Table of Contents
Chapters
- Promoting Dialogue
- Supporting the Client’s Role
- Improving Providers’ Performance
- Table: Activities to Improve CPI
- Box: Supervisors Can Improve CPI
- Best Practices in Training
- Evaluating the Quality of CPI
- Moving Beyond Family Planning
- Focus STI Counseling on the Individual
- Family Planning Providers Can Aid Victims of Violence
- Good CPI Benefits Sexual and Reproductive Health
- CPI Principles Apply to Integrated Services
- Bibliography
This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.
Published by the Information & Knowledge for Optimal Health (INFO) Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.
Volume XXXI, Number 4,
Fall 2003
Series Q, Number 1
Maximizing Access to Quality
Moving Beyond Family Planning
In keeping with the recommendations of the ICPD Programme of Action, family planning services increasingly are being integrated with other sexual and reproductive health services. In addition to family planning, integrated sexual and reproductive health services may address HIV/AIDS and other STIs, infections and cancers of the reproductive system, infertility, gynecological and maternity care, postabortion care, gender-based violence, and education on sexuality and parenting (51, 157). The need to look beyond contraception when working with family planning clients has created new challenges and opportunities for CPI.
Focus STI Counseling on the Individual
Providers must do a better job of addressing risk assessment, prevention, and treatment of HIV/AIDS and other STIs. Since family planning service delivery may be one of the few contacts that women have with the health care system, providers have a unique opportunity and responsibility to help clients make appropriate choices to protect against both unintended pregnancy and STI/HIV infection (144).
Providers may be reluctant to raise potentially embarrassing topics with clients, however, especially if the clients are married and therefore assumed—sometimes incorrectly—to be at low risk of infection. This reluctance may help explain why in the mid 1990s only about one-quarter of 3,000 clients received information about HIV/AIDS and/or STIs during maternal and child health and family planning consultations in five African countries (Botswana, Ghana, Kenya, Zambia, and Zimbabwe) (105).
Some common strategies to incorporate STI/HIV issues into family planning counseling are problematic. Adding STIs and HIV/AIDS to the routine background information given to all clients may not be feasible because of the time pressures on providers; it also raises the danger of overloading clients with more information than they can absorb (107). Giving STI/HIV information only to clients who fit a high-risk “profile”—for example, sex workers or women whose husbands travel—is no better. Profiles do not reliably identify individuals at risk of infection, and they unfairly stigmatize some clients (141).
Instead, information about STI/HIV risk assessment, prevention, and treatment should be a standard part of clinic health talks, community education, and mass media campaigns. During consultations, providers then can focus on assuring that each and every client understands what behaviors are risky and how to protect themselves from possible infection. In family planning consultations, this means helping clients assess their STI risks so they can choose an appropriate method or combination of methods (30, 158).
Family Planning Providers
Can Aid Victims of Violence
Worldwide, it is estimated, at least one woman in every three has been beaten, coerced into sex, or otherwise abused (51). Violence against women and girls can be physical, sexual, psychological, or economic, but coerced sex and abuse within marriage are among its most common manifestations.
Reproductive health care providers have a unique opportunity and special responsibility to help victims of gender-based violence because:
- Such abuse can have a major impact on women’s reproductive health and sexual well-being;
- Violence and powerlessness can limit women’s ability to make informed and voluntary decisions about their sexual and reproductive health; and
- Reproductive health providers may be these women’s only connection with the health care system and community support services (51).
Health care systems need to make a commitment to identify and address the needs of abused women and children. Many providers are unaware of the extent of violence against women. Some may even contribute to the problem by trivializing abuse or treating it as normal behavior, blaming the victims, violating their confidentiality, and placing their safety at risk (117). Victims have a range of needs, and supportive CPI can open the door to addressing those needs.
Training, guidelines, and job aids can help providers recognize their own values and biases, develop empathy, and improve their communication skills on sensitive issues such as sexual abuse (45, 60). In Venezuela, for example, the percentage of new clients who disclosed a history of violence rose from 7% to 38% after the Asociación Civil de Planifación Familiar (PLAFAM) held special awareness and skills training workshops for providers, introduced a counseling protocol and screening form, and developed informational materials for clients (46).
