notes

1. 1
UNWED MOTHERS:
Definitions:
An unsupported pregnancy is any planned or unplanned pregnancy in which the child
natural father is absent as a result of rejection of the mother and or child or in which the
child’s mother has abandoned the relationship with the child’s father due to any reasons
including emotional abuse, physical abuse, dishonesty or incarceration.
Incidence:
The number of babies born to unwed mothers nearly 8% to a new record high in 2006
and 20% increase since 2002. The percentage of all US births to unmarried mothers
increased from 36.9% in 2005 to 38.5% in 2006. That means almost two out every five
babies were born to illegitimate.
Problems of unwed mothers:
The socioeconomic and health issues of the unwed mothers are numerous. The culture
attitude and the behavior of the tribal and the non-tribals are not conducive to the needs
and the problems of unwed mothers. Poverty unemployment, rejection, isolation,
neglect , lack of shelter along with different health issues like malnourishment, STD,
psychological problems aggravates the situation. No serious attempts have been made
to reduce the problem or to rehabilitate the victims either from the government side or
from private sector. The apathy and stigma is still continuing.
Social and Cultural Stigma:
The social stigma associated with being an wnwed parent is so much that it may lead
some women to attempt or commit suicide. In our social setup, pregnancy outside
marriage is considered a humiliation that will affect not only the mother but also her
family. Such a women is ostracized in most of our Indian societies. The immediate
family and extended family, which should provide social protection to mothers to be,
leave them alone considering them social and financial burden.
According to a research conducted by a Colombo- based lawyer:
“The single women both at home and at the work place have to face many physical
advances from men young and old, married and unmarried. In our interviews these
women found it difficult to discuss these sexual advances.”
To be single and specially an unwed mother is taken as that you are available or easy
to gain access to. Furthermore what is more critical is that the responsibility of a child
born outside marriage resets solely on the mother. The lack of support from family,
relatives, society , etc makes her living quite hard and sometimes unbearable.

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The issue is that this is a man- led society a ,male dominated society which conforms
to the traditional role of women in society. In this society a male can get away with a
physical relationship and no one will blame him. But since the female has to undergo
physical and biological changes which are visible to the outside world they suffer most
of the qualms, fears and misgivings.
COUNSELING UNWED MOTHERS/ WOMEN IN SEX WORK:
 The counseling being the prominent activity is constantly done with the help of
the counselor.
 Our counseling helps the inmates (women) to reduce their mental tension and
start thinking in a new way of life.
 Counseling is used to help the women to deal with variety of problem situations.
 Some parents go with their daughters after leaving the babies in the centre.
 During counseling the counselor establishes an affectionate supportive,
therapeutic relationship with girls using a variety of skills.
 Based on the strength of this relationship the counselor helps the client explore
problems in order to establish a more meaningful and productive life style.
 Individual counseling aims at enabling the client to learn how to identify and
pursue realistic and satisfying solutions to her problems, particularly those
related to her physical abuse.
REHABILITATING UNWED MOTHERS
Rehabilitating unwed mothers is really a difficult one in a male dominated
society. But we are doing our best. Following are some facts found during
rehabilitation.
 They are of highly possessive nature.
 They have an aversion towards babies.
 They are mentally physically, emotionally, psychologically affected.
 As the result of counseling we are able to reunite some unwed
mothers/girls with their boy friends who had abandoned them.
 We are also able to motivate the parents to accept their daughters with
the babies.
 Some women surrender their babies to saranalayam and leaving the
centre with self- confidence to start a new life.
COUNSELLING SERVICES FOR UNWED MOTHERS:
Counselling services include parenting training, pre and post abortion
help and other sex related issues. Follow up counseling services

3. 3
include post natal counseling dating and relationship counseling and
career planning.
1. COUNSELLING:
Counseling by the social work staff is provided for the expectant
mother, her family and the unmarried father when appropriate. The
persons may be seen in individual or group sessions. Counseling is
short term directive help with focus upon practical problems
precipitated by the pregnancy. The young expectant mother is
helped to arrive at a decision which serves the best interests of
herself and the child. The reality of individual mother situations is
evaluated on admission to the program, and no attempt is made to
force upon hr such preconceived models for resolution of an unwed
mothers problems such as adoption, foster home placement or
keeping the baby. Group counseling is used as a prime mode of
intervention. Many of these young mothers are able to discuss their
day to day problems with greater ease and depth in the group
situations.
2. SEX EDUCATION:
The subject of sex education remains a divise one. On one side are
those who argue that Americans should learn to accept adolescent
sexuality and make guidance and birth control more easily available
as it is in Europe. On the other side are those who contend that sex
education is upto to the parents not the state and teaching children
about birth control , controlling posmiscuity or violating family
religious beliefs and values.
3. SEX EDUCATION UN THE SCHOOLS:
Eight out of 10 Americans believe that sex education should be
taught in schools and seven out of 10 believe that such courses
should include information about conception. Only a handful of
states require even encourage sex education and fewer encourage
teaching about birth control or abortion.
4. PARENTS AND SEX EDUCATION:
Parents are a child earliest models of sexuality, they communicate
with their children about sex and sexual values non verbally.
However most adolescents report that they have never been given
any advice about sex by either parent even though a majority

4. 4
teenagers prefer their parents and counselors as source of sex
information.
5. MATERNITY EDUCATION:
Information regarding human reproduction and development, sex
education, family life planning and birth control information, parental
care, physiological changes during pregnancy, preparation for labour
and delivery, postpartum hygiene and use of community health
facility, practical demonstration on the care of young infants, to
check her weight, diet , blood pressure, and to evaluate special
programmes for possible referral to the medical source.
6. FAMILY PLANNING SERVICES:
Most teenagers and adults approve of making contraceptives
available to teenagers, and most parents favour family planning
clinics providing birth control services to the children. The clinics
have had the expected result of improving the quality and
consistency of contraceptive use among teenagers.
7. HELPING ORGANIZATIONS:
The Swaziland Single Mothers Organization (Swasmo) : is a non
profit organization that aims at improving the living conditions of low
income single mothers (including teen mothers) so that they can be
healthy and self-reliant.
MOTHERS CHOICE ,HONG KONG.
BASUNHARA, ORISSA, INDIA.
THE MIRACLE FOUNDATION , INDIA.
HIV AND COUNSELLING
Counseling services are the backbone of HIV program. Counseling is
offered through the ICTC program to people at risk, pregnant women and their spouse,
infant feeding for HIV positive mothers, importance of institutions delivery and treatment
for positive women. At the ART centre counseling is offered for treatment adherence,
home based care, diet and nutrition etc. The CCC counselor supports the care and
support program by offering counseling for treatment adherence , creating social and
familial support, positive living and end of life care.
WHAT IS COUNSELING
Confidential dialogue between a person and a care provider aimed at enabling the
person to cope with stress and make personal decisions related to HIV/AIDS. The

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counseling process includes an evaluation of personal risk of HIV transmission and
facilitation of preventive behavior.
COUNSELLING IN HIV CARE
IMPORTANCE OF COUNSELLING:
1. Stigma & discrimination is related to HIV
2. Decision to undergo HIV test can be facilitated.
3. HIV is a life threatening life long disease
4. Physical psychological and social implications of HIV
5. Prevention of transmission of HIV/AIDS
6. To improve the quality of life/positive living
7. Ensure adherence to treatment.
COUNSELLING AIMS AT:
1. Providing psychological social and emotional support for people who have
contracted the virus and others affected by the virus.
2. Preventing transmission of HIV by
a. Providing in information about risk behaviours (such as unsafe sex or
needle sharing).
b. Motivating people to take go od care of their health.
c. Assisting people to develop personal skills necessary for behavior change.
3. Adopting and negotiating safe sexual practices.
4. Ensuring effective use of treatment programmes by establishing treatment
goals and ensuring regular follow up.
Principles to be kept in mind while counseling clients with HIV/AIDS
1. Respect the patient
2. Build a non judgmental & non- threatening relationship.
3. Have high level of acceptance.
4. Use simple language & short sentences.
5. Avoid using jargons
6. Listen actively
7. Be sensitive to the needs of the client
8. Provide individual based counseling
9. Provide privacy
10.Provide a comfortable environment
11.Provide realistic options
12.Watch for non verbal messages & facial expression

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COUNSELING WITHIN THE CONTEXT OF HIV CARE INCLUDES:
1. Pretest and post test counseling
2. Follow up and long term counseling (ongoing counseling)
Each stage of counseling involves multiple sessions. These sessions may be of
different lengths and intensity, but they are all equally important and contribute to
the overall counseling success.
PRE-TEST COUNSELING:
Goals:
1. Prevent transmission
2. Prepare the person emotionally for a positive or negative result
3. Identify strengths and weakness of person
Steps in pre-test counseling:
a. Assess need for HIV test: it is important that you are able to identify who needs
to be referred for an HIV test. Assess the person risk status by obtaining a
reliable personal history of the patient concerned.
b. Ask the client:
 Do you have sex with more than one person?
 Do you have sex with men or women or both?
 Do you have oral ,anal or vaginal sex without using condom?
 Do you have sex with someone with known or suspected history of
 Multiple sex partners
 Bisexuality
 Intravenous drug abuse
 Taking other drugs
 Receiving blood transfusion
 Have you ever had:
 Genital ulcers
 Warts
 STD such as syphilis, gonorrhea, crabs, scabies, herpes,
hepatitis B
 Have you ever self injected any drugs intravenously and if so do
you share needles?
WHO SHOULD UNDERGO HIV TESTING?
Any person who wants to be tested (voluntary)
 All pregnant women and women considering pregnancy
 Those with high risk behaviours (multiple parterns, drug abuse)

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 Men who have sex with men- MSM
 Persons with multiple sexual partners or who trade sex for money,
pleasure or drugs
 Sexual partners of people who have high risk behaviours
 Injecting drug users (IUDs) and their partners
 Recipients and donors of blood, organs and sperm
 Person with sexually transmitted infections (STIs)
 Hepatitis B, Hepatitis C
 Tuberculosis infected persons
 Persons with AIDS- like illness or illness consistent with AIDS
 Infants born to HIV infected or high risk mothers
c. Provide information
Be sure patient understands:
 HIV disease and transmission
 The purpose and limitation of HIV testing
 Meaning of test results
 Availability and importance of treatment and counseling
d. Describe testing procedure:
 In ICTCs the cost of testing and counseling services is free
 Rapid test for detecting antibodies to HIV is done
 Results could be obtained the same day by the client himself only
 Three positive tests on the same blood sample are needed to confirm
diagnosis
e. When delivering a positive result remember:
 Check if the person is ready for the result
 If not suggest a later date and ask him to bring a support person if needed
 Give results clearly and sensitively and deal with immediate reactions
 Allow time for result to sink
 Give information according to the needs of the person using a positive
approach
 Give information about availability of care and treatment including referral
to ART center
 Reinforce HIV prevention and risk reduction information
f. When delivering positive result to pregnant mother:
 Moderate institutional delivery
 Discuss infant feeding option

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 Focus on further family planning
 Mother baby follow up
 Provide treatment options
g. Possible responses of PLHA and family to HIV positive result:
People have different responses to crisis. The time of diagnosis of HIV could be
a crisis for any person. People may not gone through all of the reactions listed
before they reach acceptance and that PLHAs and their families can fee these
emotions during any time of the disease progession not only at the time of
diagnosis.
ONGOING COUNSELING:
Goals:
Provide support for the PLHA with regards to
 Enhanced coping skills
 Reduction of risk for re-infection
 Reduction of risk for transmission to others
 Prevention or treatment of OIs
 Improve nutrition
 Adherence to ART
 Positive living
Depression is commonly seen any time during the course of the disease
progression but is usually identified to dealt with during ongoing counseling.
NURSING INTERVENIONS:
 Assess for level of depression
 Supervise client closely
 Never allow the client to be alone
 Provide therapeutically safe environment
 Refer for appropriate treatment for depression
 Get the family or support person person to get involved in care of the
PLHA
 Encourage the use of coping skills –spiritual help, relaxation techniques
 Show the person with depression other PLHAs who are coping well, to
restore hope
 Encourage PLHAs to join positive network groups for support and help.

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AVOIDING COUNSELING MISTAKES
Counseling is not an easy task and skills will improve with practice. Use the tips below
to help avoid simple counseling mistakes.
DO
1. Encourage spontaneous expression of feelings and needs.
2. Be neutral to allow patients to express concerns
3. Ask patients what they think they can change /do better next time
4. Find out the person fears, anxieties
DO NOT:
1. Control
2. Judge
3. Moralize
4. Label