Family planning counseling is an ongoing process provided by healthcare professionals to assist individuals and couples in making informed decisions about their desired family size (number of children).

Counseling is a direct, personal communication between a healthcare provider and a client or couple. Its aim is to empower them to make voluntary and informed choices regarding family planning.

Informed Choice is defined as a voluntary decision made with relevant knowledge pertaining to that choice.

To facilitate informed choice in family planning, individuals must be educated about all available methods, including their benefits, drawbacks, and potential side effects. They should also understand how to use their chosen method safely and effectively, and be aware of possible side effects.

Aims of Counseling

The main goals of family planning counseling are:

• To support individuals in deciding the number of children they wish to have and the timing of these births.

• To assist clients in voluntarily selecting a family planning method that is both personally suitable and medically appropriate for them.

• To ensure clients understand the correct usage of their chosen method for safe and effective contraception.

• To dispel any myths or misunderstandings clients may have about different family planning methods.

Types of Family Planning Counseling

Various counseling approaches are utilized based on the situation and needs:

• Individual Counseling: This approach involves a one-on-one session with a single client, ensuring privacy and confidentiality. This is particularly important for sensitive matters related to family planning and reproductive health, such as in cases involving HIV-positive couples or when partner disagreement exists.

• Couple Counseling: This involves counseling sessions where both a woman and her partner participate in discussions with the healthcare provider. It requires sensitivity and specific skills to address potential gender-related dynamics.

• Group Counseling and Information Sharing: This approach is used with a larger group of people. It is useful when individual counseling is not feasible or when community members are more comfortable in a group setting. It’s a cost-effective way to disseminate information and answer common questions, but may not encourage sharing of personal concerns.

General Principles of Counseling

Effective counseling follows key principles:

• Ensure Privacy: Choose a quiet and private location for the conversation.

• Allocate Sufficient Time: Allow ample time for a thorough discussion.

• Maintain Confidentiality: Respect and protect the client’s privacy.

• Create a Helpful Atmosphere: Foster a supportive and non-threatening environment for open communication.

• Keep Communication Simple: Use clear and easily understandable language, avoiding jargon.

• Prioritize Information: Present information in a logical order, avoiding information overload initially.

• Repeat Key Instructions: Reiterate the most crucial instructions for clarity and retention.

• Utilize Visual Aids: Employ tools like posters and flip charts to enhance understanding and engagement.

Characteristics of a Good Counselor

Key traits of an effective counselor include:

• Respect for Dignity: Valuing each client as an individual.

• Respect for Client Concerns: Acknowledging and validating client’s worries and ideas.

• Non-Judgmental and Open-minded: Maintaining an unbiased and receptive attitude.

• Active Listening: Demonstrating attentiveness and engagement in the conversation.

• Empathy and Care: Showing understanding and compassion towards the client’s situation.

• Honesty and Sensitivity: Being truthful and considerate in communication.

Overview of Stages of Counseling

The counseling process typically involves distinct stages:

• General Counseling: This initial phase is the first point of contact for family planning counseling. It focuses on addressing the client’s broad needs and concerns. The counselor should:

  • Provide general information about the range of family planning methods available.

  • Correct any misconceptions or myths the client might hold about specific methods.

  • Offer information on related sexual and reproductive health topics, such as STIs, HIV, and infertility.
    This stage is designed to equip the client with the foundational knowledge needed to make an informed decision about contraception.

• Method-Specific Counseling: This stage focuses on providing detailed information about the contraceptive method the client has chosen. Key aspects include:

  • Fitness Assessment (Screening): Conducting necessary health checks like blood pressure measurement, weight assessment, and considering age and other health factors to ensure method suitability.

  • Usage Instructions: Clearly instructing the client on how and when to correctly use the chosen method.

  • Follow-up Scheduling: Informing the client about when to return for a follow-up appointment and asking them to reiterate key information to ensure understanding.

BRAIDED Approach to Method-Specific Counseling

The BRAIDED acronym is a helpful tool to remember the key elements of method-specific counseling:

• B – Benefits: Discuss the advantages of the chosen method.

• R – Risks: Explain the potential risks and side effects, including the consequences of method failure.

• A – Alternatives: Present other available methods, including abstinence and choosing no method.

• I – Inquiries: Encourage the client to ask questions and emphasize their right to information and responsibilities in making informed choices.

• D – Decision to Withdraw: Inform the client of their right to discontinue a method at any time without penalty.

• E – Explanation: Provide a thorough explanation of the chosen method’s usage.

• D – Documentation: Record details of the counseling session for record-keeping purposes.

Return Follow-up Counseling

Arranging follow-up counseling is a critical step after initiating family planning. The aims of follow-up are:

• To discuss and manage any problems or side effects experienced with the chosen contraceptive method.

• To provide ongoing encouragement for the continued use of the chosen method, assuming there are no issues.

• To identify and address any new concerns or questions the client may have.

Steps in Family Planning Counseling: GATHER Approach

The GATHER acronym provides a step-by-step framework for effective family planning counseling:

• G – Greet:

  • Give your client your undivided attention.

  • Greet them respectfully and introduce yourself, offering a seat.

  • Ask how you can assist them.

  • Assure them of confidentiality regarding their disclosures.

  • If in a health facility, explain what to expect during the visit, including physical examinations and tests if needed.

  • Conduct counseling in a private space to prevent eavesdropping.

• A – Ask:

  • Encourage the client to express their needs, doubts, concerns, and questions.

  • For new clients, use a checklist or health management information system to record their name, age, marital status, pregnancy history, number of living children, current and past family planning use, and basic medical history.

  • Explain that this information is collected to provide appropriate care.

  • Keep questions simple, brief, and maintain eye contact.

  • When inquiring about medical history, ask specific questions about symptoms rather than broad disease categories (e.g., “Have you had headaches in the past 2 weeks?” instead of “Have you had any diseases recently?”).

  • For returning clients, inquire about any changes since their last visit.

• T – Tell:

  • Inform the client about family planning methods.

  • Describe the available methods.

  • Ask which methods they are interested in and what they already know about them.

  • Briefly describe each method of interest, explaining how it works, its benefits, drawbacks, and potential side effects.

• H – Help:

  • Assist the client in choosing a contraceptive method.

  • Inquire about their family plans and current situation. If uncertain about future plans, focus on their present needs.

  • Ask about the spouse/partner’s preferences and desires regarding family planning.

  • Address any misunderstandings and reiterate information as necessary.

  • If the chosen method is medically unsuitable, clearly explain the reasons and guide them in selecting an alternative.

  • Confirm their decision by asking, “What method have you decided to use?”.

• E – Explain:

  • Provide detailed instructions on how to use the chosen method once decided.

  • Supply the method if appropriate and available.

  • If the method cannot be provided immediately, explain the process, timing, and location for obtaining it.

  • For methods like voluntary sterilization, ensure the client signs a consent form confirming their informed decision and understanding.

  • Ask the client to repeat the usage instructions to ensure comprehension.

  • Describe potential side effects and warning signs, and instruct them on what actions to take if they occur. Ask them to repeat this information back to you.

  • Provide printed materials about the method to take home, if available.

  • Schedule a follow-up visit and encourage them to return sooner if they wish, or if side effects or warning signs develop.

• R – Return/Refer:

  • Schedule a return visit for follow-up.

  • At the follow-up visit, inquire if they are still using the method and if they have experienced any side effects or problems.

  • Refer for treatment if severe side effects are present.

  • Reassure clients that minor side effects are usually not dangerous and suggest ways to alleviate them.

Rights of the Client

Clients have fundamental rights in family planning services:

1. Information: The right to learn about reproductive health, contraception, and abortion options.

2. Access: The right to obtain services regardless of background or status.

3. Choice: The freedom to decide whether to use contraception and which method to use.

4. Safety: The right to safe abortion services and safe, effective contraception.

5. Privacy: The right to a private environment during counseling.

6. Confidentiality: Assurance that personal information will be kept private.

7. Dignity: The right to be treated with respect, consideration, and effectiveness.

8. Comfort: The right to feel at ease while receiving services.

9. Continuity: The right to ongoing follow-up care, services, and supplies as long as needed.

10. Opinion: The right to express their views on the services provided.

Factors Influencing Family Planning Counseling Outcomes

Several factors can affect the effectiveness of counseling:

• Factors Related to the Healthcare Provider:

  • Effective communication skills.

  • Technical knowledge and skills in family planning.

  • Provider attitudes and behaviors, such as respect and empathy.

• Factors Related to the Client:

  • Client’s existing knowledge and understanding of family planning.

  • Client’s level of trust and respect for the service provider.

  • Personal circumstances, such as spousal or family member influence.

• External Programmatic Factors:

  • Facility limitations: Lack of private spaces can compromise confidentiality and privacy during counseling sessions in integrated health facilities.