Family planning counseling

1. GATHER APPROACH
Prepared by: Mrs. Namita Batra Guin
Associate Professor
1. Introduction
GATHER is an acronym that will help in remembering the 6 basic steps for family planning
counselling. It is important to know that not every new client in the village needs all the steps.
GATHER approach is used sensitively so that it is appropriate to each client’s need.
2 Steps under GATHER approach
Family planning counselling — the GATHER approach
G Greet the client respectfully.
A Ask them about their family planning needs.
T Tell them about different contraceptive options and methods.
H Help them to make decisions about choices of methods.
E Explain and demonstrate how to use the methods.
R Return/refer; schedule and carry out a return visit and follow up.
3. Brief Description of each step
3.1. G — Greet the client
 In the first case, give your full attention to your clients.
 Greet them in a respectful manner and introduce yourself after offering seats.
 Ask them how you can help them.
 Tell them that you will not tell others what they say.
 If the counselling is in a health institution, you have to explain what will happen during
the visit, describing physical examinations and laboratory tests if necessary.
 Conduct counselling in a place where no-one can overhear your conversation.
3.2. A — Ask the clients about themselves
 Help them to talk about their needs, doubts, concerns and any questions they might have.

2.  If they are new, use a standard checklist or form from your Health Management
Information system to write down their name and age, marital status, number of
pregnancies, number of births, number of living children, current and past family
planning use, and basic medical history.
 Explain that you are asking for this information in order to help you to provide
appropriate information, so that they can choose the family planning method which is the
best for them.
 Keep questions simple and brief, and look at her/them as you speak.
 Many people do not know the names of diseases or medical conditions. Ask them
specific questions. Say, ‘Have you had any headaches in the past two weeks?’, or ‘Have
you had any genital itching?’, or ‘Do you experience any pain when urinating?’ Do not
say, ‘Have you had any diseases in the recent past’.
 If you have seen the client(s) previously, ask if anything has changed since the last visit.
3.3. T — Tell them all about family planning methods
 Tell them which methods are available.
 Ask which methods interest them and what they know about the methods.
 Briefly describe each method of interest and explain how it works, its advantages and
disadvantages, and possible side-effects.
3.4. H — Help them to choose a method
 To help them choose a method of contraception, ask them about their plans and family
situation. If they are uncertain about the future, begin with the present situation.
 Ask what the spouse/partner likes and wants to use.
 Ask if there is anything they cannot understand, and repeat information when necessary.
 When the chosen method is not safe for them, explain clearly why the method may not be
appropriate and help them choose another method.
 Check whether they have made a clear decision and specifically ask, ‘What method have
you decided to use?’
3.5. E — Explain how to use a method
After a method has been chosen:
 Give supplies if appropriate.
 If the method cannot be given immediately, explain how, when and where it will be
provided.
 For methods like voluntary sterilisation the client will have to sign a consent form. The
form says that they want the method, have been informed about it, and understand this
information. You must help the individual understand the consent form.
 Explain how to use the method.

3.  Ask the client to repeat the instructions.
 Describe any possible side-effects and warning signs, and tell them what to do if they
occur.
 Ask them to repeat this information back to you.
 Give them printed material about the method to take home if it is available.
 Tell them when to come back for a follow-up visit and to come back sooner if they wish,
or if side-effects or warning signs occur.
3.6. R — Appoint a return visit for follow-up
At the follow-up visit:
 Ask the client if she is, or they are, still using the method, and whether there have been
any problems.
 Ask if there have been any side-effects.
 Reassure the client/s concerning minor side-effects. Explain that the side effects are not
dangerous and suggest what can be done to relieve them.
 Refer for treatment in the case of severe side-effects.
 Ask the client if they have any questions.
If the clients want to use a different method, tell them about other methods and help in this choice.
It is important to remember that changing methods is not bad. The main thing is that they can
choose a method which is acceptable and appropriate. If the clients now want to have a child, help
them to discontinue the use of their current method of family planning. Make sure the clients know
when and where to go for prenatal care when the spouse becomes pregnant.
4. Factors influencing family planning counselling outcomes
There are different factors that affect the quality and effectiveness of communication in
counselling. You should identify and address these factors in order to have successful family
planning counselling sessions. These factors are divided into three broad categories.
4.1 Counselor factors
It involves ability to engage in effective communication, technical knowledge, skills,
attitudes and behaviors, that can influence the effectiveness of the counselling process. Health
professional’s own values and beliefs on specific methods, can also influence the family planning
counselling outcomes and couple’s choice.
4.2 Client’s factors
The client’s level of knowledge and understanding may affect their choice. What they
choose to do may also be affected by the extent to which they trust and respect you. Their personal
situation may make it difficult for them to choose some methods, for example if their spouse or
another family member has a different preference to them.

4. 4.3 Programmatic/External Factors
Various developing nations have limitation in regard to programme implementation. There
may be unavailability of resources, limited methods to offer to community people and irregularity
and unreliability of supplies, can make the counseling services and program ineffective.
In most health facilities the space or room for the provision of family planning is integrated with
other reproductive health programmes. This can make it really difficult to find a place where
privacy and confidentiality can be maintained.
5. Principles of Counselling
5.1. Counseling should take place in a private quiet place where client and provider can hear each
other, and with sufficient time to ensure that all necessary information, client's concerns, and
medical requirements are discussed and addressed.
5.2. Confidentiality must be ensured, both in the process of counseling and the handling of client
records.
5.3. It is essential that counseling take place in a non-judgmental, accepting, and caring
atmosphere.
5.4. The client should be able to understand the language the provider uses (e.g., local dialect,
simple, culturally appropriate vocabulary, no highly technical medical terminology).
5.5. Clinic staff must use good interpersonal communication skills, including the ability to question
effectively, listen actively, summarize and paraphrase clients' comments or problems, and adopt a
non-judgmental, helpful manner.
5.6. The client should not be overwhelmed with information. The most important messages should
be discussed first (e.g., what the client must do to use method correctly and safely) and be brief,
simple, and specific. Repeating critical information is the most effective way to reinforce the
message. Repeat, repeat, repeat.
5.7. Use audiovisual aids and contraceptive samples to help the client better understand her chosen
method.
5.8. Always verify that the client has understood what has been discussed. Have the client repeat
back the most important messages or instructions.
6. Characteristics of a counselor
An effective counselor:

5.  believes in and is committed to the basic values and principles of family planning and client
rights
 is accepting, respectful, non-judgmental, and objective when dealing with clients
 is aware of her/his own values and biases and does not impose them on clients
 understands and is sensitive to cultural and psychological factors (such as family or
community pressures) that may affect a client's decision to adopt family planning
 always maintains clients' privacy and confidentiality
7. Counselor Skills
An effective counselor possesses strong technical knowledge of contraceptive methods:
 knows all technical aspects of family planning methods thoroughly
 is prepared to answer contraceptive and non-contraceptive questions comfortably on
subjects such as myths, rumors, sexuality, STDs, reproductive and personal concerns
 is able to use visual aids and explain technical information in language that the client
understands
 is able to recognize when to refer the client to a specialist or other provider
8. Non-verbal Communication
Nonverbal communication is especially important because it communicates to clients the level of
interest, attention, warmth, and understanding we feel towards them.
Positive nonverbal cues include:
 leaning toward the client
 smiling, without showing tension
 facial expressions which show interest
and concern.
 maintaining eye contact with the client
 encouraging supportive gestures such
as nodding one's head.
Negative nonverbal cues include:
 not making or maintaining eye contact
 glancing at one's watch obviously and
more than once
 frowning
 fidgeting
 sitting with the arms crossed
 leaning away from the client
Providers should remember ROLES. when communicating with clients:

6. R = Relax the client by using facial expressions showing concern.
O = Open up the client by using a warm and caring tone of voice.
L = Lean towards the client, not away from them.
E = Establish and maintain eye contact with the client.
S = Smile
9. Basic rights of all Family Planning Clients
9.1. Information: The right to learn about the benefits and availability of family planning.
9.2 Access: The right to obtain services regardless of sex, creed, color, marital status, or location.
9.3 Choice: The right to decide freely whether to practice family planning and which method to
use.
9.4 Safety: The right to be able to practice safe and effective family planning.
9.5 Privacy: The right to have a private environment during counseling or services.
9.6 Confidentiality: The right to be assured that personal information will remain confidential.
9.7 Dignity: The right to be treated with courtesy, consideration, and attentiveness.
9.8 Comfort: The right to feel comfortable when receiving services.
9.9 Continuity: The right to receive contraceptive services and supplies for as long as needed.
9.10 Opinion: The right to express views on the services offered.
Summary
Family planning counselling is the process whereby clients can make informed and voluntary
choices about the number of children and the spacing of the children within their family. There are
different ways of providing effective family planning counselling. Counselor may work with
individual, couples or with a group. Usually working with an individual works best.
GATHER is an acronym to help remember the 6 basic steps in the counselling process: Greet, ask,
tell, help, explain and return/refer. There may be several factors affecting the counseling, which
may be overcome, as ultimate success of the counseling has impact on future generations.
References:
1. http://www2.pathfinder.org/pf/pubs/mod3.pdf

7. 2. https://www.open.edu/openlearncreate/mod/oucontent/view.php?id=138&section=1.7