Talking with Clients about Reproductive Health

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Talking with Clients about Reproductive Health

Around the world, health care workers are changing the way they communicate about reproductive health care and family planning with the women and men they serve. In the past, providers dominated the conversations, and many providers focused exclusively on contraception. It was presumed that they were the appropriate ones to make decisions for individual clients about which contraceptive method to use. However, providers have learned that clients are more often satisfied if they are informed and active decision-makers in their health care. They have also come to understand that family planning services are more effective when they are linked with other reproductive health services.

This page contains information for providers on talking with clients about family planning, sterilization, sexually transmitted infections, sexuality, and gender issues.

Return to the Informed Choice page.

Talking with Clients about Family Planning

Family planning counseling is the process of helping clients make informed decisions about fertility and related issues. Counseling helps clients make good decisions by ensuring that they receive accurate information, by helping them apply that information to their own circumstances, and by ensuring that they make voluntary decisions. When clients arrive at their own decisions about their fertility, they are more likely to be satisfied with the choices they make.

Family planning providers can participate in a two-way information exchange by asking questions to assess what the client knows about available contraceptive methods. Providers should give any information the client lacks, identify and correct any misconceptions about methods, and gain insight into the client's medical and contraceptive history and personal circumstances.

When providers present basic facts about the range of available contraceptive options, they should include information about how the method works, its effectiveness, and characteristics, including possible side effects. The provider and client use this information to match the client's needs with an appropriate method, and to help the client make a carefully considered decision. Once an individual chooses a method, the provider can describe how to get the method, how to use the method, and what to do if side effects or warning signs occur. This process is particularly important for programs providing sterilization services, because the method involves surgery and is intended to be permanent.

AVSC publishes a number of materials on counseling for family planning clients, including client brochures, a curriculum on family planning counseling, and publications on the special counseling needs of clients interested in sterilization. For more information, see the AVSC publications on Counseling, informed choice, and informed consent and AVSC's Client education materials.

Return to the Informed Choice page.

Talking with Clients about Sterilization

Counseling and informed choice are of particular importance in programs providing sterilization services, because the method involves surgery and is intended to be permanent. Sterilization involves consequences, risks, and fears that need to be discussed with each client. Providers have an obligation to assure that the client understands the benefits, risks, implications of, and alternatives to sterilization. Clients should be advised that sterilization does not protect against the transmission of HIV infection or other STIs.

The provider should discuss each client's feelings about ending fertility and assess the client's psychological readiness for the procedure and its consequences. Client doubts, fears, or misconceptions should be identified and addressed. Counseling is a critical checkpoint between the client's intention to seek sterilization and the steps that follow which lead to surgery. An important aim of counseling for sterilization is to identify clients who are likely to adjust poorly or change their minds after undergoing sterilization. Clients with certain high-risk characteristics (such as being in an unstable marriage, having no children, or having unresolved feelings about ending fertility) may require additional counseling. It may also be appropriate to encourage some individuals to take more time to reconsider the request for sterilization and to consider using a temporary method of contraception in the interim.

Counseling helps clients who are candidates for sterilization by preparing them psychologically, both for what it will mean not to be able to have any more children and for the experience of surgery. By guiding clients to consider the implications of their choice and helping them to address whatever doubts or anxieties they may have before surgery, providers enhance the chances that those who choose sterilization will be satisfied with their decision. In general, clients are likely to adjust well and be satisfied with their decision after surgery if service providers have told them what to expect and if they take responsibility for the decision to end their fertility.

To obtain informed consent for sterilization, providers need to ensure that clients understand the following elements:
  1. Temporary contraceptive methods are available.
  2. Voluntary sterilization is a surgical procedure.
  3. There are certain risks associated with the procedure, as well as benefits.
  4. If successful, the operation will prevent the client from having any more children.
  5. The effect of the procedure is considered to be permanent.
  6. The individual can decide against the operation at any time before the procedure (without losing the right to other medical, health, or other services or benefits).

AVSC publishes a wide range of information about counseling for sterilization, including client-education brochures about sterilization and sterilization reversal, reference guides for providers and surgeons, information for service managers, and medical guidelines. For more information, see the AVSC publications page.

Return to the Informed Choice page.

Talking with Clients about HIV Infection and STIs

Family planning counseling provides a critical opportunity for talking about the prevention of sexually transmitted infections (STIs), including HIV infection. Providers should help clients use that information to make informed choices about contraception. Clients need to know about all the forms of sexual activity (vaginal, anal, oral) that can lead to STI or HIV transmission so that they do not mistakenly believe that some forms of unprotected sex are "safe." Clients who have been using contraception to avoid pregnancy may not consider their need for protection against STIs, including HIV infection. Individuals should be informed about which methods protect against infection if they are not in a mutually monogamous relationship with a partner who is infection free.

When providers speak to clients about STIs, they need to do so in a nonjudgmental way. Imposing guilt or voicing disapproval rarely helps people deal responsibly with an STI. Providers need to help clients who have an STI learn how to prevent transmission to others and to protect themselves from other future infections. They should also provide information about where to go for treatment or education about treatment options.

Return to the Informed Choice page.

Talking with Clients about Sexuality

Many aspects of their lives, including sexuality, affect an individual's choices about contraception. Family planning providers need to understand and address the role that individual sexuality plays in contraceptive decision making and to be comfortable discussing these issues with clients. The principal reason for many people to use contraception is to enjoy sexual relations without conceiving a child. Providers must be able to respond to people's concerns about sexuality in ways that are respectful and nonthreatening. They should also help clients select contraceptive methods that are compatible with their attitudes and expectations in their relationships, frequency and patterns of sexual relations, and feelings about their bodies. By helping clients choose methods that are compatible with their sexual practices, counselors can increase the likelihood of satisfaction and continuation. Providers and counselors who do not address sexuality may rely on assumptions that do not reflect a client's situation and may even put a client's health and safety at risk.

Return to the Informed Choice page.

Talking with Clients about Gender Issues

Providers must be sensitive to gender issues to fully meet the reproductive health needs of women and men. The sustainability of family planning and reproductive health programs depends on acknowledging the role gender plays for both women and men when making decisions about reproductive health, particularly as concerns contraceptive decision making and use.

For providers, the expressed need for attention to gender issues often comes when women clients report that their male partners are barriers to good reproductive health. For example, some men refuse to use or facilitate women's use of contraception. Because of such attitudes, some of these men may continually re-infect their partner with sexually transmitted infections. Sometimes a woman is beaten simply for raising the issue of contraception with her partner. Providers must be aware of how gender biases and perspectives might affect counseling and service delivery. Staff should be trained in gender issues and should evaluate and overcome their own biases.

Return to the Informed Choice page.

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