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Family Planning

Family Planning Counseling Principles & Key Steps

Overview of key steps and principles involved in providing quality family planning services, including information provision, counseling for informed choice, risk assessment, history taking, physical assessment, and method provision, emphasizing pre-conception care and considerations for specific groups like PLWHIV.

Also known as: FP Counseling, Contraceptive Counseling

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Referral and warning signs

When to refer

Refer clients with medical conditions contraindicating chosen method, abnormalities found on exam requiring further evaluation (e.g., breast lump, severe hypertension, suspected malignancy), or complications needing higher-level management.

Red flags

  • Signs/symptoms suggesting serious underlying medical condition discovered during assessment.
  • Severe complications related to chosen FP method (see individual entries).

Signs and symptoms

  • Key Counseling Areas: Different FP methods available (Type, Mechanism, Use, Advantages, Disadvantages, Indications, Contraindications, Side-effects, Complications/Warning Signs).
  • Pre-conception Care Topics: Pregnancy planning, Folic acid, Diet, Risk assessment, STI/HIV screening, Hereditary disease screening.
  • PLWHIV Considerations: HIV transmission prevention (spouse/child), Safer sex/conception, ART interaction with hormonal methods (need for dual protection), Opportunistic infection evaluation.

Risk factors

  • High-Risk Clients for Unwanted Pregnancy: Recent delivery/abortion, >4 pregnancies, Age >35 or <20, Complicating medical conditions (diabetes, heart disease), PLWHIV, Birth interval <2 years, Poor obstetric history (PPH, pre-eclampsia).

Diagnosis

Clinical assessment

Assessment involves thorough history taking (social, family health, personal medical, surgical, reproductive, menstrual, gynaecological, FP history) and physical assessment (general head-to-toe, breast exam, abdominal exam, pelvic exam including cervical cancer screening) to determine eligibility and suitability for chosen method.

Investigations

  • Blood Pressure measurement
  • Weight measurement
  • Pelvic Examination (including speculum exam)
  • Cervical Cancer Screening (VIA/VILI/Pap)
  • HIV Screening (offered)
  • Other tests based on history/exam (e.g., STI screening, Hb if anaemia suspected)

Diagnostic criteria

Eligibility determined by client history, examination findings, and application of Medical Eligibility Criteria (MEC) for contraceptive use (see FP002).

Management

Non-pharmacological management

  • Information Provision: Create awareness, disseminate correct info, influence attitudes, recruit clients.
  • Counseling: Dispel myths, help client make voluntary informed choice, check understanding, explain next steps.
  • History Taking: Obtain comprehensive personal/social/medical/reproductive data.
  • Physical Assessment: Assess general health, examine relevant systems.
  • Pelvic Examination: Inspect genitalia, perform speculum/bimanual exam.
  • Privacy and Confidentiality: Ensure during counseling and examination.

Pharmacological treatment

  • Provide suitable chosen method after confirming eligibility.
  • Ensure client understands method use, side effects, warning signs.
  • Discuss management of potential side effects.
  • Arrange follow-up and supply refills.

Monitoring

Follow-up appointments as per chosen method guidelines. Monitoring for side effects or complications.

Complications

  • Complications specific to chosen method (see individual entries).
  • Unintended pregnancy if method fails or used incorrectly.
  • Missed diagnosis of underlying condition if assessment inadequate.

Prevention

  • Providing accurate information and effective counseling.
  • Using MEC to ensure safe method choice.
  • Promoting dual method use (condoms) for STI/HIV prevention.

Patient education

  • Benefits of family planning.
  • Different methods available and how they work.
  • Importance of informed choice.
  • Correct use of chosen method.
  • Potential side effects and warning signs.
  • Need for follow-up.
  • Importance of dual protection (condoms) for STI/HIV prevention.

Uganda-specific notes

Emphasis on integrating FP services into various clinics (MCH, Postnatal, HIV, Outpatient). Special attention to adolescents and PLWHIV. Utilizes MOH guidelines and MEC.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 15, Sections 15.1.1 - 15.1.9

  • Procedure Manual for Family Planning and Maternal Health Service Delivery MOH, 2016

    (General reference)

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