Successful Counseling

Good counseling helps clients choose and use family planning methods that suit them. Clients differ, their situations differ, and they need different kinds of help. The best counseling is tailored to the individual client.

• Provide more supplies or routine follow-up
• Ask a friendly question about how the client is doing with the method

• Understand the problem and help resolve it—whether the problem is side effects, trouble using the method, an uncooperative partner, or another problem

• Check that the client's understanding is accurate
• Support the client's choice, if client is medically eligible
• Discuss how to use method and how to cope with any side effects

• Discuss the client's situation, plans, and what is important to her or him about a method
• Help the client consider methods that might suit her or him. If needed, help her or him reach a decision
• Support the client's choice, give instructions on use, and discuss how to cope with any side effects

Give time to clients who need it. Many clients are returning with no problems and need little counseling. Returning clients with problems and new clients with no method in mind need the most time, but usually they are few.

Tips for Successful Counseling

• Show every client respect, and help each client feel at ease.
• Encourage the client to explain needs, express concerns, ask questions.
• Let the client's wishes and needs guide the discussion.
• Be alert to related needs such as protection from sexually transmitted infections including HIV, and support for condom use.
• Talk with the client in a private place, where no one else can hear.
• Assure the client of confidentiality— that you will not tell others about
  your conversation or the client’s decisions.
• Listen carefully. Listening is as important as giving correct information.
• Give just key information and instructions. Use words the client knows.
• Respect and support the client’s informed decisions.
• Bring up side effects, if any, and take the client's concerns seriously.
• Check the client’s understanding.
• Invite the client to come back any time for any reason.

Counseling has succeeded when:

• Clients feel they got the help they wanted
• Clients know what to do and feel confident that they can do it
• Clients feel respected and appreciated
• Clients come back when they need to
• And, most important, clients use their methods effectively and with satisfaction.

Counseling About Effectiveness

The effectiveness of a family planning method is very important to most clients. The effectiveness of family planning methods varies greatly (see Appendix A – Contraceptive Effectiveness). Describing and discussing effectiveness is an important part of counseling.

Describing effectiveness to clients takes thought and care. Instead of talking about pregnancy rates, which can be hard to understand, it may be more useful to compare the effectiveness of methods and to discuss whether the client feels able to use the method effectively.

The chart on the back cover can help. The chart groups contraceptive methods according to their effectiveness as commonly used. Also, it points out how the user can obtain the greatest possible effectiveness.

• In general, methods that require little or no action by clients are the most effective. The 4 most effective methods—implants, IUDs, female sterilization, and vasectomy—are shown in the top row of the chart. All 4 methods need a health care provider’s help to get started, but then they need little or no action by the user. These methods are very effective for everyone who uses them—less than one pregnancy in 100 women in 1 year of use. Moreover, implants and IUDs are highly effective for 4 to 5 years or more, and female sterilization and vasectomy are permanent.
• Methods in the second row can be highly effective when used correctly and consistently. They require some repeated action by the user, however—some seldom, such as getting 4 injections a year, and some often, such as taking a pill every day, 365 days a year. As a result, they are less effective, on average, than methods in the top row, but still effective. Pregnancy rates for these methods range from 2 to 7 pregnancies in 100 women in a year.
• The methods in the lower rows of the chart usually have much higher pregnancy rates—as high as 20 or more pregnancies in 100 women in 1 year of use for the least effective methods. The effectiveness of these methods depends greatly on the user taking correct action repeatedly, such as using a condom with every act of sexual intercourse. Particularly for these methods, some highly motivated couples are much more successful than average. Others make more mistakes and are more likely than average to get pregnant.

Women tend to underestimate the effectiveness of the methods on the upper rows of the chart and overestimate the effectiveness of the methods on the lower rows. This may lead them to make misinformed decisions and to choose a contraceptive method that does not meet their needs. Counseling may need to gently correct these common misperceptions.

In counseling it is not possible or necessary to provide complete information about every method. Clients do, however, benefit from key information, especially about the method that they want. The goal of counseling about method choice is to help the client find a method that she or he can use successfully and with satisfaction. Well-informed clients are more likely to be satisfied with their method and to use it longer. Clients need to understand how that method works, how effective it is, how to make the method most effective, what are the most likely side effects, and what to do if such side effects occur. With this knowledge and understanding, clients are better able to exercise their right to make a truly informed choice.