Education and counseling on Family Planning methods | CHAPTER 9 | Community Health Nursing

Education and counseling on Family Planning methods- This book covers the entire syllabus of “Community Health Nursing” prescribed by the Universities of Bangladesh- for Basic and diploma nursing students. We tried to accommodate latest information and topics.

This book is examination friendly setup according to the teachers’ lectures and examination’s questions. At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.

Education and counseling on Family Planning methods

Education and counseling on Family Planning methods

Family planning counselling is defined as a continuous process that you as the counsellor provide to help clients and people in your village ake and arrive at informed choices about the size of their family (i.e. the number of children they wish to have).

1. Individual counseling

Find that in most cases individuals prefer privacy and confidentiality during communication or counselling. It is important to respect the needs and interests of a client by finding a private room or place where you can talk with them

Figure: A Health Extension Practitioner giving individual counselling

2. Couple counseling

Couple counselling is when you give a counselling service to a couple or partners together. This is particularly common when they are thinking of using irreversible family planning measures, such as voluntary surgical methods.

Figure: A Health Extension Practitioner counselling a couple

3. Group counselling and information sharing

Group information sharing is used when individual counselling is not possible, or if there are people in your village who are more comfortable in a group. In this situation, after greeting everyone in a friendly manner, you would explain to them the benefits of family planning, discuss briefly common myths and mistaken beliefs about family planning, and then inform the group about how to obtain appropriate contraception

Figure: Group counselling and information sharing

The importance of counselling in family planning is to help the client to make, and arrive at, informed and well-considered voluntary choices about their fertility, or help a client to decide on the number of children they want and when to have them.

General principles of counselling for family planning

The most important principles in counselling are:

• Being in a private room and quiet place.
• Taking sufficient time.
• Maintaining confidentiality.
• Conducting counselling in a tolerant/non-judgmental, accepting and conducive/helpful way.
• Using direct and simple words.
• Using good interpersonal communication skills.
• Telling the most important messages first.
• Using available visual aids.

Or (another answer)

General principles of counselling for family planning

Listening skills

Listen attentively to the client in an attempt to understand both the content of their problem, as they see it, and the emotions they are experiencing related to the problem. Do not make interpretations of the client’s problems or offer any premature suggestions as to how to deal with, or solve the issues presented. Listen and try to understand the concerns being presented. Most people want and need to be heard and understood, not advised.

Resistance

Changing human behavior is not usually a linear, direct, and logical process. It is very emotional and many habits of behavior and thought that are dysfunctional are difficult to break. People invest a sense of security in familiar behavior, even some behavior that causes them pain. Changing this is often a difficult and tangential process. Many threads of behavior are tied to others and when one thing is changed a new balance must be established, otherwise people couldn’t function.

This means people change at different rates depending on how well they can tolerate the imbalance that comes from change. So, when people resist certain changes that one hopes will occur in therapy it is important that the therapist not take this personally and recognize the stressful nature of the process for the client. Some resistance to therapeutic change is quite natural.

Respect

No matter how peculiar, strange, disturbed, weird, or utterly different from you that the client is, they must be treated with respect! Without this basic element successful therapy is impossible. You do not have to like the client, or their values, or their behavior, but you must put your personal feelings aside and treat them with respect. In some institutional settings you made observe some slippage in this principal among staff which is both inadequately trained and overstressed and overworked, but you must try to keep this principal in mind at all times in you want to be an effective counselor or therapist.

Empathy and Positive Regard

Based in the writings of Carl Rogers, these two principles go along with respect and effective listening skills. Empathy requires you to listen and understand the feelings and perspective of the other person (in this case your client) and positive regard is an aspect of respect. While Rogers calls this “unconditional positive regard” it may be a bit too much to ask that it be “unconditional.” Treating the client with respect should be sufficient.

Clarification, confrontation, interpretation

These are techniques of therapeutic intervention that are more advanced, although clarification is useful even at a basic level. Clarification is an attempt by the therapist to restate what the client is either saying or feeling, so the client may learn something or understand the issue better. Confrontation and interpretation are more advanced principles and we won’t go into them except to mention their existence.

Transference and Counter transference

This is a process wherein the client feels things and has perceptions of the therapist that rightly belong to other people in the client’s life, either past or present. It is a process somewhat related to projection. Understanding transference reactions can help the client gain understanding of important aspects of their emotional life. Counter transference refers to the emotional and perceptional reactions the therapist has towards the client that rightly belong to other significant people in the therapists life. It is important for the therapist to understand and manage their counter transference.

Special nature of family planning counseling

• Many people have strong ideas about family planning, but some of the ideas they have may be based on myth or misinformation. You need to be respectful and welcoming when sharing ideas, and demonstrate commitment to the necessary values and principles of family planning.
• Try to find out your clients’ views by encouraging them to talk. Do not ask them direct and judgmental questions such as: “Are you one of those people who believe that modern family planning is forbidden for religious people?” Such questions sound critical and can make people feel inferior, or may make them mistrust you because they may ask themselves, “Why should I believe this person when all my relatives share my belief?”
• Always try to understand, and be sensitive to, cultural and psychological factors that may affect clients in your village adopting and using family planning methods. For example: there may be opposition to the idea of controlling the size of the family from some cultures and religions. Some methods may be unpopular with clients, for example a woman might not like the idea of having to insert a contraceptive into her body before having sex, or a man may think that a condom will take away the pleasure of sex.

Steps of family planning counseling

“GATHER” is an acronym that will help you remember the 6 basic steps for family planning counseling. It stands-

G Greet the client respectfully.

A Ask them about their family planning needs.

T Tell them about different contraceptive options and methods.

H Help them to make decisions about choices of methods.

E Explain and demonstrate how to use the methods.

R Return/refer, schedule and carry out a return visit and follow up.

Or (another answer)

Steps of family planning counseling

G-Greet the client

• In the first case, give your full attention to your clients.
• Greet them in a respectful manner and introduce yourself after offering seats.
• Ask them how you can help them.
• Tell them that you will not tell others what they say.
• If the counselling is in a health institution, you have to explain what will happen during the visit, describing physical examinations and laboratory tests if necessary.
• Conduct counselling in a place where no-one can overhear your conversation.

A-Ask the clients about themselves

• Help them to talk about their needs, doubts, concerns and any questions they might have.
• If they are new, use a standard checklist or form from your Health Management Information system to write down their name and age, marital status, number of pregnancies, number of births, number of living children, current and past family planning use, and basic medical history.
• Explain that you are asking for this information in order to help you to provide appropriate information, so that they can choose the family planning method which is the best for them.
• Keep questions simple and brief, and look at her/them as you speak.
• Many people do not know the names of diseases or medical conditions. Ask them specific questions. Say, “Have you had any headaches in the past two weeks?’, or ‘Have you had any genital itching?’, or ‘Do you experience any pain when urinating?’ Do not say, ‘Have you had any diseases in the recent past’.
  If you have seen the client(s) previously, ask if anything has changed since the last visit.

T-Tell them all about family planning methods

Tell them which methods are available.
Ask which methods interest them and what they know about the methods,
Briefly describe each method of interest and explain disadvantages, and possible side-effects. how it works, its advantages and

H-Help them to choose a method

• To help them choose a method of contraception, ask them about their plans and family situation. If they are uncertain about the future, begin with the present situation.
• Ask what the spouse/partner likes and wants to use.
• Ask if there is anything they cannot understand, and repeat information when necessary.
• When the chosen method is not safe for them, explain clearly why the method may not be appropriate and help them choose another method.
• Check whether they have made a clear decision and specifically ask, ‘What method have you decided to use?”

E-Explain how to use a method

After a method has been chosen:

• Give supplies if appropriate.
• If the method cannot be given immediately, explain how, when and where it will be provided.
• For methods like voluntary sterilisation the client will have to sign a consent form. The form says that they want the method, have been informed about it, and understand this information. You must help the individual understand the consent form.
• Explain how to use the method.
• Ask the client to repeat the instructions.
• Describe any possible side-effects and warning signs, and tell them what to do if they occur.
• Ask them to repeat this information back to you.
• Give them printed material about the method to take home if it is available.
• Tell them when to come back for a follow-up visit and to come back sooner if they wish, or if side-effects or warning signs occur.

R-Appoint a return visit for follow-up

At the follow-up visit:

• ask the client if she is, or they are, still using the method, and whether there have been any problems.
• ask if there have been any side-effects.
• reassure the client/s concerning minor side-effects. Explain that the side effects are not dangerous and suggest what can be done to relieve them.
• refer for treatment in the case of severe side-effects.
• ask the client if they have any questions.

If the clients want to use a different method, tell them about other methods and help in this choice. It is important to remember that changing methods is not bad. The main thing is that they can choose a method which is acceptable and appropriate. If the clients now want to have a child, help them to discontinue the use of their current method of family planning. Make sure the clients know when and where to go for prenatal care when the spouse becomes pregnant.

Factors that can affect family planning counselling outcomes

• Provider factors, such as your ability to engage in effective communication, your technical knowledge, skills, attitudes and behaviours.
• Client factors, such as a client’s level of knowledge and understanding.
• External and programmatic factors which you cannot control, such as lack of availability of certain methods or equipment, or irregular supplies of family planning materials.

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• Community Health Nursing | Diploma in Nursing Science and Midwifery