Method-specific Method-specific CounselingCounseling

2727 . .1212 . .20122012

Specific counselingSpecific counseling

Choosing a contraceptive: efficacy, Choosing a contraceptive: efficacy, safety and personal considerationssafety and personal considerations

Common side effectsCommon side effects..

Counseling in Follow up visitsCounseling in Follow up visits

Revision Revision

Clients should make their own decision. Clients should make their own decision.

The counselor should help clients to match their FP The counselor should help clients to match their FP needs and preferences to a safe and appropriate needs and preferences to a safe and appropriate method.method.

If the client is visiting the clinic to start using a If the client is visiting the clinic to start using a method of contraception, ask the client if s/he method of contraception, ask the client if s/he has a particular method of contraception in has a particular method of contraception in mind.mind.

If the client is considering If the client is considering a methoda method::

• • Review client’s medical and social history for Review client’s medical and social history for appropriatenessappropriateness

- If the method is appropriate What?- If the method is appropriate What?

- If the method is not appropriate. What?- If the method is not appropriate. What?

• • If the client chooses the inappropriate method. If the client chooses the inappropriate method. MECIVMECIVMEC IIIMEC IIIMEC IIMEC II

If the client has no method If the client has no method in mindin mind

Ask the client which methods of family planning Ask the client which methods of family planning s/he knowss/he knows

Briefly describe each method to the client. Briefly describe each method to the client.

If still unable, suggest a method and explain If still unable, suggest a method and explain whywhy

If the client does not agree, recommend If the client does not agree, recommend another method another method

If there is still some hesitation, give her more If there is still some hesitation, give her more timetime

Never try to impose a method on the client.Never try to impose a method on the client.

Special situationsSpecial situations

• • If the client chooses a method which you If the client chooses a method which you do not have in stock or do not offerdo not have in stock or do not offer

• • If the client chooses female or male If the client chooses female or male sterilizationsterilization

Explanation of how to use the Explanation of how to use the methodmethod

- How to use the method.- How to use the method.- Possible side-effects.- Possible side-effects.- Management of side-effects.- Management of side-effects.- Warning signs that indicate need for medical follow-up, and where - Warning signs that indicate need for medical follow-up, and where

to obtain this follow-up.to obtain this follow-up.- Re-supply information, if applicable.- Re-supply information, if applicable.- When the next follow-up visit should take place.- When the next follow-up visit should take place.

• • Provide each client with printed information on the chosen Provide each client with printed information on the chosen method method

• • Explain when the client should return for routine follow-up and Explain when the client should return for routine follow-up and re-supply.re-supply.

Explain the importance of a Explain the importance of a return visitreturn visit if the client: if the client:- Is experiencing any side-effects.- Is experiencing any side-effects.- Has any questions.- Has any questions.- Wishes to switch to a different method.- Wishes to switch to a different method.- Wants to stop using the method.- Wants to stop using the method.

Return for follow-upReturn for follow-up Follow-up visits are an important opportunity to:Follow-up visits are an important opportunity to:• • Reinforce the decision clients have made to plan their family.Reinforce the decision clients have made to plan their family.• • Discuss any problems and Answer any questions they may have.Discuss any problems and Answer any questions they may have.• • Explore changes in their current health status or life situation.Explore changes in their current health status or life situation.

During a follow-up visit:During a follow-up visit:• • Briefly review the chart for the main details of the reproductive health Briefly review the chart for the main details of the reproductive health

history.history.

• • Ask the client how s/he feels with the method and if there are any questions.Ask the client how s/he feels with the method and if there are any questions.

• • If s/he is having any problem with the method, assess and discuss possible If s/he is having any problem with the method, assess and discuss possible solutions.solutions.

• • If the problem is a side-effect, assess how severe it is and offer suggestions If the problem is a side-effect, assess how severe it is and offer suggestions for managing it or refer the client for treatment.for managing it or refer the client for treatment.

• • If the client is not using the method any more, ask why not (it may be due to If the client is not using the method any more, ask why not (it may be due to problems related to misunderstanding, side-effects or supply). problems related to misunderstanding, side-effects or supply).

• • If the client still wishes to continue using a contraceptive answer her If the client still wishes to continue using a contraceptive answer her questions and provide informationquestions and provide information

Choosing a contraceptive: Choosing a contraceptive: efficacy, safety and efficacy, safety and

personal considerationspersonal considerations

A (Ask her about her A (Ask her about her needs)needs)

Types of clientsTypes of clients

Newly marriedNewly married

Breast-feederBreast-feeder

SpacerSpacer

LimiterLimiter

Others (postabortion, medical Others (postabortion, medical disorders)disorders)

IIS SHE ELIGIBLES SHE ELIGIBLE

Tell her about the Tell her about the methodsmethods

EfficacyEfficacy

SafetySafety

Convenience (Side effects, ease of use, Convenience (Side effects, ease of use, reversibility, cost …...etc) reversibility, cost …...etc)

ContraceptiveFailure Rate

Used CorrectlyAs Commonly Used

COC0.1%6-8%

POP0.5%1%

DMPA0.3%0.3%

Once-a-month Combined Injectables

Less than 1%Less than 1%

ImplanonAlmost 0%Almost 0%

Cu T 380-IUD0.6%0.8%

IUSLess than 1%

Condoms3%14%

Diaphragm with Spermicide6%20%

Spermicide6%26%

LAM (first 6 months)0.5%2%

Tubal Ligation0.5%2%

AbstinenceN/AN/A

Coitus InterruptusN/AN/A

Fertility Awareness Methods1-9%20%

Vasectomy0.1%0.15%

Counseling for Side EffectsCounseling for Side Effects

When counseling clients for side effects:When counseling clients for side effects:• • Prepare clients Prepare clients for what might occur while using a method.for what might occur while using a method.• • Tell the client about symptomsTell the client about symptoms/side effects which probably or /side effects which probably or

may diminish over timemay diminish over time(e.g., lack of menses with DMPA).(e.g., lack of menses with DMPA).• • Do not dismissDo not dismiss, but take seriously, any client's concern about , but take seriously, any client's concern about

side effects.side effects.• • Provide reassurance and practical suggestions Provide reassurance and practical suggestions for coping for coping

with side effects.with side effects.• • Assist the client to switch Assist the client to switch to or choose another method to or choose another method if the if the

client wishes client wishes

Common Side Effects by MethodCommon Side Effects by MethodWeight Gain: Weight Gain: COCs, InjectablesCOCs, InjectablesSpotting: Spotting: COCs, POPs, Injectables, Implants, IUDsCOCs, POPs, Injectables, Implants, IUDsAmenorrhea: Amenorrhea: POPs, Injectables, ImplantsPOPs, Injectables, ImplantsNausea: Nausea: COCsCOCsCramping: Cramping: IUDsIUDsHeavier Menses: Heavier Menses: IUDs, POPs, Injectables, ImplantsIUDs, POPs, Injectables, Implants

Side effects/ Side effects/ complications COCcomplications COC

Nausea (most common in first 3 months).Nausea (most common in first 3 months). SpottingSpotting Mild headaches.Mild headaches. Breast tenderness.Breast tenderness. Slight weight gain.Slight weight gain. StrokeStroke blood clots in deep veins of the legsblood clots in deep veins of the legs AmenorrhoeaAmenorrhoea may cause mood changes may cause mood changes heart attackheart attack

POPPOP

„„ „„ Changes in bleeding patternsChanges in bleeding patterns

lengthened postpartum amenorrhoealengthened postpartum amenorrhoea

Irregular menstrual bleedingIrregular menstrual bleeding

AmenorrhoeaAmenorrhoea

„„ „„ HeadachesHeadaches

„„ „„ DizzinessDizziness

„„ „„ Mood changesMood changes

„„ „„ Breast tendernessBreast tenderness

„„ „„ Abdominal painAbdominal pain

„„ „„ NauseaNausea

„„ „„ For women not breastfeeding, enlarged ovarian For women not breastfeeding, enlarged ovarian folliclesfollicles

IUCDIUCD

Changes in bleeding pattern, especially in the first 3–6 Changes in bleeding pattern, especially in the first 3–6 months, but likely to lessen after 3 months of use:months, but likely to lessen after 3 months of use:

Longer and heavier menstrual periodsLonger and heavier menstrual periods Irregular bleeding or spotting between periodsIrregular bleeding or spotting between periods More cramps or pain during periodsMore cramps or pain during periods Cramping pain may occur for the first 24 to 48 hours

after insertion. Vaginal discharge may occur during the first few weeks May contribute to anemiaMay contribute to anemia Perforation of the wall of the uterus (very rare)Perforation of the wall of the uterus (very rare) ExpulsionExpulsion PIDPID

ImplanonImplanon

Discomfort for several hours to 1 day after insertion Discomfort for several hours to 1 day after insertion

Removal is sometimes painful and more difficult than Removal is sometimes painful and more difficult than insertion.insertion.

One in every six pregnancies is ectopic.One in every six pregnancies is ectopic.

Menstrual irregularityMenstrual irregularityHeadache. nervousness,NauseaDizzinessweight gain skin side-effects such as acne

Tubal sterilizationTubal sterilization

Complications of MinilaparotomyComplications of MinilaparotomyDrug reactionDrug reactionBleeding from the woundBleeding from the woundUterine perforation Uterine perforation Bladder or intestinal injuryBladder or intestinal injuryAnesthesia problemsAnesthesia problemsTears/transaction of the tubesTears/transaction of the tubesWound infectionWound infectionHaematoma or abscess formationHaematoma or abscess formationMenstrual disordersMenstrual disordersEctopic pregnancyEctopic pregnancyFailure Failure

Complications of Complications of LaparoscopyLaparoscopy

BleedingBleedingVisceral injuriesVisceral injuriesInfectionInfectiongas embolismgas embolismsubcutaneous emphysemasubcutaneous emphysemarespiratory or cardiac respiratory or cardiac

arrestarrestInjured blood vessel or Injured blood vessel or

viscera  viscera  

Most effective and nothing to

remember.

Effective but must be carefully used.

Fewer side-effects:

Very effective but must be carefully

used.

More side-effects:

Pills Injectables

Fertility awareness-

based methods

Vaginal methods

Male and female condom

IMPORTANT!Only condoms protect against both pregnancy and STIs/HIV/AIDS

Fewer side-effects, permanent:

More side-effects:

Implants

IUD

Fewer side-effects:

LAM

Femalesterilization

Vasectomy

Comparing methods

counseling in Follow up counseling in Follow up visitsvisits

COCCOC

ask the client:ask the client:

„„ „„ If she has any questions or anything to discuss.If she has any questions or anything to discuss.

„„ „„ whether she is satisfiedwhether she is satisfied

whether she has any problems. whether she has any problems.

„„ „„ If she has had any health problems since her last If she has had any health problems since her last visit visit

Assess the following:Assess the following:

Check blood pressure once a year if possible.Check blood pressure once a year if possible.

Ask if she has developed any contraindicationAsk if she has developed any contraindication

If appropriate, help her choose another method.If appropriate, help her choose another method.

Plan for Her Next VisitPlan for Her Next Visit

COCCOC

Warning signsWarning signs

A= Abdominal pain (severe)A= Abdominal pain (severe)

C= Chest pain (severe) with cough and C= Chest pain (severe) with cough and shortness of breathshortness of breath

H= Headache (severe) with dizziness and H= Headache (severe) with dizziness and shortness of breathshortness of breath

E= Eye problems (vision loss, blurring, or E= Eye problems (vision loss, blurring, or flashes of light)flashes of light)

S= Severe leg pain (calf or thigh)S= Severe leg pain (calf or thigh)

POPPOP

Ask if the client has any questions or anything to Ask if the client has any questions or anything to discuss.discuss.

Ask whether she is satisfiedAsk whether she is satisfied

Whether she has any problems. Whether she has any problems.

Plan for Next VisitPlan for Next Visit

Encourage her to come back for more pills before Encourage her to come back for more pills before she uses up her supply of pills.she uses up her supply of pills.

DMPADMPA

Ask the following questions at any return visit:Ask the following questions at any return visit:

„„ „„ if she has any questions or anything to discuss.if she has any questions or anything to discuss.

„„ „„ whether she is satisfied,whether she is satisfied,

whether she has any problems. whether she has any problems.

„„ „„ Ask about her bleeding patterns.Ask about her bleeding patterns.

„„ „„ Ask if she has had any health problems since her Ask if she has had any health problems since her last visit:last visit:

Warning symptoms

A= Abnormal heavy bleedingS= Stroke and heart disease (chest

pain and dyspnea)H= Headache (severe)Y= Yellow color of eyes (jaundice)

warning symptomswarning symptoms

PAINS PAINS

P= Period late or heavyP= Period late or heavy

A= Abdominal painA= Abdominal pain

I= InfectionI= Infection

N= Not feeling well (pyrexia and N= Not feeling well (pyrexia and chills)chills)

S= String changes or problems.S= String changes or problems.

IUCD return visitIUCD return visit

The client can come after her first menses, but not The client can come after her first menses, but not later than 3 months, for her first check-up. later than 3 months, for her first check-up.

If no complaints, she can come whenever a problem If no complaints, she can come whenever a problem arises.arises.

During the first follow-up visit:During the first follow-up visit:

„„ „„ Ask the client if she has any complaints, whether she Ask the client if she has any complaints, whether she is satisfied or has anything to discussis satisfied or has anything to discuss

„„ „„ Check for anemia if excessive or prolonged bleeding.Check for anemia if excessive or prolonged bleeding.

„„ „„ Do a pelvic examination to check if: Do a pelvic examination to check if:

IUCD threads are visible. IUCD threads are visible.

There are any signs of infection.There are any signs of infection.

ImplanonImplanon

„„ „„ Ask the client to come for a check-up after 1 month and for Ask the client to come for a check-up after 1 month and for removal of the implants at the end of their effective lifespan.removal of the implants at the end of their effective lifespan.

„„ „„ Reassure her that removal is available whenever she wants it.Reassure her that removal is available whenever she wants it.

„„ „„ Ensure that she understands that the implants must be Ensure that she understands that the implants must be removed after the effective period is over.removed after the effective period is over.

„„ „„ Check the insertion site to see whether it has healed.Check the insertion site to see whether it has healed.

„„ „„ Check that the implants are in place.Check that the implants are in place.

On the visit for removal of implants, do the following:On the visit for removal of implants, do the following:

„„ „„ Remove the implants.Remove the implants.

„„ „„ Insert a new set of implants if the client desires.Insert a new set of implants if the client desires.

  

Warning SignsWarning Signs

D= D= Delay in monthly periodsDelay in monthly periods

I= I= Infection at insertion siteInfection at insertion site

S= S= Severe abdominal painSevere abdominal pain

C= C= Capsule of the implant comes out of the skinCapsule of the implant comes out of the skin

U= U= Unusually heavy vaginal bleedingUnusually heavy vaginal bleeding

S= S= Soreness of the armSoreness of the arm

S= S= Severe headache or blurred visionSevere headache or blurred vision

أسئلة أسئلة

أنا أسأل أنا طيب أسأل طيب1. For most clients, the best family planning method is:1. For most clients, the best family planning method is:a. the one that the health provider thinks is best for a a. the one that the health provider thinks is best for a

particular client.particular client.b. the one that is most effective.b. the one that is most effective.c. the one that is most convenient for the provider.c. the one that is most convenient for the provider.d. the one that the client chooses after learning about all the d. the one that the client chooses after learning about all the

available methods.available methods.e. The one that the husband chooses.e. The one that the husband chooses.

2. 2. Informed choice Informed choice means that a family planning client:means that a family planning client:a. has been informed about all methods and agrees to use the a. has been informed about all methods and agrees to use the

contraceptive method the provider recommends.contraceptive method the provider recommends.b. has been informed about the side effects of the method she b. has been informed about the side effects of the method she

has chosen.has chosen.c. has informed you of the method she wants.c. has informed you of the method she wants.d. has the right to choose any method she wants based on full d. has the right to choose any method she wants based on full

information information

An informed consent form signed by the client is required for:An informed consent form signed by the client is required for:a. COCsa. COCsb. IUDb. IUDc. DMPAc. DMPAd. Tubal Ligationd. Tubal Ligatione. all of the abovee. all of the above

Which is the best way to correct a rumor about a FP method?Which is the best way to correct a rumor about a FP method?a. Laugh at the client for believing such a silly rumor.a. Laugh at the client for believing such a silly rumor.b. Politely tell the client the rumor is not true, and try to b. Politely tell the client the rumor is not true, and try to

change the subject.change the subject.c. Politely explain that the rumor is not true and why it is not c. Politely explain that the rumor is not true and why it is not

true.true.d. Ignore the comment.d. Ignore the comment.e. None of the above.e. None of the above.

Which of the following are characteristics of Which of the following are characteristics of active listeningactive listening? T/F? T/Fa. Occasionally paraphrasing or summarizing what the client has a. Occasionally paraphrasing or summarizing what the client has

saidsaidb. Looking at the client while s/he is talkingb. Looking at the client while s/he is talkingc. Thinking about what you will say next to the clientc. Thinking about what you will say next to the clientd. Writing or reading notes while the client is speakingd. Writing or reading notes while the client is speakinge. Asking specific questions related to what the client has told youe. Asking specific questions related to what the client has told youf. Interrupting the clientf. Interrupting the clientg. Nodding your head and making encouraging sounds while client g. Nodding your head and making encouraging sounds while client

is speakingis speakingh. Filing papersh. Filing papers

Which of the following are characteristics of Which of the following are characteristics of effective questioningeffective questioning? ? T/FT/F

a. Asking more than one question at a timea. Asking more than one question at a timeb. Asking one question and waiting for an answerb. Asking one question and waiting for an answerc. Asking questions that begin with c. Asking questions that begin with whywhyd. Phrasing questions to avoid d. Phrasing questions to avoid yes yes or or no no answersanswerse. Using a tone of voice that indicates interest and concerne. Using a tone of voice that indicates interest and concernf. Using words to encourage client to keep talking, such as "oh?" and f. Using words to encourage client to keep talking, such as "oh?" and

"then?""then?"g. Asking leading questionsg. Asking leading questions

The word The word GATHER GATHER is a memory aid to help us remember the is a memory aid to help us remember the steps of the counseling. What does each letter stand for?steps of the counseling. What does each letter stand for?

G = ___________________________________________________G = ___________________________________________________A = ___________________________________________________A = ___________________________________________________T = ___________________________________________________T = ___________________________________________________H = ___________________________________________________H = ___________________________________________________E = ___________________________________________________E = ___________________________________________________R = ____________________________________________________R = ____________________________________________________

A client will better understand and remember the correct use of a A client will better understand and remember the correct use of a method if:method if:

a. she is given general counseling and a detailed pamphlet to read at a. she is given general counseling and a detailed pamphlet to read at home.home.

b. the instructions are given to her mother-in-law or husband.b. the instructions are given to her mother-in-law or husband.c. she is able to handle and/or look at the method chosen c. she is able to handle and/or look at the method chosen d. technical medical language is used.d. technical medical language is used.e. she is encouraged to ask questions.e. she is encouraged to ask questions.

A client has had an IUD in for three months and now wants to have A client has had an IUD in for three months and now wants to have it removed. What would be the best counseling response?it removed. What would be the best counseling response?

a. try to persuade her to keep it for another three months.a. try to persuade her to keep it for another three months.b. remove it without questions and help her choose another method.b. remove it without questions and help her choose another method.c. Ask her why she wants it removed and act accordinglyc. Ask her why she wants it removed and act accordinglyd. Remove and tell her that she will not have another insertedd. Remove and tell her that she will not have another insertede. Counsel about consequences of unintended pregnancye. Counsel about consequences of unintended pregnancy

Indicate whether the statement is Indicate whether the statement is true or falsetrue or false..

a. A good counseling session is one in which the service provider a. A good counseling session is one in which the service provider leads and controls the discussion.leads and controls the discussion.

b. A spouse or mother-in-law should be encouraged to participate in b. A spouse or mother-in-law should be encouraged to participate in FP counseling sessions, even if the client does not seem eager to FP counseling sessions, even if the client does not seem eager to involve them.involve them.

c. It is acceptable for a provider to persuade a client to use a c. It is acceptable for a provider to persuade a client to use a method that the provider genuinely thinks is better for the client.method that the provider genuinely thinks is better for the client.

d. Counseling is more important when the client is illiterate than d. Counseling is more important when the client is illiterate than when the client is highly educated.when the client is highly educated.

e. Brief, simple, specific messages which are repeated often are a e. Brief, simple, specific messages which are repeated often are a good way to provide instructions for method use.good way to provide instructions for method use.

f. The decision to use a particular method must be made by the f. The decision to use a particular method must be made by the client.client.

Detailed information about a particular method is Detailed information about a particular method is usually discussed with a client during:usually discussed with a client during:

a. general FP counseling.a. general FP counseling.b. method-specific counseling.b. method-specific counseling.c. follow-up counseling.c. follow-up counseling.d. all of the above.d. all of the above.

If a client is unsure about choice of a FP method, a If a client is unsure about choice of a FP method, a service provider shouldservice provider should::

a. tell the client which method the provider thinks is best.a. tell the client which method the provider thinks is best.b. not mention a method that involves action on part of b. not mention a method that involves action on part of

client.client.c. counsel the client on all the methods available and c. counsel the client on all the methods available and

suggest she think about it and return when she has suggest she think about it and return when she has made a decision.made a decision.

d. explore with the client what method would best fit her d. explore with the client what method would best fit her and guide her in her final decision.and guide her in her final decision.

Which of the following is an open-ended Which of the following is an open-ended question?question?

a. Do you want to use the Pill?a. Do you want to use the Pill?b. How would you feel about using the Pill?b. How would you feel about using the Pill?c. What have you heard about the IUD?c. What have you heard about the IUD?d. Have you heard of the IUD?d. Have you heard of the IUD?e. Do you remember what to do if you miss one pill?e. Do you remember what to do if you miss one pill?f. Tell me what you will do if you miss one pill.f. Tell me what you will do if you miss one pill.g. How would you feel about not having any more g. How would you feel about not having any more

children?children?h. You realize that female sterilization is permanent?h. You realize that female sterilization is permanent?