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| Choice of contraceptive methods |
| (6) Discuss a range of methods |
- Definition: Providers should tell clients about a range of family planning methods, including how different methods can help them achieve their reproductive intentions. Providers can include in this discussion both clinical and supply methods and methods that do not require supplies or a medical procedure. This includes the Lactational Amenorrhea Method (LAM) for postpartum women and fertility awareness methods. They should also discuss methods that are available from other sources, such as pharmacies, shops and other private sector providers, as well as from clinics. The majority of the discussion should be spent on the methods in which the client is most interested.
- Relevance to a continuing-client strategy: For continuing clients who have a concern about their current contraceptive method, a discussion of the range of available methods helps them learn about and consider switching to another method that they might prefer.
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| (7) Provide client with method of choice |
- Definition: A new or continuing client may have a preferred family planning method. As long as the client is medically eligible to use this method, a provider should offer it.
- Relevance to a continuing-client strategy: Clients who receive their method of choice are more likely to continue contraceptive use.
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| Interpersonal relations |
| (8) Treat client with respect |
- Definition: A provider should treat clients with respect and consideration. Showing respect includes greeting the client in a friendly manner, actively listening, and understanding and responding to the client.
- Relevance to a continuing-client strategy: A client who feels respected and well cared for is more likely to continue to seek services at the clinic and respond to provider counseling.
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| (9) Tailor information to client needs |
- Definition: Providers should determine client needs based on the client's clinical history, reproductive intentions, and whether the client is a new or continuing family planning user. Providers who are familiar with their client's background will know better what to cover in a session and how to present the information clearly and effectively.
- Relevance to a continuing-client strategy: For continuing clients, a provider should focus the discussion on any new health conditions that the client has developed since the previous visit, any problems with use of the method, including side effects, and whether the client's reproductive intentions or life situation have changed.
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| (10) Encourage active client participation |
- Definition: Clients should feel comfortable asking questions and should be able to participate in a discussion with the provider. An active participant initiates some of the topics of discussion, seeks information from the provider, and participates in choosing a contraceptive method.
- Relevance to a continuing-client strategy: By actively participating, continuing clients will gain the confidence to make good choices, including whether to switch contraceptive methods when they experience a problem or their reproductive intentions change.
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| (11) See client in private |
- Definition: Clients should feel that their privacy is protected during the clinic visit. Seeing a client in a separate room or in an area enclosed by curtains where they cannot be seen or heard during counseling and physical exams can help ensure privacy.
- Relevance to a continuing-client strategy: Clients whose privacy is respected are more likely to be satisfied with the services they receive and to return for follow-up care.
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| (12) Assure client of confidentiality of visit |
- Definition: Providers should assure clients that their personal information will be kept confidential. Assuring clients of confidentiality can encourage them to mention sensitive personal issues about which providers can offer counseling.
- Relevance to a continuing-client strategy: Clients who are assured that the information they share will be kept confidential can develop a more trusting and open relationship with their providers, leading them to discuss their needs, experiences, and concerns more openly.
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| Information exchange with client |
| (13) Discuss reproductive intentions |
- Definition: Providers should determine their client's reproductive intentions—particularly whether the client wants to have more children, and if so, when. This information will help the provider respond better to the client's contraceptive needs for spacing and limiting births, both now and in the future.
- Relevance to a continuing-client strategy: When providers discuss reproductive intentions with continuing clients, they can assess whether the client's family planning needs have changed or will soon change and thus be better able to offer effective counseling.
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| (14) Give accurate information |
- Definition: To use a method effectively, clients should know how to use it correctly and consistently and should understand its potential side effects and the possibility of medical complications. Discussing rules for proper use of the method can help ensure that the client will use the method effectively and will know when to seek timely treatment. Discussing potential side effects in advance often reassures clients who experience them, while discussing possible complications ensures that clients can recognize symptoms that might put their health at risk.
- Relevance to a continuing-client strategy: A client who receives accurate information about a chosen method, including its side effects, is more likely to manage normal side effects and to continue using the method consistently and correctly.
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| Technical competence |
| (15) Follow infection-prevention procedures |
- Definition: Infection-prevention procedures protect client and provider health. These procedures vary by contraceptive method but in general include: using aseptic techniques, washing hands, correctly processing instruments and gloves (e.g., decontamination, cleaning, sterilization, high-level disinfection), putting on gloves before an exam, wiping contaminated surfaces with a disinfectant, properly using and disposing of sharps, and properly disposing and handling waste (7).
- Relevance to a continuing-client strategy: Following standards and procedures of infection prevention protects the health and safety of new and continuing clients.
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| (16) Screen clients using medical eligibility criteria |
- Definition: Providers should check for and be able to recognize the conditions that determine when a user can start or continue using a specific contraceptive method. Screening clients for medical eligibility criteria ensures the safe provision of appropriate methods (16).
- Relevance to a continuing-client strategy: Determining who can use which contraceptives safely can protect client health and avoid the problem of clients starting to use an unsuitable method that they later have to discontinue. By correctly applying medical eligibility criteria providers can avoid imposing unproven medical barriers on clients' contraceptive use.
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| (17) Perform clinical procedures according to medical standards |
- Definition: Providers should follow standards for the delivery of each contraceptive method to safely and comfortably provide them to clients.
- Relevance to a continuing-client strategy: When providers deliver contraceptive methods according to standards, they help to ensure the comfort, health, and safety of the continuing client and make sure that clients receive good-quality services.
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| Mechanisms to ensure continuity |
| (18) Give clear instructions for follow-up |
- Definition: Providers should discuss the reasons for clients to return to the clinic. Reasons include resupply or removal of their current contraceptive and consultations if problems occur while using the method. Providers should schedule the next appointment with the client and give an appointment reminder card. Clients should be encouraged to return whenever they have questions or concerns, but should not be required to make unnecessary visits.
- Relevance to a continuing-client strategy: By explaining to clients when follow-up is essential, where follow-up services are located, and what problems require immediate follow-up, providers can encourage continuation by making contraceptive use more understandable and convenient.
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| (19) Inform client of alternative sources of care |
- Definition: Alternative sources of care outside of the clinic include community-based distribution, pharmacies, or referrals to other health programs that provide contraceptive services.
- Relevance to a continuing-client strategy: Giving clients information on alternative sources of supply and making referrals can help ensure that continuing clients have access to contraception not only from clinics but from a variety of other sources available in the community or elsewhere in the health system, assuring that they do not experience any gaps in protection.
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| Appropriateness and acceptability of services |
| (20) Ensure acceptable waiting time |
- Definition: In general, waiting more than one hour to see a clinic provider can be considered unacceptable.
- Relevance to a continuing-client strategy: Long waiting times can discourage continuing clients from returning to a family planning clinic. Analyzing and streamlining client flow can help identify bottlenecks, resulting in more efficient service delivery, including reduced waiting times. If a long wait is unavoidable, clinic staff should courteously acknowledge the client and give an estimate of the waiting time and the reason for it.
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| (21) Make information and services available to the community |
- Definition: Programs can involve the community to support and encourage continued contraceptive use, including reaching men and community members with contraceptive services and information.
- Relevance to a continuing-client strategy: Women often discontinue contraceptive use because husbands, other family members, friends, or neighbors disapprove of family planning. Involving the community can counter false rumors and myths about family planning and help make contraceptive use more acceptable.
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