Introduction To Family Planning
Facilitator ;Elisia
Learning Objectives
• By the end of this session, students are expected to be able to:
Define the terms family planning (FP) and counselling for
informed choice
Explain the purpose of family planning counselling
Describe factors that promote effective counselling
Demonstrate skills on counselling a client using the ‘GATHER’
technique
Describe seven steps in counselling clients for informed choice
List guidelines for explaining specific FP methods and explain
benefits
Definition of Terms
Family planning:
The decision of an individual/couple as to when
to start having children, how long to space
between children, how many children to have
and when to stop having children.
Definition of Terms
A means to prevent unplanned pregnancies.
Unplanned pregnancies are associated with
significant perinatal mortality and morbidity due
to complications related to:
• Induced abortions
• Pregnancies too early in life
• Too frequent (closely spaced) pregnancies
(pregnancies late in life)
Definition of Terms cont….
Counseling
• Refers to the process where by a trained
provider helps a client to make an informed
voluntary decision to solve a problem with full
understanding of the facts and emotions
involved.
– This process is dynamic, interactive and allows
clients to explore and express their needs, issues
or problems
Definition of Terms cont….
• Counseling for informed choice: The process
whereby an individual/couple is assisted to
choose a preferred FP method after being
provided with clear, accurate, complete and
specific information tailored to client’s
reproductive goals and needs.
– Informed choice also implies having a range of FP
methods to choose from.
Purpose of FP Counseling (Counseling for informed choice)
To help the client to make a decision on a FP method
according to their situation
To give accurate information
To allow the client to ask questions according to
problems identified
To help the client understand the effects of high risk
factors to their health and health of their child
To ensure continuity and use of FP/RCH services
To create demand for clients at risk to use existing
FP/RCH services
Factors Contributing To Effective Counseling
• Verbal Communication Skills
– Asking open ended questions
– Clarifying
– Paraphrasing
– Using encouragers
– Responding to non-verbal behaviour
– Summarizing
Factors Contributing To Effective Counseling
cont…
• Non-Verbal Communication Skills
– Listening actively
– Smiling
– Eye contact
– Nodding of head
– Leaning forward
– Relaxing and open posture
Counseling a Client Using The “GATHER”
Technique
• The ‘GATHER’ technique stands for Greet, Ask, Tell, Help,
Explain and Refer.
• Greet
– Introduce yourself by name, ask the woman how she is feeling, and
establish rapport.
– Assess if she is well enough for family planning counselling now.
– If not, speak with her later or refer her to a family planning clinic.
– Find a private, calm environment where you can talk.
– If the woman is lying in bed, be at her level and not standing above
her.
– Promise confidentiality.
Counseling a Client Using The “GATHER”
Technique cont….
• Ask
– Ask her what she knows about family planning.
– Ask if she has ever used a FP method and if she was using one
when she became pregnant.
– If she is using a method, ask her how she used the method, if
she has any concerns about it, and if she knows about other
methods.
– Ask her if she has other concerns about her current situation.
– Listen carefully and acknowledge what she says.
– Encourage her to ask questions and discuss her feelings and
concerns
Counseling a Client Using The “GATHER”
Technique cont….
• Tell
– Tell her about various family planning methods,
relating them to her situation.
– Tell her it is possible to get pregnant even though
breastfeeding reduces the chances but it is not
100%.
Counseling a Client Using The “GATHER”
Technique cont….
• Help
– Help her choose the method that will be most
appropriate and effective for her, given her own
circumstances.
– Discuss options that will make her comfortable,
safe and are effective.
– Do not choose a method for her.
NOTE
Counseling is a helping session
Counseling a Client Using The “GATHER”
Technique cont….
• Explain
– Explain in detail how to correctly use her chosen
method.
– Give her the method immediately if possible and if not
refer.
– If she has contradictions to using her method
immediately, explain when she can start, and what she
can use for a back-up method in the meantime
• Refer
– Always refer her to a family planning clinic for a follow-
up visit.
Steps in Counseling a Client for Informed
Choice
• Prepare yourself, the counseling room and materials
• Establish and maintain a positive client/interpersonal
relationship
– Welcome and greets the client, introduce yourself, examiners
and explain your role, assures confidentiality.
• Collects information from the client
– Asks the client personal particulars, inform the client on the
services offered by the clinic and ask the client for type of service
is looking for, seeks consent to discuss his or her concerns.
Steps in Counseling a Client for Informed
Choice cont…
• Establishes past obstetrics history
– Ask the history of previous pregnancies, birth
interval, number of children, who are alive, the
date of last delivery, if she is breastfeeding
• Establishes past gynecology history
– Ask questions which are relevant to family
planning
Steps in Counseling a Client for Informed
Choice cont…
• Assessing clients’ prior understanding of FP methods
– Ask for contraceptive used before (Pills, loop, injection, Norplant,
condom or any others), duration, failure if any for which method, if
stopped reason; acknowledge client understanding.
• Give correct information about different family planning
methods available
– Meaning of family planning, Types of family planning which are
available (pills, loops, injection, implants)
– Explain each method how it works, advantages and disadvantages
of each method and contraindications.
– Ensure the clients’ understanding of provided information
Steps in Counseling a Client for Informed
Choice cont…
• Establishes clients choice.
– Help the client to choose an appropriate method
– Asses clients of the selected method, advantages,
disadvantages and contraindication
• Close the counseling session and link the client to
the next procedure ( General examination,
abdominal examination, performing essential
investigations.
• Explain correctly how to use the selected method
and provide the method correctly.
Guide for Explaining Specific Family
Planning Methods
State what the method is
Explain how it works to prevent pregnancy Explain
the effectiveness of the method
Explain the advantages, including non-contraceptive
benefits, of the method
Explain the disadvantages/side effects of the method
Explain who can use the method
Explain who cannot use the method
(contraindications)
Benefits/Importance of FP
Contraceptive benefits
• Mother
– will have time to recover fully from previous
pregnancy
– Will have enough time to take care of her baby
– Reduce the chance for maternal death by spacing
pregnancies at least 2 years apart (explain that
increased maternal mortality if the mother is not
healthy)
Benefits/Importance of FP cont….
• Child
– Will have adequate time for breast feeding which creates
antibodies, helps avoid diarrhoea, provides adequate
protein and calories
– Will get love from his or her parents
– Be able to receive the needs from his/her parents
• Family and Nation
– Enables a female to perform other income generating
activities and family/national resources will be sufficient for
the family size/Nation
Benefits/Importance of FP cont….
Non contraceptive benefits
– these vary somewhat by the method
• Decreases risk of transmission of STI (condoms)
• Prevention of some genital tract tumours
(hormonal agents containing estrogen)
• Decreases risk of benign breast disease, ovarian
and endometrial cancer (hormonal methods)
• Provides opportunity for screening and early
detection of disease (health surveillance)
Benefits/Importance of FP cont….
• Reduced chances for benign breast tumours,
ovarian and endometrial tumours (combined
estrogen/progesterone methods)
• Can be useful in the treatment of
dysfunctional uterine bleeding (DUB), COC)
(hormonal methods)
• Decreased blood loss during menses
(hormonal methods)
Key Points
• Counseling for informed choice is an entry point to the
use of family planning services
• Counseling enables clients to make informed decisions
• Effective counseling is provided following the principles
of counseling
• Family planning has both contraceptive and non
contraceptive benefits
Evaluation
• What is family planning?
• Explain the steps in counseling clients for
informed choice.
• What are the benefits of family planning
References
• De Cherney, A.H. & Nathan, L. (2002). Current Obstetrics
and Gynaecology (9th ed.). McGraw Hill.
• MOHSW, (2005). Advanced LSS Trainee Manual. Dar es
Salaam, Tanzania: Ministry of Health and Social Welfare.
• Monga, A. & Baker, P. (Eds). (2006). Gynaecology by Ten
Teachers (18th ed.). London: Arnold.
• Oats, J.K. & Abraham, S. (2005). Llewellyn-Jones
Fundamentals of Obstetrics and Gynaecology (8th ed.).
Edinburgh: Elsevier Limited/Mosby.
• Wood, C.H. et al (1997). Community Health. Nairobi, Kenya:
The African Medical and Research Foundation.