09/19/2021

Client assessment and Counseling in

family planning

Tsiyon.K
Prepared by Tsiyon .K
1 JIMMA,ETHIOPIA
JULY 2021
PRESENTATION OUTLINE

09/19/2021
 Session objective
 Client assessment and Counseling in family

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planning
 Client assessment in provision of implants
 Client assessment in case of IUCD
 Counseling in family planning use
 Steps of FP counselling
 Tools for effective FP counselling
 Summary
 references
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OBJECTIVE

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 At the end of this session, the students will be able to:
 Define what is client assement in family planning mean ??

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 Describe relevant physical examination for a family planning
client
 Determine whether a client is pregnant or not?
 Explain the importance of counselling during family planning
 Describe effective tools to family planning counselling.
 Define steps of family planning counselling.
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CLIENT ASSESSMENT AND COUNSELLING OF FAMILY PLANNING

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 Client assessment usually can be accomplished by asking

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few key questions.

 Unless specific problems are suspected, the safe provision

of most contraceptive methods does not require

performing a physical, pelvic or laboratory examination.

 client assessment is an important aspect of FP services.

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CONTI…

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 It helps to ensure the client receives safe and
effective contraception.

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 Client assessment during family planning
includes :-

History

Physical examination

Laboratory examination
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CONTI…

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History

The following information should be sought from clients

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that request FP services to ensure safety and effectiveness
before providing contraceptives.
 Age
 Parity, last delivery, last abortion, history of ectopic
pregnancy
 Breastfeeding
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 Smoking
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 Sexual behaviour: self, partner

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 Present and past medical conditions :-STIs, HIV
status, Pelvic infection, Tuberculosis, Pelvic
surgery, Hypertension, Diabetes, CVS risk factors
(smoking, obesity, hypertension, previous
thromboembolic, phenomena, and high lipids),
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Migraine, Viral hepatitis, Gall bladder disease
CONTI…

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 Medications the client is taking:- Antiretroviral
drugs, Rifampicin, Antibiotics, Antidepressants,

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Anticonvulsants.
 Family history of cancers ,cardiovascular diseases
and cerebro-vascular, accidents

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Physical Examination
 Before deciding on the best FP method it is

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preferred to perform at least the following:
 Blood pressure measurement and the BMI .
 Clinical breast Examination (CBE)
 Pelvic exam in case IUD is to be inserted

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CONTI…

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Laboratory examination (only when indicated)

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Haemoglobin, Screening for STIs/HIV

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 Be reasonably sure that a woman is not
pregnant so the diagnosis of pregnancy is very

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important.
 The provider can be reasonably certain that the
woman is not pregnant by asking the some
questions like :-

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CONTI..

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To determine the possibility of pregnancy

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 Have you abstained from sexual intercourse since your last monthly bleeding

or delivery?

 Have you been using a reliable contraceptive method correctly and

consistently?

 Did your last monthly bleeding start within the past 7 days (or within 12 days

if the client is planning to use an IUCD)?

 Have you had a baby in the last 4 weeks?

 Have you had a miscarriage or abortion in the last 7 days (or within 12 days if
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the client is planning to use an IUCD)?
CONTI…

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Did you have a baby less than 6 months ago; if so, are you
fully or nearly fully breastfeeding, and had no monthly

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bleeding since then?
If the client answered ’yes’ to at least one of the questions,
and she has no symptoms or signs of pregnancy, she can
start the method she has chosen.
If the client answered ‘no’ to all questions, pregnancy
cannot be ruled out. The client should wait for her next
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monthly bleeding or use a pregnancy test.
 09/19/2021
Client assessment in provision of implants
 Assessing the client by history taking identifies the

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client’s reproductive goals, screens for medical
eligibility criteria for the use of implant, and screens
for any medical problems.

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CONTI…

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 For majority of clients, pregnancy can be ruled

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out by using pregnancy checklist.
 Pregnancy testing is unnecessary except in cases
where pregnancy cannot be ruled out by checklist.
 If pregnancy cannot be ruled out, counsel the
client to use a temporary contraceptive method or
abstain from intercourse until menses occur or
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the possibility of pregnancy is confirmed .
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Client assessment in case of IUCD

 Once a client has made the decision to use an IUCD after

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counselling on all methods , she needs to have IUCD
method specific counselling.

 Although IUCD is appropriate for most women, it may

not be appropriate for a few women.

 Careful screening is crucial for successful IUCD use. Some

complications can be prevented by thorough screening.
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 Using a screening checklist helps one to obtain
information systematically and completely.

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 If client answered yes to all this question IUCD can
not be inserted. Further evaluation for condition is

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required.
 If client answered no to all this question proceed
with pelvic examination

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 If the answer is no to all of the question ,insert
IUCD.
 If the answered any of question yes, IUCD can not
be inserted without further evaluation .

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 Finally, you should perform a complete pelvic exam in
order to:-

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-Determine position and size of uterus.

-Rule out likelihood of pregnancy.

-Rule out presence of visible and/or palpable

abnormalities, including infections, masses, Tumors, etc.
 If any of these are present, an IUCD should not be
inserted until the problem is investigated and resolved 20
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 Client assessment in case of permanent family
planning

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 The medical history that is taken must be complete,
whether or not questions are specifically related to
the surgical procedure.

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CONTI..

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 The medical history includes a history of past medical conditions

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(related to each organ system), a reproductive health history

(e.g., number of pregnancies, number of living children and their

age, last pregnancy, outcome and last normal menstrual period,

contraceptive history, and history of STIs or HIV), past history

of pelvic inflammatory disease (PID,) and a history of any

previous surgeries, anaesthesia, allergies, and medications.

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CONTI..

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 Clients should be asked about any current illness or any
symptoms that could add risk to the procedure or that could

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warrant a postponement.
 Pre-operative or pre anaesthesia nursing assessment should
be performed include hx taking and documenting vital signs
and conducting a cardiopulmonary, abdominal, and
gynaecological exam.

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CONTI..

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 In postpartum clients, an abdominal examination is
important for assessing the size and relative location of the

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uterine fundus.
 For clients who will be having an interval or post-abortion
mini laparotomy, the physical exam should include a
bimanual pelvic exam to determine the position, flexion,
mobility, size, shape, and condition of the uterus.

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CONTI..

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 The possibility of pregnancy must also be ruled out, but there
is no need to perform a pregnancy test; instead, the examining

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provider may use the Provider Checklist for Reproductive
Health Services

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ELIGIBILITY CRITERIA TO USE FAMILY
PLANNING METHOD

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 is tool which used to review who can and cannot safely
use a contraceptive method.

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 It offers guidance on the safety of using different
methods for women and men with specific reproductive
and social characteristics or known medical conditions.
 medical eligibility criteria improve both the quality of
and the access to family planning services for clients.
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ELIGIBILITY CRITERIA TO USE FAMILY
PLANNING METHOD
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COUNSELING IN FAMILY PLANNING USE

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 Family planning service is not a one-time intervention.

 It involves counselling and provision of each specific contraceptive

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method as per the standard and ensure the follow up and
continuity of service.

 So counselling of family planning is very important to prevent

discontinuation.

 Counselling is a type of client-provider interaction that involves

two-way communication between a health care staff member and a
client for the purpose of confirming or facilitating a decision by the
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client or helping the client address problems or concerns.
TASKS DURING COUNSELLING

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When providing counselling, health care staff is

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responsible for:
 Helping clients to assess their own needs for services,
information, and emotional support
 Providing information appropriate to clients’ identified
problems and needs
 Assisting clients in making their own voluntary and
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informed decisions by helping them weigh the options
CONTI..

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 Helping clients explore possible barriers to the
implementation of their decisions and helping them

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develop the strategies and skills to overcome those
barriers, and carry out their decisions
 Answering questions and addressing concerns, and
making sure the client understands all the
information they have received
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SERVICE PROVIDER’S ROLE

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TOOLS FOR EFFECTIVE FP
COUNSELLING

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1- Evidence Based Health Information.

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:-Composition and mode of action

:-Effectiveness

:-Advantages & Disadvantages:

:-Side effects &Complications

:-How to use:

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2- EFFECTIVE INTERPERSONAL COMMUNICATION

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SKILLS

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3. FOCUS ON CLIENT’S NEEDS

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 To be able to focus on client’s need the provider needs to know to which category the
client belong:

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I. New client

 With a method in mind

 With no method in mind

II. Returning client:

 No problems or concerns/ for refill

 Experiencing problems or has concerns

 Wishes to switch to another method

 Wishes to discontinue the method

III. Potential client: any client coming to the clinic for other reason should be counselled
on FP e.g. a woman coming for breast exam or post-partum care. 36
SUCCESSFUL FP COUNSELLING

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 Deal with each client respectfully, listen actively, ensures
privacy and confidentiality..…etc.

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 Clients differ and their situations differ.
 Allow interactive discussion & let the woman ask questions
 Do not overload them with unnecessary information and use
simple language.
 Warn about serious signs that need immediate care .
 Mention common side effects and their management
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 Plan a return visit.
WHAT DOES EFFECTIVE
COUNSELLING DO TO CLIENTS??

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 Enables clients to choose a method that suits their
needs

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 Enables clients to use their chosen method correctly

 Enables the client to continue using a FP method with

satisfaction

 Informs and prepares clients for side effects

 Family planning counselling is a good opportunity to give

clients key messages about the healthy timing and spacing

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of pregnancies (HTSP).
CONSEQUENCES OF POOR COUNSELLING
EFFECT

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 Incorrect method use which leads to Unwanted
pregnancy

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 Not counselled for side effects so leads to
Dissatisfaction/ Discontinuation
 Failure to recognize serious warning signs which
leads to Health risks
 Does not suit - Dissatisfaction with method which
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leads low utilization
STEPS OF FP COUNSELLING

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 The REDI framework moves away from traditional FP
counselling that relies on routinely giving detailed

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information about every FP method.
 It avoids overloading clients with unnecessary
information and instead emphasizes the client’s
preferences, individual circumstances, and sexual
relationships and knowledge.
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CONTI..

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REDI framework:

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 Emphasizes the client’s right and responsibility for
making decisions and carrying them out.
 Provides guidelines to help the counsellor and client
consider the client’s circumstances and social context.
 Identifies the challenges a client may face in carrying
out their decision.
 Helps clients build skills to address those challenges. 41
CONTI..

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 Based on REDI approach

1. Identify to which category the client belong, explore her needs,

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preference, personal & medical conditions (Clinical Assessment)

2 .Based the WHO MEC decide which methods can be used and
briefly explain about each method

3. Based on the personal condition and preferences, narrow options

let the woman choice and explain in detail about the method
chosen

4. Implement the shared decision and plan for continuity of care

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THE REDI FRAMEWORK HELPS ADDRESS THE
DIFFERING NEEDS OF CLIENTS
Client Type Usual Counseling Tasks

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Returning  Provide more supplies or routine follow-up
clients with  Ask a friendly question about how the

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no problems client is doing with the method

Returning clients  Understand the problem and help resolve

with problems
it—whether the problem is side effects,
trouble using the method, an
uncooperative partner, or another problem

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New clients  Check that the client's understanding
with a is accurate
method in
 Support the client's choice, if client is

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mind
medically eligible
 Discuss how to use method and how

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to cope with any side effects
New clients  Discuss the client's situation, plans, and what is
with no
important to her or him about a method
method in
mind  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
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 09/19/2021
 The ideal time to initiate counselling for postpartum FP
is during the antenatal period.

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 Early counselling allows sufficient time for the clients to
make their decisions without the stress associated with
the delivery.
 Counselling clients just during labour and delivery is
not appropriate.
 The next appropriate opportunity to counsel the client is
after delivery but before she leaves the facility.

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 Again Providing FP counselling and methods is one

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of the key elements of post abortion care.

 The provider should decide about the best timing to

initiate counselling for post abortion FP

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KEY INFORMATION FOR CLIENTS CHOOSING A CONTRACEPTIVE
METHOD

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 Effectiveness should be explained in easily understood terms.

 Clients need advice on when to return for follow-up or re-supply.

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In addition to scheduling return visits, providers should tell clients
that they are welcome to return to the facility any time they have
questions or concerns.

 The provider should give the client a piece of paper that shows the
date of the return appointment

 Talking about Side Effects, Health Risks, and Complications which

can related to medication, medical treatment, or a FP method
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SUMMARY

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 what is client assement in family planning mean ??

Tsiyon.K
 What relevant physical examination for a family
planning client?
 When we say whether a client is pregnant or not?
 What are the importance of counselling during
family planning?
 effective tools to family planning counselling.?
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 Define steps of family planning counselling.?
 REFERENCES

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1). General Family Planning Counselling Management Of
Contraceptives Side Effects Objectives. 2018 EDITION

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What ’ s New in This Edition ? 2018.

2) World Health Organization. Family Planning, A Global

Hand Book For Providers (2011 update): 2011.

3)World Health Organization, Medical Eligibility Criteria

for Contraceptive use,5th edition, 2015.

4) National Guideline for Family Planning Services in

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Ethiopia, 2019
 n k
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T ou
y

09/19/2021 BY BIRHANU K 50