal, newborn and child health services
How can I help you? Plan for the future You can become pregnant if you are not BF BF will protect you from pregnancy for 6 months if you do not give other food or drink. Many good FP methods to use while BF
Family Planning Needs of Post Abortion Women Women need easy and immediate access to family planning services after an abortion Women with post abortion complications need support. - Be understanding - Be respectful & avoid judgment and criticism - Ensure privacy and confidentiality - Ask if she wants someone she trusts to be present during counselling Explain that fertility returns quickly and discuss family planning options
How can I help you? Let’s discuss your needs: You can get pregnant again quickly I can help you choose and use a method All family planning methods are safe now if you have no infection.