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close this bookHealth Benefits of Family Planning (WHO, 1995, 38 p.)
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Open this folder and view contentsFamily planning saves lives and improves health
View the documentInformed choice is a key element of high quality services
View the documentExpanding and improving family planning services is critical
View the documentConclusion: Family planning benefits all
View the documentGlossary
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Informed choice is a key element of high quality services

“The availability of a variety of methods encourages contraceptive continuation by allowing women and couples to switch to methods that better meet their changing needs.”

In order to determine the number and spacing of their children freely and responsibly, women and men need a choice of contraceptive methods appropriate to their needs. Choice of contraceptive methods is a key element of high quality services that benefits both clients and programmes. Clients benefit because they are able to select the method that best meets their needs and can switch to a different method as their needs change or if they experience difficulties. Programmes benefit because their clients are more likely to be satisfied and, therefore, to continue using a method.

Offering a variety of methods is important because each person’s contraceptive choice is influenced by personal concerns, health considerations, cost, and the cultural environment. These factors vary according to the individual, the couple, and the setting. Contraceptive needs also change as an individual moves through her reproductive life cycle from adolescence to menopause. A method that is appropriate and acceptable to a young woman may not be the best choice for the same woman several years later.

Offering clients choices can help increase contraceptive prevalence rates. Data from 36 developing countries indicate that making one additional modern method2 widely available could increase contraceptive prevalence by about twelve percent (see Figure 3) (Ross et al., 1989).

2 Modern methods were defined as including IUDs, oral contraceptives, injectable contraceptives, male and female sterilization, condoms, other conventional methods (such as spermicides), and abortion.


Figure 3: Making more methods available increases contraceptive use

Number of modern methods available

* IUD, OC, injectable, male and female sterilization, condoms, other conventional methods (such as spermicides), and abortion

Source: Ross et al., 1989

The availability of a variety of methods encourages contraceptive continuation by allowing women and couples to switch to methods that better meet their changing needs. When the Matlab Family Planning Health Services Project in Bangladesh began to offer a full range of contraceptive methods, 80 percent of the women were still using some method after one year, a dramatic increase over the 40 percent continuation rate that occurred when only condoms and oral contraceptives were available.

“Counselling can have a significant impact on user satisfaction and programme impact.”

Counselling is an important part of ensuring that clients make informed choices. The face-to-face meeting between a client and provider may be the only chance the client has to ask questions, express concerns, or learn about different methods from someone who is knowledgeable and concerned. A successful interaction will build trust between the provider and client, thereby encouraging the client to return if she or he needs more help.

Good counselling is not difficult but requires training and practice. Good counsellors not only are knowledgeable about the technical aspects of contraception, but also listen with empathy, help clients make their own decisions, and provide clients with the information they need to use their chosen method safely and effectively. A good counsellor will not let personal biases influence the information presented to clients.


Figure

When done well, counselling can have a significant impact on user satisfaction and programme impact. For instance, a study in Gambia found that women who reported that they were inadequately counselled were more than three times as likely to stop contracepting as those who felt they received sufficient information about side effects (see Figure 4) (Family Health International, 1991).


Figure 4: Counselling improves contraceptive continuation


Figure