1. Quality Family Planning Counseling
Munir Kassa, MD
CIRHT- Ethiopia

2. Outline Objectives Definition of quality family planning counseling
Uses of quality family planning counseling
Principles of family planning counseling
Reproductive life plan
Summary

3. Objectives Define counseling
Articulate uses of family planning counseling
Identify principles of family planning counseling

4. Definition Family Planning Counseling
Process that enables clients to make and follow through on their decisions concerning contraceptive use

5. Question – True or False?
“Practicing good family planning counseling take a lot of time.”

6. Use of Family Planning Counseling
Help clients make better choices
Help clients use, improve and continue their use their method properly
Increase their satisfaction
Facilitate their participation
Increase return for follow-up

7. Principles for Providing Quality Counseling
Establish and maintain rapport
Assess the client’s needs and personalize discussions accordingly
Work with the client interactively to establish a plan
Provide information that can be understood and retained
Confirm client understanding

8. 1. Establish and Maintain Rapport
Create a welcoming environment
Rapport-building: happens the moment an encounter begins
Good rapport requires client-centered communication skills that:
Help build and maintain rapport throughout a client encounter.
Aims to listen for client’s goals and preferences to communicate with empathy
Ensure privacy and confidentiality

9. OARS Communication Model during Family Planning Counseling
O - Open-Ended Questions
A - Affirming
R - Reflective Listening
S - Summarizing

10. Ask Open-ended Questions
Build a trusting and respectful professional relationship
Help gain an understanding about the client and the “client’s world”
Example: How regularly do you use your contraception method?

11. Affirm Find out about healthy behavior like adherence to the method
Compliment: “You ask really great questions!”
Doing this
Helps build trust
Makes them feel that you are on their side
Engages their best self

12. Listen with Reflection
Listening to what the client says, then briefly reflecting key words:
To check accuracy and understanding
To show that you are listening
To help the client explore her/his own thoughts and feelings
Example: “So I hear you saying… (ie: your husband wants to have more children, but you are not sure?)… Do I have that right?”
Format
Introduction
Re-phrase
End

13. Summarize
Transition - Reflecting what’s been said so far and moving to a new topic
Closing - Reflecting what’s been said during the session and moving to a plan of action

14. 2. Assess the Client’s Needs and Personalize Discussions Accordingly
Does the client have any health issues and/or safety considerations that would rule out certain methods?
What is the client’s reproductive life plan and pregnancy intention?
What is important to the client in a birth control method?
(These factors will likely have been raised during the brainstorm on the previous slide.)
When thinking of all of the different areas of assessment you could explore with a client, it’s helpful to think about where you might start. Here are three key questions to consider at the start of an assessment conversation:
(Click the mouse for each bullet to appear.)
Does the client have any health issues and/or safety considerations that would rule out using any methods?
What is the client’s reproductive life plan or pregnancy and parenting intentions, both now and in the future?
What’s important to your client in a method? This will be different for every client. Some clients don’t want hormones and others just want the most effective method, some need their method to be private, etc. This key question helps you start to identify how your client values different method characteristics.
(Trainer Tip: Characteristics of birth control methods are reviewed in detail in Module 3, Activities 3.1 and 3.2.)

15. Reproductive Life Plan (RLP)

16. RLP: What is it? A self-assessment of life goals
Goals in several broad categories (based on the social determinants of health)
Education
Work/Career
Family Planning
We assist or guide as needed

17. What to Consider in Developing a Reproductive Life Plan
Age
Educational goals
Career plans
Living situation
Financial situation
Social support
Relationship with partner
Readiness to become a parent
Medical history
Current health status
Health behaviors
Contraceptive use
You can add some more specific questions – how old would you like to be? What type of job do you plan to have? Could you support a baby now – emotionally,
physically, financially. How will having a baby affect your relationship with your partner, etc.
How is your health now? Do you have any chronic conditions like diabetes? What about your medical history? Does anything run in your family?
Do you have any health risk behaviors like tobacco use? Are you currently using contraception? Are you able to use your method consistently? 17 17 17

18. When Pregnancy is Desired - Preconception Care
Women/men who are currently seeking pregnancy need preconception health and STD services as well as counseling on how to achieve pregnancy – This is a high priority population!
For addressing “achieving pregnancy” and “possible basic infertility services”- Providers should ask the client (or couple) how long they have been trying to get pregnant, and when she hopes to get pregnant. If the client’s situation does not meet one of the standard definitions of infertility, then counseling about how to maximize fertility should occur. If a couple needs basic infertility care, the provider focuses on determining potential causes of their inability to achieve pregnancy and make referrals to specialists.
Preconception health services should be offered to male and female clients. This includes medical history and sexual health assessment; intimate partner violence; alcohol and drug use; tobacco use; immunizations; depression; nutrition including folic acid (for women only); height, weight, and body mass index; blood pressure; diabetes; and of course STD testing services.
Related preventive health services should also be delivered, as appropriate.

19. When Pregnancy is Not Desired - Contraception
The woman in this picture is someone who has decided she is not ready for children now!
If this woman’s answers to the reproductive life planning questions indicate she is sexually active, and doesn’t want to get pregnant now, this would lead to a discussion of contraceptive services, beginning with the most effective methods first, such as IUDs or implants. Preconception health services should also be offered especially true for those using the less effective methods or inconsistent method use, as this puts them at a higher risk of pregnancy.

20. CDC Reproductive Life Plan Tool Questions
Do you plan to have any (more) children at any time in your future?
If Yes
How many children would you like to have?
How long would you like to wait until you or your partner becomes pregnant?
What family planning method do you plan to use until you or your partner are ready to become pregnant?
How sure are you that you will be able to use this method without any problems?
CDC’s recommendation is that all persons capable of having a child should have a reproductive life plan.
Basically, do you want to have children, the timing and spacing of healthy children and what can I do to help you achieve these goals.
The additional two questions, #4 and #5 on this slide are asked if pregnancy is NOT desired.
PUT REFERENCE AT THE BACK SLIDE:

21. CDC Reproductive Life Plan Tool Questions (cont’d)
Do you plan to have any (more) children at any time in your future?
If No:
What family planning method will you use to avoid pregnancy?
How sure are you that you will be able to use this method without any problems?
People’s plans change. Is it possible you or your partner could ever decide to become pregnant?

22. 3. Work with the Client Interactively to Establish a Plan
Shared decision-making
We all have goals and obstacles
Obstacles:
Potential side effects
Fear of negative health effects
Risk of unplanned pregnancy
Concern for future fertility
Perception of risk
Concealing contraception from a partner

23. What is Important to the Client about the Method?
Effectiveness
Frequency of use
Different ways of method delivery
Return to fertility
Specific side effects

24. 4. Provide Information that can be Understood and Retained
Strategies to give patient education
Simple language
Give balanced information on benefits as well as risk
Limit the amount of information
Best time is when they ask
Be stingy
Highlight the most important information
Use educational materials

25. We don’t need to go through each method with each client
Tiered Effectiveness
We don’t need to go through each method with each client

27. 5. Confirm Client Understanding
Use the teach-back method to ensure the client understands
Asking clients to use their own words
An indication of how well YOU communicated, NOT a "test" of the patient
Help evaluate if you did a good job of explaining 
Last: provide the service

28. Summary
Family planning counseling is not only about providing information
Family planning counseling helps clients make their own decisions about methods and continued use
The five principles in family planning counseling include establishing rapport, assessing client needs, helping to reach a shared decision, providing education and ensuring understanding
Returning to our steps for closing the session, here are some key things to cover with the client:
We’ve talked about teach back, which is a helpful tool both for confirming understanding and summarizing key points for the client to remember at the close of a session
You also want to help the client solidify a plan to use their method. What do you think the plan should include?
Pause for responses before clicking to show slide text
How the client will access their chosen method; ideally you’ll be able to provide it onsite, but you may need to give them a referral;
How the client plans to use their chosen method effectively – that is, consistently and correctly;
What the client should do if they have questions or problems; and
How to use back-up and/or emergency contraception
You also will want to provide your contact information and any other information related to follow-up appropriate for that particular client and their chosen method. This should include a genuine invitation to return to see you at any time for any reason, including if they are wanting to change methods.
Lastly, provide any additional services and/or referrals needed to address any other stated client needs. 28