2AIMTo prepare midwives to provide effective family planning counselling to women and their familiesTo enable midwives to understand the importance of family planning related to protecting, respecting and fulfilling women‘s rights to safe motherhood
3Family Planning Training Project AcknowledgementThis powerpoint presentation is adapted and used with permission from:Family Planning Training Project
5Learning OutcomesExplain how to support informed choice and maintain confidentialityDiscuss sexual health without embarrassmentDemonstrate how to help clients discuss and negotiate FP use with partnersIdentify beliefs and attitudes that may interfere with effective counselingDescribe the four stages of FP counseling and factors that affect FP method choice
6Demonstrate effective communication and counselling skills Demonstrate how to use a counselling tool and other job aids effectivelyDemonstrate effective communication and counselling skillsDemonstrate competence in providing informed choice FP counsellingExplain the counselling needs of women who are postpartum and post abortionExplain how traditions or beliefs may limit a woman’s ability to freely choose and use FPSuggested script:During this training you will learn, practice, and demonstrate these skills during role plays and other activities. You will also be encouraged to think about what it will be like to perform these tasks on-the-job.How well do these objectives match your expectations for the training?Note to facilitator:The session is designed to address the objectives on FP counselling listed in the session plan. If it is helpful, you may inform participants about the people and organizations involved in developing the learning objectives and the training program. Also mention that the learning intervention will include a practicum or simulation (if applicable) and briefly describe how skills will be assessed.
7Personal 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 willgood FP counselling help with?Illustration credit: Ambrose Hoona-KabAs a warm up activity, get class to divide into groups of 3-4 and answer some of the questions above
8What is Informed Choice? All family planning clients have the right to informed choice:Opportunity to freely choose among optionsandComplete, accurate information that is easy to understand about appropriate, available optionsWhat do we mean by informed choice? <allow participants to respond; use responses to help define informed choice>
9Clients Have a Right to Freely Choose Whether to:Have children, and how many to haveUse FP or notBe tested for STIs/HIVUse condomsHave one or more sexual partnersTalk with partner about condoms or FPReveal their HIV statusClients have the right to freely choose <click the mouse to display and read each point on the slide>What are some other examples of when a client’s choice does not seem like the appropriate decision from the provider’s perspective? <allow participants to respond and discuss as appropriate>Why is it important to support a client’s choice or choices, even when it does not seem, in your opinion, to be best for the client? <allow several participants to respond>Reference:1.Abdel-Tawab N, RamaRao S. Do improvement in client-provider interaction increase contraceptive continuation? Unraveling the puzzle. Patient Education and Counseling, :
10Maintaining Confidentiality Confidentiality is a client’s rightAll sessions with FP clients must be kept confidentialDo not tell anyone what client has told you or show client records to anyone except a health providerAssuring clients of confidentiality helps them to relax and share more openlySuggested script:How would you feel if your best friend revealed a secret you had told her, and had asked her not to tell anyone, and now the whole village knows your secret? <allow participants to respond; responses may include angry, betrayed, mistrustful, embarrassed, shamed>Would you trust her again? <allow participants to respond>How would you feel if you went to a clinic and confided in the provider, but then heard that she had shared the information with others? <allow participants to respond>Now, how do you feel about a friend who always keeps your secrets? <allow for a few responses>You trust her, yes? You are more likely to speak openly with her in future conversations.
11Effective FP Counselling Communication and counselling skills, including skills of giving focused informationAbility to guide the client through the counselling processFP methods information
12How Do We Communicate? Interpersonal communication is: Nonverbal communication:Face-to-face exchange of information, ideas or feelings through facial expressions, gestures and body positionsVerbal communication:Face-to-face exchange of information, ideas or feelings through use of the voiceCan anyone describe nonverbal communication? <allow one or two responses>Yes, nonverbal communication is <define nonverbal communication as shown on slide>And verbal communication is <define verbal communication as shown on slide >
13Effective Non-verbal Communication Paying full attention—listeningRelaxed and accepting body postures facing the clientFacial expressions that show interest, acceptance and concern (smiling)Encouraging gestures (nodding the head)Avoiding checking watch or looking awayHelp establish a good connectionWhat might be other examples of negative nonverbal behavior or cues? <allow participants to answer, affirm appropriate responses>Can you think of any other nonverbal cues or gestures that you could you use during your counselling sessions to help put clients at ease? <discuss and answer any questions>
14Effective Verbal Communication Active Listening:Giving verbal encouragementUsing appropriate tone of voiceParaphrasing what the client saysReflecting feelingsParaphrasing means to change words used to make it simpler or give a different way of saying the same thing
15Paraphrasing and Reflecting Feelings Purpose:Lets client know you are listeningChecks that you have understoodReflects the client’s feelings about situationSummarizes or clarifies what client saysExpress empathy, not sympathy:Client: My baby wants to feed very often and it makes me feel so tired.Health worker: You are feeling very tired all the time then?NOT: I know how you feel. My baby also wanted to feed often and I was so exhausted!
16Using Simple, Clear Language Use words and explanations that clients can easily understandIf clients do not understand, they may not:Ask for clarificationMake good decisionsFollow instructions
17Other Key Counselling Skills Remain nonjudgmental and avoid using judgemental wordsDiscuss sexuality and sexual practices comfortablyHelp clients prepare to talk with partners about FPAsk questions effectivelyAsk class what are some judgemental words?
18Purpose of Asking Questions Assess client’s needs and concernsInvolve client in conversationHelp client express feelings and attitudesShow interest and concernDetermine what client already knowsIdentify misinformation or myths to correctInstructions for facilitator:Ask the participants: What is the purpose of asking questions during FP counselling? Allow for several responses.Then click the mouse to reveal each of the bullet points, in turn.
19Types of FP Counselling Questions Two types:Do you wish to have children in the future?How may I help you today?Closed and open ended questions
20How 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?Are these examples of open-ended or closed question?
21Tips for Asking Questions Effectively Use a tone of voice that shows interestAsk one question at a time, wait for answerAsk questions that encourage client to express needsAvoid leading questionsAvoid judgmental questions or questions starting with “Why” or “Why didn’t you?”Repeat a question in different way if client has not understoodIf asking a delicate question, explain whyAsk participants, How many of you would feel uncomfortable asking your client about the number of their sexual partners or about their sexual practices?Use the responses to lead into the next activity about practicing asking questions about sexual behavior.What advice could you give about asking questions effectively? <allow participants to respond; use responses to present the tips>To ask questions effectively, it is important to maintain your active listening tone of voice, while showing interest and concern.In addition, ask only one question at a time, wait with interest and patience for the answer.Ask questions that encourage clients to express their needs. Here’s one example: How would you feel if you became pregnant soon? What would be another example? <allow participants to respond; affirm and/or correct their responses>Avoid leading questions; these are questions that indicate the answer the provider wants to hear, such as: You wouldn’t want to use the Pill, would you? Or: You use a condom every time you have sex, right?Avoid judgmental questions or starting questions with “Why” or “Why didn’t you…” These can sound as if you are blaming the client or finding fault.Repeat a question in a different way if the client has not understood you the first time.If you need to ask a delicate question, explain why. For example, asking about the number of sexual partners to find out about STI risk. What is one way you could ask about this and also explain why it is important for you to do so?<allow time for a few responses; affirm or correct and provide an example of asking about the number of sexual partners; discuss as needed, emphasizing that it can be difficult to discuss sexual health and sexuality>
22Negotiating 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?Instructions for facilitator:Divide into two groups. Give each group a blank flip chart and pens. Ask each group to assign a recorder for the group. Ask “What are some reasons a woman’s partner may give her for not using FP or why he doesn’t like FP?” Ask the groups to brainstorm and write on their flip chart answers to the question. Tell the groups to leave space for a response under each statement on the flip chart. Give the groups about five minutes to work.After two minutes, call time and ask the groups to switch places. Now, ask the groups to examine the other group’s list, and brainstorm and write one response to each of the statements on the flip chart. Give the groups another two minutes or so to do this.Bring the groups back together and discuss the two lists of statements and responses. Note similarities and differences. Note that this list can be a resource for participants to use during role plays and in their work.Explain that they can use this technique to help a client prepare to talk with her husband or boyfriend about using FP.Ask participants: “What are other ways to help a client prepare to negotiate FP use with a partner?” Allow participants to respond, then explain that it is often helpful to rehearse the negotiation conversation, with the midwife taking the role of the partner so the client can practice her responses.Tell participants that if the client is having difficulty responding to what you, as her partner, are saying, you may rehearse the conversation again, this time with the client taking the role of her partner while you play the client’s role and model possible responses.Ask two participants to do a short role play of a couple negotiating family planning use, using some of the dialogue from the flip charts.Ask participants if they have any questions and discuss further as needed. Tell participants that next you will demonstrate these techniques.
23Counselling is Not … Solving a client’s problems Telling a client what to do or making decisions for clientJudging, blaming, or lecturing a clientInterrogating a clientImposing your beliefsPressuring a client to use a specific methodLying to or misleading a clientAsk participants to partner with someone sitting near them.Ask participants to reflect on a negative counselling experience and to share with their partner what made the experience negative and one or two characteristics of the counsellor or health worker involved in the negative experience. Ask the participants to talk about what the counsellor did or said that was not productive or did not help the situation. If participants have difficulty thinking of a negative counselling experience, give them an example.Allow two or three minutes for this discussion.In the larger group, ask the participants to share what they discussed about their negative experiences. Click the mouse to reveal the list on this slide, and relate the bullet points to the participants’ responses. Discuss.Give examples from your experience of how clients have been treated and how that influences their behaviors and use of services; if possible, use quotes from clients about their experiences, without identifying the client.Remind participants that sometimes we are not aware of how we affect clients by things we say and do, therefore it is helpful to get feedback from each other during the training and from our supervisors when we return to our communities.Inform participants that next we will look at our own beliefs and attitudes and how they may get in the way of effective, informed choice counselling if they are not managed properly.
25Be aware of your beliefs and attitudes Clients may not return if they feel judged or pushedRemain neutral and nonjudgmentalRespect the rights of your clientsPractice helpsIt’s important to be aware of our own beliefs and attitudes and how they may influence how we counsel our clients.Clients may not return for services if they feel they have been judged or pushed. Remaining neutral and nonjudgmental toward a client is an important skill in counselling. This means managing what we feel and say so that we do not let our beliefs and attitudes interfere with our counselling.Everyone has their own beliefs and value system. Often, these attitudes may come in conflict with different clients that you see. It is important to respect an individual’s beliefs. Clients have the right to be treated with respect.However, while remaining respectful, it is also important to challenge client beliefs that might be harmful to that individual or to others. As you engage in family planning work, it is equally important to challenge your own values and beliefs.
26Communication and Counselling Skills Success of FP counselling depends on ability to establish and maintain a good connection:Builds trustHelps client relaxHelps client communicate openlyGood communication and counselling skills are keys for maintaining good connection throughout the counselling sessionThe success and effectiveness of the counselling session depend on your ability to establish and keep a good, warm connection with the client, so that you build trust with the client and help them to relax, which helps them to communicate openly with you. What are some things that you do when greeting a client to establish a good connection? <allow participants to respond; affirm or build upon their responses to make the following points>Yes, you greet them using a warm tone of voice, use eye contact if appropriate, call them by name, and ensure that they are seated comfortably.What are some things that you do to maintain this connection? <allow participants to respond; affirm correct responses>All of the communication and counselling skills that you have learned up to this point will help you to establish and maintain a good connection.As we begin to learn and practice each stage of the counselling process, it is good to keep in mind the importance of using these and other skills to maintain a good connection with your client throughout the counselling session.References:1. Knebel E. The use of manual job aids by health care providers: What do we know? Issue Paper Volume 1. Baltimore, MD: Quality Assurance Project, 2000.2. Tumlinson K; Hubacher D; Wesson J; Lasway C. Measuring the usefulness of family planning job aids following distribution at training workshops. Journal of Biosocial Science, Sep;42(5):695-8.Reference:1.Johnson SL, Kim YM, Church K. Towards client-centered counseling: Development and testing of the WHO decision-making tool. Patient education and counseling, :
27Communicating Effectively and Maintaining Rapport Show respectBe relaxed, friendly and attentiveUse simple, clear languageUse open-ended and probing questions appropriatelyListen carefully to clientAsk client about feelingsEncourage client participationExplain what will occur during visit and proceduresEnsure client understanding and correct misunderstandingsUse job aids appropriatelyCorrectly record information on data-collection formsAsk a trainee to read the slide out loud. Note the list of skills and tasks. Note how all the items on this slide are important for establishing and maintaining rapport and are also used or done throughout the session or more than once during the session. Ask trainees to recall how they have practiced these skills in previous exercises.Leave the slide in place and tell trainees that they can refer to the slide during their practice exercises when they are learning the stages of the FP counselling process. Inform trainees that you will demonstrate most of these tasks and skills when demonstrating the first stage of counselling.
28Stages of FP Counselling 1234Establish rapport and assess client’s needs and concernsProvide information to address client’s needs and concernsIn this section of the training we will review the stages of counselling during a client visit and how we can use the counselling tool to help guide our discussion with the client. There are four stages of the family planning counselling session. The title of each stage describes the primary task or tasks of that stage:In Stage 1, you establish rapport and assess the client’s needs and concerns.In Stage 2, you provide information to address the client’s needs and concerns.In Stage 3, you help the client make an informed decision or decisions about FP or help them decide how to address a problem.Stage 4, you help carry out the client’s decision.The communication and counselling skills that you have learned and practiced are important in all of these stages. Though we will discuss each of these stages separately, in actual practice the stages flow one into the other and the boundaries between them are not distinct. To give you an idea of how a family planning counselling session works, I will demonstrate a counselling session that moves through all of these stages. Watch and see if you can identify when I am in each of these stages. I will stop the demonstration at certain points and ask you what stage you think I am in.Conduct a brief FP counselling session demonstration using Roleplay Scenario 1 in the Educator’s Manual. Ideally, arrange for two co-facilitators to conduct the demonstration so you may comment on the interaction. If necessary, conduct the demonstration with your co-facilitator. Stop the demonstration at several points to give participants the opportunity to identify each stage, correcting their responses as needed. Note the use of the counselling tool and other job aids used during the demonstration that participants will be using at their workplace, (i.e., FP Choices cards) and inform participants that they will use these during practice role plays. Inform participants that next they will review the counselling tool.Distribute a counselling flip chart or counselling tool used in the country. If no local tool is available use WHO’s A Guide to Family Planning for Community Health Worker’s and Their Clients.Help client make an informed decision or address a problemHelp carry out client’s decision
29Counselling Tool for Family Planning The purpose of this activity is for participants to become familiar with using counselling tool, so they can more easily absorb information about the stages of the FP counselling process during the activities that follow. Adapt this overview and the activities for the tool that the participants will be using during FP counselling.Begin by asking participants, Recalling the demonstration, what do you think is the benefit of using a counselling tool during FP counselling? Allow participants to answer and discuss.Use responses to highlight these points: A counselling tool helps:guide decision-making for the clientorganizes the counselling for the providerhelp a client clarify what she wants in a methodconsider benefits and limitations of method options, and how these might affect her or his life.It encourages client participation and helps a client feel confident in her decision- making.Helps a midwife give accurate and complete information and reduces the need to memorize information.supports and facilitates informed decision-making.Ask trainees to open their counselling tools , look at the first few pages and become familiar with them. To conclude the activity, demonstrate how to hold the counselling tool so the provider and the client can see it, and how to point to information. Ask participants to practice showing pages of the counselling tool to each other.
30Assess Client’s Needs and Concerns 1Assess Client’s Needs and ConcernsGreet client appropriatelyEnsure privacy, confidentiality, and client comfortAsk about reason for visitAsk about partner(s), home life, family, health, sexual behavior, HIV statusAsk about plans to have children, desire for FPExplore STI risk and what client does to avoid STIsSuggested script:The first stage of FP counselling has three main purposes:To establish a good connection with the client,To find out why the client has come to see you, andTo gather basic information about the client’s situation so you can help them.As we saw in the roleplay, it is very important to establish a good connection with the client at the beginning of the visit by greeting them appropriately. Make sure that you are in a private space where others cannot see you or overhear your conversation, and assure the client that everything he or she says will be kept confidential. Also make sure that the client is seated comfortably.After greeting your client, ask “How may I help you today?” What is another way to ask about the reason for the visit? <allow participants to answer> <give an example, such as “What do you hope that I can do for you today”>Then gather information about these areas of the client’s life: home life, ideal family size, health, partner or partners, sexual behavior and HIV status. Ask a brief series of questions to gather this information. The amount of detail discussed at this point depends on the client’s needs and whether or not the client is new or is a returning client. Ask about a client’s plans to have children and desire for family planning—to delay or prevent pregnancy, or to become pregnant.Next, help the client consider their STI risk. When assessing STI risk, ask questions and then listen closely to the client. Respond in a way that helps them explore their own risk and decide for themselves if they are at risk. You should not tell them that they are at risk, even if you think they are. The information gathered at this stage should be used to tailor the rest of the counseling session to the client’s individual needs. Each session will be different.
31Questions About the Client Ideal family sizeHome lifePartner(s)HealthSexual behaviorHIV statusThe purpose of this exercise is for participants have fun while generating a list of questions they can use in the first stage of FP counselling.Show slide with the categories of information to be gathered from clients. Remind participants that, at the start of a session with a new client, they need to gather information from the client about the client’s ideal family size, partners, home life, health, sexual behavior, and HIV status.Ask the trainee’s to form small groups of no more than three to four trainees.Make sure each group has a blank piece of paper, pens or pencils and a place to write. Assign one or two categories from the slide above to each group, so that all categories are covered and no two groups have the same category. Tell the groups to discuss and agree on what questions they would use to gather information about their assigned category. Tell them that each group will have just two minutes to discuss and write their questions and that they should create mostly open-ended questions, as appropriate. Tell them to write their assigned category or categories at the top of their blank sheet of paper, then signal the groups to begin.At the end of the two minutes, tell the groups to stop writing. Instruct them to fold their papers into paper airplanes, demonstrating how to do this, if necessary. Tell each group to “fly” the airplane to the group next to them. After each group receives an airplane, they should unfold it carefully and examine the questions listed on this new sheet of paper. Give them about one or two minutes to add any questions to those on the list, or to suggest new ways to ask a question that is already listed. At the end of this time, instruct them to refold the papers into an airplane and “fly” it back to the group it received it from. Ask one representative from each group to read their list of questions aloud to the rest of the participants. Give feedback on the questions; write some of the best questions as examples on flip chart paper, and ask the group to suggest ways to improve other questions.
322 Provide Information to Address Client’s Needs and Concerns Part 1No method in mind? We can discuss:Protection from sexually transmitted infections (STIs) or HIV/AIDSYour experiences with family planningWhat you have heard about family planning methodsYour plans for having childrenYour partner’s or family’s attitudesOther needs and concernsThe second stage of FP counselling is about providing your client information and options to address their identified needs and concerns. <read the list of these tasks on the slide>What you say to your client in this stage is based upon what you learned during the first stage, when you asked questions to find out about the client’s needs and situation, such as about their home life, partners and HIV status. For example, what did we learn about [Sarah] during the role play? <allow participants to answer, record responses on flip chart, summarize the information learned about the client and point at the relevant information on the flip chart>To summarize, we learned about Sarah that she is 21 and married, she is interested in injectables but also wants to learn about other FP methods, she is still breastfeeding her eight- month-old baby, her menses returned two months ago, her husband was treated for an STI recently, and she wants to delay pregnancy for at least several years.<The information in this paragraph applies only if participants are qualified nurses/midwives.> If during Stage 1, or during any part of the counselling session, your client tells you about a need or concern that you have not been trained to respond to, it is important to tell them that you can not deal with that issue and refer them to the local health center or to a clinical provider. <give name of local health center or provider>The first task in this stage is to advise the client how to prevent STIs, if the client believes he or she is at risk for STIs or HIV infection. This advice should flow naturally from your assessment of STI risk. Do you recall how I helped the client assess her STI risk at the end of Stage 1? What are the ways you can advise your clients to prevent STIs including HIV? <allow for several responses> <affirm and highlight correct answers; refer to any relevant pages of the counselling tool>What do you say to your client at this point? <allow for several responses> Yes, that’s correct, what you say is based on the goals they described in Stage 1. If they said they want to become pregnant, you describe things they should do or consider when thinking about becoming pregnant.Now let’s discuss how a method can meet your needs
33Provide Information to Address Client’s Needs and Concerns 2Part 2Inform client when needs or concerns are beyond provider’s capabilityAdvise on how to prevent STIsAdvise on how to have a healthy pregnancy (if client wants to become pregnant)
34Provide Information to Address Client’s Needs and Concerns 2Part 3Explain benefits of FP and healthy spacingIf client wants FP, help client identify methods suited to her needsGive information on methods of interestRespond to other client questions or concernsFor clients who are thinking about using family planning for the first time, the next step in Stage 2 is to describe the benefits of family planning. <display any relevant counselling tool pages and note the main points>If your client says she wants to limit or delay childbearing, or stop childbearing, then ask her if she already has a method in mind. If she does, you would give her information about that specific method. If she does not have a specific FP method in mind, what do you say? <allow participants to respond>You explain that there are many family planning methods to choose from, and then display the FP choice cards for the client. <display the method selection job aid(s) participants will be using. Explain or demonstrate how simple diagrams and cards can be made if they don’t have an ‘official looking aid’>Then we come to the heart of Stage 2: Identifying methods that are suitable for the client’s situation. By asking four questions, you can quickly narrow down the list of available FP methods to those that best meet the client’s needs. After asking the method selection questions, there will usually be two to four methods remaining that are suitable for the client. At this point you describe for the client the main features of each of these methods.All of the information that is important to give to the clients to help them choose a method are in your counselling tools. For example, let’s look at information on the Pill (or COCs). <show where this information is provided in the counselling tool >What are the features of the Pill described here? <allow for several responses> Yes, how it works, the fact that it reduces menstrual bleeding and cramps, possible side effects, health benefits, it requires taking a pill every day, and that it is less effective if you miss a pill. The important thing to remember is not to overload the client with too much information at this point. Just share with them the five to seven key facts about the method that are shown in counselling tools.You would also respond to any other client concerns or questions. For instance, if the client wants FP and also wants help with discussing FP with her partner, you would tell her you can help her find approaches that will work, and that you will discuss this further after she has decided on a FP method. Do you have any questions about this stage so far? <allow participants to respond and answer questions as needed>I will demonstrate how to ask the four questions and use the FP choice cards to eliminate methods. Please follow along using your counselling tools (or other job aids).
35Provide Information to Address Client’s Needs and Concerns 2Part 4Ask these 4 questions to identify methods suited to client’s needs and goals:Do you wish to have children in the future?Are you breastfeeding an infant less than six months old?Do you have the cooperation of your partner in FP?Are there any methods that you do not want to use or have not tolerated in the past?Display the FP choice cards and ensure that each participant has a copy. They may have to cut them out from the templates provided, or draw their own set of cards.Arrange them by type—permanent methods, temporary methods, and fertility awareness methods— and demonstrate how to ask the questions and eliminate methods.Review the questions on the slide. Explain that the questions help you rule out certain methods.If a client answers yes to question 1, what methods should we set aside? (vasectomy and tubal ligation)If a client answers yes to question 2 , what methods could we safely rule out (or set aside)? (The Pill/ COCs)Question 3, what methods require partner involvement or cooperation? (Male and female condoms, and Standard Days Method)Question 4, what does this question rule out (or set aside)? (Methods the client does not want or did not tolerate in the past)Ask trainees if they have any questions, clarify any points as needed.Reference:1. León, Federico, Ricardo Vernon, Antonieta Martin, and Linda Bruce The Balanced Counseling Strategy: A Toolkit for Family Planning Service Providers. Washington, DC: Population Council.
36How Clients Choose Methods EffectivenessHow long client wants protection from pregnancyEase of useHealth benefits and possible side effectsSafetyDuring the next stage of counselling, new clients will choose an FP method.Talk about how clients choose a FP method. When members of your community are considering using a FP method, what features or characteristics of the methods do you think are important to them? What features are important to you? Why do people choose FP methods? <allow participants to respond; use their responses to highlight the following points>Factors that women and couples often consider when they decide which contraceptive method to use include:How effective a method is at preventing pregnancy is a very important consideration for most users. Turn to a counselling tool page on method effectiveness . You can use these effectiveness charts to help describe and compare the effectiveness of the methods that your client is considering.How long the client wants protection from pregnancy—whether for a year or less, two to three years, four years or more, or whether they want to stop childbearing altogether.How easy it will be to use. Some methods do not require users to do anything—such as the IUD—while others require action at the time of intercourse or at specific time intervals. What are examples of method that require user actions? <allow for several responses> Yes, examples include using a condom with each act of sex, taking a pill every day, or getting an injection every three months.Health benefits and possible side effects of the method are also important considerations. Some methods offer important health benefits that may be particularly appealing to some women. Side effects are different from method to method and knowing them in advance helps a woman decide what potential side effects she is willing to tolerate.How safe the method is for them to use. However, few women of childbearing age have serious health conditions that may affect safe use of contraceptives.What other factors are important when choosing a FP method? <allow for several responses; discuss> <possible responses may include: cost and access to resupply; previous experiences with a method; desire for STI/HIV protection; whether partner involvement is required>
373 Help Client Make An Informed Decision Ask client if she or he has any questions about methods you discussedAsk client to choose a methodUse pregnancy checklist or method screening checklist to determine if client can use methodAgree on decision or plan in partnership with clientThe purpose of the third stage of counselling is to help the client make an informed decision about a FP method or help them decide how to address a problem they want help with.These are the tasks of this stage: <click the mouse to display each bullet in turn and read each one as it displays on the slide>The first task is to ask the client if she has any questions about the methods that you discussed. Answer any questions, and then ask the client to choose the method that is most convenient for him or her.Clients may ask the counsellor their opinions of the remaining methods. However, it is important not to impose your opinion on a client. Remain neutral even if you favor or dislike a particular contraceptive method or believe that the client would do better with a different method. If your client is not clear about which method she prefers, how can you help her? <allow several participants to respond> You can review information about the two or three methods that she is considering, emphasizing the characteristics of each method that are important to the client, and using a counselling tool (or other job aids) to explain how the methods differ. These are the characteristics that we just discussed, such as effectiveness, ease of use, side effects and health benefits.The next task is to use a screening checklist, if needed, to determine if the client has any conditions that would make it unsafe for her to use the method.The final task of this stage is to agree on a decision or plan in partnership with your client. This means summarizing the decisions that the client has made during this session and describing what comes next. For clients who have chosen a FP method, you would confirm the client’s choice. You may say something such as, “So you’ve decided that you definitely want to use injectables, is that right?” In addition, if the client chooses a method that you cannot provide, what would you say at this point? <allow participants to respond; affirm correct responses> Yes, you would say “I will give you a referral to the clinic for implants.”Ask participants whether they have any questions about this stage; answer questions and clarify points as needed.
38What method are you using? Vasectomy or Female SterilizationCondoms (Male or Female)Vaginal MethodsLAMFertility Awareness-Based MethodsIUDThe PillThe Mini-PillLong-Acting InjectableMonthly InjectableImplants
39Help Carry Out Client’s Decision 4Give FP method and condoms, if neededExplain/demonstrate correct useAsk client to explain/ demonstrateRemind client about side effects, reasons to returnRole-play or rehearse skills to talk to partnerArrange follow-up, resupply, or referral, as neededIn the fourth and last stage of FP counselling, these are the steps: <click the mouse to display and read each bullet point on the slide>First give the client their requested FP method—or, <if participants are CHWs>, a referral to get a method such as implants, plus condoms, if needed.Then explain how to use the method using a counselling tool.Next, check to make sure that the client understands how to use the method or methods by asking him or her to explain and or demonstrate correct use. Remind the client about any side effects she may experience, and signs of problems or complications for which she should return, using the appropriate pages in the counselling tool.Do the next task, “Role-play negotiation skills” only if the client requested help in preparing to talk with their partner. At this time you help them to plan and rehearse the discussion. This may include discussing what they will say and when and where they will have the talk, helping them brainstorm possible responses and role-playing the conversation so they can rehearse responses, as you practiced previously. I will do this during my demonstration of this stage.Invite the client to come back any time for any reason. If the client has chosen a method that you will provide on a regular basis, explain what will happen during future visits and schedule the next visit. Do you have any questions? <answer any questions as needed> Let’s see what this stage looks like.
40Family Planning Counseling Optional Session Session III
41Serving Diverse Groups Different client’s have different needsWhat are some of the special needs of these groups?male vs. female,adolescents vs. adults,postabortion or postpartum womenHow would you address each of these client’s needs?Ask participants to form groups of four groups. Give each group one of the case studies from the handout Case Studies, Serving Diverse Groups.Ask each group to answer the following questions about their case:What are some of the special needs of the type of client in your case study?How would you address each of these client’s needs?Give the participants 10 minutes, and at the end of that time ask them to join the larger group.Ask each group to present their responses to the questions. If two or more groups worked on the same case, ask these groups to present their responses consecutively. Record each group’s responses on a flip chart. Discuss each case before moving to the next. Use the participants’ responses to summarize and highlight the particular needs of each of the four types of clients, as represented in the case descriptions (adolescents, men, postabortion and postpartum clients). The next 3 slides will summarize correct responsesDuring the discussion after each presentation, ask the small group(s) that presented on that case the following additional questions:Was there anything related to these clients’ situations that felt uncomfortable? What are some strategies or tools for handling these types of situations?After all groups have presented, ask the larger group:How do you decide when you might not be in the best position to help a client and therefore refer the client?If participants are CHWs, remind them that if they ever feel that the needs of the client are beyond what they can provide they should refer them to a clinic or other similar resource. <give name of local clinic, health center or clinical provider>
42Counselling Needs of Adolescents Young people deserve nonjudgmental and respectful careShow them that you enjoy working with themUse terms that suit young peopleTry to make sure that a young woman's choices are her ownSpeak without expressing judgmentTake time to fully address questions, fears, and misinformationYoung people deserve nonjudgmental and respectful care no matter how young they are. Criticism or unwelcoming attitudes will keep young people away from the care they need. Family planning counselling and services do not encourage young people to have sex. Instead, they help young people protect their health.To serve the needs of adolescents, you can:Show young people that you enjoy working with them.Use terms that suit young people. Avoid such terms as "family planning," which may not make sense to unmarried adolescents.Try to make sure that a young woman's choices are her own and are not pressured by her partner or her family. In particular, if she is being pressured to have sex, help a young woman think about what she can say and do to resist and reduce that pressure. Practice skills to negotiate condom use.Speak without expressing judgment (for example, say "You can" rather than "You should"). Do not criticize even if you do not approve of what the young person is saying or doing. Help young clients make decisions that are in their best interest.Take time to fully address questions, fears, and misinformation about sex, sexually transmitted infections (STIs), and contraceptives. Many young people want reassurance that the changes in their bodies and their feelings are normal.Young people can safely use any contraceptive method. Young women are often less tolerant of side effects than older women. With counselling, however, they will know what to expect and may be less likely to stop using their methods.
43You are welcome here any time 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
44Counselling 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.For family planning counsellors, men are important for two reasons. The first reason is the influence that men have on women. Some men care about their partner's reproductive health and support them. Others stand in their way or make decisions for them. Men's attitudes can determine whether women can practice healthy behaviors. In some situations, such as needing to avoid HIV infection or getting help quickly in a medical emergency, a man's actions can determine whether a woman lives or dies.Men are also important as clients. Men use major family planning methods—male condoms and vasectomy. Men also have their own sexual and reproductive health needs and concerns—such as concerns about sexually transmitted infections (STIs)—which deserve the attention of health care providers.Meeting the needs of male clients:Coach men and women on 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 counseling, 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. Topics important to men include:Family planning methods for men and for women, including safety and effectivenessSTIs including HIV/AIDS—how they are and are not transmitted and where to go for testing and treatmentThe benefits of waiting until the youngest child is two years old before a woman becomes pregnant againMale and female sexual and reproductive anatomy and functionWhere to learn about safe pregnancy and childbirth
45Counselling Needs of Postpartum Women Discuss the importance of birth spacingExplain the rapid return to fertility for women who are not breastfeedingDiscuss return to sexual activityExplain benefits of LAM and exclusive breastfeedingDiscuss family planning options and when each method can be startedIntegrate family planning within maternal, newborn and child health servicesEarliest times that a woman can start a family planning method after childbirthImmediately: Lactational Amennorhea Method or male or female condomsWait 6 weeks after childbirth if partially or fully breastfeeding before beginning progestin-only methods such as injectables, implants. * Note: This is the current recommendation of WHO. Not all international experts agree and feel that women should be able to start contraception immediately after giving birth.Combined oral contraceptives can be given:- immediately if not breastfeeding days after childbirth if not breastfeeding- 6 weeks after childbirth if partially breastfeeding- 6 months after childbirth if fully breastfeedingFertility awareness methods: A woman may start when she has had 3 regular menstrual cycles (for calendar-based methods). This will be later for breastfeeding women than for women who are not breastfeeding.
46How can I help you? Plan for the future You can become pregnant if you are not BFBF 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
47Family Planning Needs of Post Abortion Women Women need easy and immediate access to family planning services after an abortionWomen 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 counsellingExplain that fertility returns quickly and discuss family planning optionsWomen who have just been treated for post abortion complications need easy and immediate access to family planning services. When such services are integrated with post abortion care, are offered immediately postabortion, or are nearby, women are more likely to use contraception when they face the risk of unintended pregnancy.Counsel with compassionA woman who has had postabortion complications needs support. A woman who has faced the double risk of pregnancy and unsafe induced abortion especially needs help and support. Good counselling gives support to the woman who has just been treated for post abortion complications.- Try to understand what she has been through- Treat her with respect and avoid judgment and criticism- Ensure privacy and confidentiality- Ask if she wants someone she trusts to be present during counsellingA woman has important choices to make after receiving post abortion care. To make decisions about her health and fertility, she needs to know:- Fertility returns quickly—within two weeks after a first-trimester abortion or miscarriage and within four weeks after a second-trimester abortion or miscarriage. Therefore, she needs protection from pregnancy almost immediately.- She can choose among many different family planning methods that she can start at once. Methods that women should not use immediately after giving birth pose no special risks after treatment for abortion complications.She can wait before choosing a contraceptive for ongoing use, but she should consider using condoms in the meantime if she has sex. If a woman decides not to use contraceptives at this time, providers can offer information on available methods and where to obtain them. Also, providers can offer condoms, oral contraceptives, or emergency contraceptive pills for women to take home and use later.To avoid infection, she should not have sex until bleeding stops—about five to seven days.If she wants to become pregnant again soon, encourage her to wait.Combined oral contraceptives (the Pill), progestin-only injectables, implants, male condoms, female condoms, and withdrawal can be started immediately in every case.
48Let’s discuss your needs: How can I help you?.Let’s discuss your needs:You can get pregnant again quicklyI can help you choose and use a methodAll family planning methods are safe now if you have no infection
49Spin the Wheel Points 4/14/2017 Instructions for facilitator: Use the questions and answer key in the document FP Game in the Educator’s manualGive each team one question before continuing to the next team. Display this slide in Slide Show Mode. Spin the wheel (click the mouse) only if the team correctly answers the question.Keep score on the Team Scores flip chart. When you have completed the game you will need to end the slide show in order to get to the next slide;PointsA Training Resource Package for Family Planning, Counseling—CHW, Presentation, 4/2011