COUNSELLING FOR

EFFECTIVE FAMILY PLANNING

USE
 COURSE OBJECTIVES
• Explain the importance of quality client-centered FP

counseling
• Build effective rapport with clients

• Assess clients’ individual FP needs, knowledge, and concerns

• Identify the key decisions clients need to make or confirm

• Support them through the process

• Assist clients carry out their FP decisions

WHY FP COUNSELING
MANY PROVIDERS

Think they know what is best for clients

Direct choices of FP methods

Lack

• Good communication skills

• Knowledge and skill needed for effective counseling

• Comfort in discussing sexual and reproductive health

Tell, tell and tell …

INTRODUCTION TO COUNSELING
Rights to family planning services
Recognized by international conventions and signed by most
countries of the world
It include
• The right to decide on the number, spacing, and timing of children
• The right to have the information to do so
• The right to attain the highest standards of sexual and reproductive
health; and
• The right to make these decisions without discrimination,
coercion, or violence
 PART 1: SUPPORTING CLIENTS’ INFORMED
VOLUNTARY DECISION MAKING

INFORMED CHOICE:
Individual’s well-considered, voluntary decision based on options,
information, and understanding.
WHEN APPLIED TO FP:
 It means that individuals freely choose whether to use a
contraceptive method and which one
 Whether to use contraception to delay, space, or end childbearing
 THE BENEFITS OF INFORMED AND VOLUNTARY
DECISION MAKING IN FP

• Better use of methods (and thus greater effectiveness)

• Higher continuation rates, and

• More satisfied clients who in turn are good

advocates/program promoters.
ELEMENTS THAT SUPPORT INFORMED AND
VOLUNTARY DECISION MAKING

• Service options are available.

• Decisions are made without coercion.

• People have appropriate information.

• Good client-provider interaction, including counseling, is ensured.

• Sexual and reproductive rights are respected at the community and

program levels.
 PART 2: THE DIFFERENCE THAT COUNSELING
MAKES

CLIENT PROVIDER INTERACTION

Critical for effective family planning counselling

Is interpersonal communications (verbal/nonverbal)

between health care staff and the client

Health care staff includes anyone associated with a service
site e.g., medical and paramedical staff, outreach staff,
receptionists, cleaners, and drivers
CLIENT-PROVIDER INTERACTION …
IMPORTANT
A client’s first impressions of a health care facility are usually
made through interactions with frontline staff.

The client’s sense of trust and confidence that he or she has

made the right decision to seek services can be reinforced or
completely undermined by frontline staff.
 PRINCIPLES OF GOOD CLIENT-PROVIDER INTERACTION

• Treat each client with respect

• Tailor the interaction to the individual client’s needs, circumstances,

and concerns
• Interact; elicit the client’s active participation

• Avoid information overload

• Provide the client’s preferred method (for FP) or address the client’s

primary concern (for other SRH issues)

• Use and provide memory aids
 COUNSELING

A type of client-provider interaction (CPI)

involving two-way communication between a
health care staff member and a client for the
purpose of confirming or facilitating a decision
by the client or helping the client address problems
or concerns
 IMPORTANCE OF COUNSELING

• It ensures clients’ right to informed and voluntary

decision making
• It is an essential element of quality FP services

• It is a key determinant of the adoption and continuation

of family planning
 THE DIFFERENCE BETWEEN CPI AND
COUNSELLING
The key principles for good CPI also apply to counseling,
In addition, providers should follow these guidelines when
counseling clients:
• Create an atmosphere of privacy, respect, and trust.

• Engage in two-way communication with the client.

• Ensure confidentiality.

• Remain nonjudgmental about values, behaviors, and

decisions that differ from your own

 THE DIFFERENCE BETWEEN CPI AND
COUNSELLING...

• Show empathy for the client’s needs.

• Demonstrate comfort in addressing sexual and gender issues.

• Remain patient with the client during the interaction and

express interest.
• Provide reliable and factual information tailored to the needs of

the client.
• Support the client’s rights to sexual and reproductive health.
 EFFECTIVE COUNSELING

• Enables clients to chose a method that suits their needs

• Enables clients to use their chosen method correctly

• Enables the client to continue using a FP method with

satisfaction
• Informs and prepares clients for side effects
 CONSEQUENCES OF POOR COUNSELLING

Effect Outcome
Incorrect method use Unwanted pregnancy

Not counseled for side effects Dissatisfaction Discontinuation

Failure to recognize serious warning Health risks

signs

Does not suit Dissatisfaction with • Drop out

method • Poor word-of-mouth
• Low utilization
 TASKS DURING COUNSELING

When providing counseling, health care staff is responsible

for
• Helping clients to assess their own needs for services,

information, and emotional support

• Providing information appropriate to clients’ identified problems

and needs
• Assisting clients in making their own voluntary and informed

decisions by helping them weigh the options

 TASKS DURING COUNSELING…

• Helping clients explore possible barriers to the implementation

of their decisions and

• Helping them develop the strategies and skills to overcome

those barriers, and carry out their decisions

• Answering questions and addressing concerns, and

• Making sure the client understands all the information they

have received
 PART 3. PROVIDERS’ BELIEFS AND ATTITUDES IN FP COUNSELING

BELIEFS:
• Beliefs are concepts and ideas that are accepted and thought to be true
• Our beliefs shape our attitudes and thus the way we think about and act
toward people and ideas
• Every interaction between a client and health care staff affects the
client’s willingness to trust and share personal information and concerns
• Everyone has a right to his or her own beliefs. However, as service
providers.
• We have a professional obligation to provide health care and to do so in
a respectful and nonjudgmental manner
 BUILDING COMMUNICATION SKILLS
Good counseling requires good communication skills.

Counselors need the ability to

Establish rapport,
Elicit information, and
Provide information effectively in order to support
clients’ informed and voluntary decision making
 BUILDING COMMUNICATION SKILLS…
To effectively assess clients’ needs,
Providers must couple open-ended questions that encourage clients to talk

about themselves and listen actively

To give appropriate information,

 Providers must be able to effectively communicate their knowledge
about RH/FP issues.
 They must have the ability to explain things in language and terms
that the client understands and
 They must be comfortable talking about issues related to sexuality .
 BUILDING COMMUNICATION SKILLS…
PRAISE AND ENCOURAGEMENT
• Praise is the expression of recognition, approval, and admiration.
• Encouragement is the provision of support, courage,
confidence, and hope
The purposes of praise and encouragement are to:
– Show that you are listening to the client and valuing what he or
she says
– Show your support
– Motivate the client to continue the discussion (telling and
asking)
BUILDING COMMUNICATION SKILLS…
THREE ASPECTS OF COMMUNICATION
• The following three key components of communication
have been shown to have varying degrees of impact on
the person(s) with whom you are interacting:
 Body Language 55%
Tone of Voice 38%
Actual Words 7%
BUILDING COMMUNICATION SKILLS…
ACTIVE LISTENING
• Active Listening is listening to another person in a way
that communicates understanding, empathy, and
interest.
• It is different from hearing.
• It requires energy, attentiveness, skills, and commitment.
• It makes the speaker feel important, acknowledged, and
empowered.
BUILDING COMMUNICATION SKILLS…
PARAPHRASING
• Paraphrasing means restating the client’s message simply
and in your own words.
• The purposes of paraphrasing are to:
– Make sure you correctly understand the client
– Let the client know that you are trying to understand
what he or she is saying
– Clarify what client is saying
COMMUNICATION TECHNIQUES

Positive Nonverbal Cues

• Leaning towards the client
• Smiling (in a way that is culturally appropriate);
not showing tension
• Avoiding nervous or inappropriate mannerisms
• Presenting facial expressions that inspire trust
• Maintaining eye contact with the client
• Making encouraging gestures, such as nodding
one’s head
COMMUNICATION TECHNIQUES…
Negative Nonverbal Cues
• Reading from a chart
• Glancing at one’s watch
• Yawning or looking at papers or out of the window
• Frowning/lowering
• Toying
• Not maintaining eye contact
COMMUNICATION TECHNIQUES…

Important
A good relationship with a client is based not only on what
the client hears but also on what she or he observes and
senses about the counselor.
 ASKING QUESTIONS DURING
COUNSELING
Two categories of questions
Closed-ended questions usually will be answered by a very
short response, often just one word.
Closed-ended questions can be used to ask about feelings,
but they usually provide limited insight
Open-ended questions are useful for exploring the opinions
and feelings of the client, and
They usually call for longer responses and are effective in
determining what the client needs and what he or she already
knows.
 THE REASON WHY WE ASK QUESTIONS
• To assess the client’s FP needs and knowledge

• To learn about the client’s medical status, previous

contraceptive use, personal circumstances, preferences,

and concerns
• To actively engage the client and elicit information about his

or her needs, concerns, and preferences

• To establish a good relationship by showing concern and

interest
 THE REASON WHY WE ASK QUESTIONS
• To prioritize the key issues to target during the
time available for counseling
• To determine the educational or language level
that will be best understood by the client
• To avoid repeating information that the client
already knows
• To identify areas of misinformation that needs to
be corrected
 LISTENING, PARAPHRASING REFLECTING…

Tips for Active Listening

 Establish and maintain eye contact.
 Demonstrate interest by nodding, leaning toward the client, and smiling.
 Sit comfortably and avoid distracting movements.
 Pay attention to the client.
 Do not engage in other tasks or talk to others …
 Listen to the clients carefully.
• Do not become distracted and think about other things or about what
you are going to say next.
 Listen both to what your clients say and to how they say it, and make note
of tone of voice, choice of words, facial expressions, and gestures.
LISTENING, PARAPHRASING, REFLECTING…

Paraphrasing is restating of the client’s message simply and in your

own words.

Reflecting is recognizing and interpreting the client’s feelings and

integrating what has been said into further discussion.

Clarification is asking questions to better understand what the client

has said.
 PART 5. WHO ARE OUR CLIENTS?

Clients can be categorized in different ways that can help to

understand their needs and your ability to tailor counseling
Clients could be categorized as:
• New versus returning clients
• Clients returning for re-supply and/or routine follow-up versus
those returning with problems
• Clients wishing to limit childbearing versus those wishing to
space births
Providers need to quickly assess individual clients’ needs so they
can serve them in an efficient manner.
 TYPES OF CLIENTS

CLIENTS BY REASON FOR VISIT:

– New clients who have no method in mind

– New clients with a method in mind

– Clients returning for re-supply (satisfied return clients)

– Clients returning with problems or a different need (such as

dissatisfied return clients)

 TYPES OF CLIENTS

CLIENTS BY FERTILITY PLAN:

• Delayers

• Spacers

• Limiters

• Want to get pregnant

 TYPES OF CLIENTS
CLIENTS BY POPULATION GROUP:
Men, women
Married, Unmarried
Adolescents
Clients with high individual risk for STIs
Clients living with HIV
 TYPES OF CLIENTS
CLIENTS BY TIMING OF LAST PREGNANCY
• Postpartum
• The ideal time to initiate counseling for postpartum FP is during the
antenatal period.
• It also helps to ensure that clients receive their method of choice
immediately after giving birth
• Post-abortion
• Counseling before the procedure can only be an option if the client is
not under stress related to the procedure.
• This allows the client to receive her method of choice immediately after
the procedure
 TYPES OF CLIENTS
Special Population Groups
• Most FP programs focus on married women
• Other population groups that also need FP service include
Unmarried people,
Adolescents (married or unmarried), Single men
People with Physical/Mental disability
Refugees, minority groups……
• They have also FP needs that require special
consideration and accommodation
• What are the special information needs of these clients?
• What are the special emotional needs of these clients?
• What can providers do during counseling to support these
different groups of clients?
TYPES OF FP CLIENTS AND DECISIONS THEY FACE

NEW CLIENT
• Method in mind
• Decision: Is this method the best choice and can he or she use it
effectively?
• No method in mind
• Decision: Which appropriate method to use
TYPES OF FP CLIENTS AND DECISIONS THEY FACE

RETURNING CLIENT
• Concerns about method
• Decision: Should he or she continue to use the method or switch to a
new method?
• No major concerns
• Decision: No decision to make
 PART 2
COUNSELING STEPS IN FAMILY PLANNING

THE REDI FRAMEWORK

R = Rapport Building
E = Exploration
D = Decision Making
I = Implementing the decision
 THE REDI FRAMEWORK

• Emphasizes the client’s right and responsibility for

making decisions and carrying them out

• Provides guidelines to help the counselor and client

consider the client’s circumstances and social

context
 THE REDI FRAMEWORK

• Identifies the challenges a client may face in

carrying out their decision

• Helps clients build skills to address those challenges

• The REDI framework moves away from traditional

FP counseling that relies on routinely giving detailed

information about every FP method.
 THE REDI FRAMEWORK

• It avoids overloading clients with unnecessary

information and
• Instead it emphasizes on the client’s preferences,
individual circumstances, and sexual relationships
and knowledge.
• It helps address the differing needs of clients
 COMPARING REDI AND GATHER
REDI GATHER
Rapport Building (R) = Greet, Ask/Assess
Exploration (E) = Ask/Assess, Tell
Decision Making (D) = Ask/assess, tell, help
Implement the decision(I) = Help, explain, return
 STEP 1: RAPPORT BUILDING

1. Greet client with respect

2. Make introductions
Identify category of the client—i.e., new, satisfied
return, or dissatisfied return
3. Assure confidentiality and privacy
4. Explain the need to discuss sensitive and personal
issues
 STEP 2: EXPLORATION

Explore in depth the client’s reason for the visit

This information will help determine the client’s counseling needs
and the focus of the counseling session
FOR NEW CLIENTS:
1. Explore client’s past experience, current situation, and future
RH-related plans
a. Explore client’s reproductive history and goals,
b. Explore client’s social context, circumstances, and
relationships
c. Explore issues related to sexuality
d. Explore client’s history of STIs, including HIV
e. Explain STI risk and dual protection, and help the client
perceive his or her risk for contracting and transmitting STIs
 STEP 2: EXPLORATION

FOR NEW CLIENTS…

2. Focus your discussion on the method(s) of interest to client
• Discuss the client’s preferred method, if any, or
• Relevant FP options if no method is preferred,
• Give information as needed, and correct misconceptions
3. Rule out pregnancy and explore factors related to monthly
bleeding, any recent pregnancy and medical conditions
 STEP 2: EXPLORATION
FOR RETURNING CLIENTS:
1. Explore the client’s knowledge and satisfaction
with the current method used
2. Confirm correct method use
3. Ask the client about changes in his or her life
Such as
-Plans about having children,
-STI risk and status, and so on
 STEP 2: EXPLORATION
FOR RETURN CLIENTS…
Dissatisfied clients
Explore the reasons for the client’s dissatisfaction or the
problem
Including
Causes of dissatisfaction and
Possible solutions such as
Reassurance
Treatment of side effects,
Switching methods as well as other options
 STEP 3: DECISION MAKING
1. Identify the decisions the client needs to confirm or make
2. Explore relevant options for each decision
3. Help the client weigh the benefits, disadvantages, and
consequences of each option
Provide information to fill any remaining knowledge
gaps
4. Encourage the client to make his or her own decision
 HELPING THE CLIENT REACH TO DECISION
• Does the client want any more children?
Permanent vs temporary methods
• How long does the client want to be protected from pregnancy?
Long-acting vs short-acting methods
• Can the client use and does the client want to use hormonal
methods?
Hormonal vs non-hormonal methods
• Does the client want a method for herself or himself or for his or
her partner?
Male vs. female methods
• Does the client want a method that will be used each time he or
she has sexual relations, or does he or she want
continuous protection?
 STEP 4: IMPLEMENTING THE DECISION

1. Assist the client in making a concrete and specific plan

for carrying out the decision(s) (obtaining and using the FP
method chosen, risk reduction for STIs, dual protection, and
so on)
2. Have the client develop skills to use his or her chosen
method and condoms
3. Identify barriers that the client might face in implementing
his or her decision
4. Develop strategies to overcome the barriers
5. Make a plan for follow-up and/or provide referrals as
needed
 FILLING CLIENTS’ KNOWLEDGE GAPS

Principles of Giving Information

• Tailor information to the client’s needs
• Find out the client’s need or problem (method in mind? return
client?)
• Find out what the client already knows
• Identify information gaps that need to be filled or
misconceptions that need to be corrected
• Personalize information for the client
 FILLING CLIENTS’ KNOWLEDGE GAPS

• Put information in terms of the client’s situation

• Help the client understand what the new information means
to her or him personally
what would it take or mean
• To start a new method,
• To cope with side effects,
• To discontinue or to switch to another method?)
• Make information understandable
• Use understandable language,
• Speak clearly
• Use analogies
HELPING CLIENTS REMEMBER INFORMATION
1. Choose appropriate language
2. Start with what is best known
3. Keep it short.
4. Keep it simple.
5. Put information in perspective
6. Use examples from everyday life
7. Point out what to remember
8. Put first things first.
9. Organize. Put information in categories
HELPING CLIENTS REMEMBER INFORMATION
10. Repeat The last thing you say should remind the client of the
most important instruction
11. Show as well as speak Sample contraceptives, flipcharts
12. Be specific
13. Make links Help clients find a routine event that reminds
them to act
14. Check understanding Ask clients to repeat important
instructions
15. Send it home. Give the client simple print materials to take
home
 KEY INFORMATION FOR CLIENTS CHOOSING A
CONTRACEPTIVE METHOD
EFFECTIVENESS
• Should be explained in easily understood terms
When to return
• Clients need advice on when to return for follow-up or re-
supply
Prevention of HIV and other STIs
• Clients should know whether their FP method protects them
against STIs
THANK
YOU