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Improving Counseling Quality to Better Meet Women’s Contraceptive Needs

This article summarizes important findings from several Global Health: Science and Practice Journal articles that report on contraceptive method discontinuation and issues related to quality of care and counseling.

Contraceptive discontinuation remains a challenge to providing Universal Health Coverage and reaching Sustainable Development Goal 3.7: that all women of reproductive age have their contraceptive needs satisfied. Increasing access to services and method choice is only one part of the picture. Just because a woman is using a contraceptive method doesn’t mean her needs are being met. Up to two-thirds of sexually active women who want to delay or prevent pregnancy stop using a method because of side effects and health-related concerns. These women are at high risk of unintended or mistimed pregnancy.

Is There a Link Between Counseling and Discontinuation?

GHSP JournalEvidence on whether improving the quality of counseling will lead to improved outcomes and address unmet need is lacking. As Danna and colleagues write in a Global Health: Science and Practice article examining client-provider interaction and links to contraceptive discontinuation, “uncovering the links between improvements in quality of care in counseling and method discontinuation would allow the community of practice to better supply clients with counseling that addresses their needs, leaves them satisfied, and ensures their right to quality care.”

Does Counseling Help Decrease Discontinuation?

Danna and colleagues conducted a review of the literature on different counseling approaches and assessed whether these techniques and tools had been evaluated for an effect on contraceptive discontinuation while still in need. They found that several studies reported an association between the information providers give to clients, particularly on possible side effects, and contraceptive discontinuation.

Yet, many women still report missed opportunities for counseling when they visit health facilities. And the counseling they receive is not adequately informing them about the method and its possible side effects. A GHSP study reported that approximately 9% of clients who had a removal of a long-acting reversible contraceptive did not receive counseling after the removal, indicating they were not receiving high-quality care. That study’s findings point to the importance of every client-provider point of contact as a critical moment for repeatedly providing clients with comprehensive information about all their method choices, side effects, and how to manage them.

“A GHSP study reported that approximately 9% of clients who had a removal of a long-acting reversible contraceptive did not receive counseling after the removal, indicating they were not receiving high-quality care.”

How Can Counseling Interactions Be Improved to Better Address Client Need?

In addition to the information clients receive, the quality of the interaction between clients and providers plays an important role in discontinuation. “Evidence shows that clients of all ages desire a relationship with their provider that exhibits respect and trust, correct and relevant information, and a person-centered interaction that affords them the dignity of making an informed choice about their contraceptive use, free from provider bias,” Danna et al. wrote.

Quality counseling that addresses side effects and health concerns, as well as myths and misperceptions about a method, during the first interaction and subsequent points of contact could reduce the reasons why women seek to stop using a method. Over the years, programs have used different interventions to improve client-provider interactions, as well as strategies to ensure that clients receive comprehensive information, but these have not been shown to have a measurable impact on contraceptive discontinuation rates.

The results of the GHSP review of the existing evidence support the need to improve the quality of counseling by adhering to several principles, such as shared decision making.

Summary of Quality Counseling Principles

  • Counseling should be responsive to client’s individual priorities, questions, and concerns.
  • Counseling should support shared decision making between the client and the provider, where the client’s wishes should come first. Clients should have the ability to choose which contraceptive method they want and should receive what they choose regardless of age, marital status, religion, or provider bias, etc.
  • Counseling should ensure clients have confidence in the privacy and confidentiality of their sessions.
  • Providers should display trustworthiness, empathy, and solidarity with the client, friendliness, and warmth. Encourage open-minded questions, dialogue, and listening.
  • Counseling should provide information that is accurate and relevant to the client, narrowing down the client’s options based on their stated needs and preferences.
  • Counseling should address and prepare clients for potential side effects of their method options and provide concrete examples of how these might affect their health and lifestyle.
  • Counseling should prepare clients for follow-up, including the understanding of warning signs that require attention by a health care provider. Make a plan for follow up appointments if necessary.

Source: Danna et al.

More research needs to be done on the specific points of contact that can be improved to ensure that the client-provider relationship is what it’s intended to be: a means to provide clients with the rights-based family planning they deserve to fulfill their needs.

Sonia Abraham

Scientific Editor, Global Health: Science and Practice Journal

Sonia Abraham is the scientific editor for the Global Health: Science and Practice Journal and has been writing and editing for over 25 years. She holds a Bachelor’s in Biological Sciences from the University of Maryland and a Master’s in Writing from Johns Hopkins.

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