Around the world, a quiet revolution is occurring: health care workers are changing the way they communicate about family planning with the women and men they serve.

In the past, providers dominated the conversations, mainly giving information and advice. It was presumed that they "knew best" about which contraceptive methods their clients should use. And women, who have traditionally lacked a sense of entitlement to make choices about their own reproductive health, simply deferred to their providers on such matters.

But clients are more likely to be satisfied with and continue using contraception if they are informed and active participants in the decision-making process. So providers are learning to give up the authority they traditionally assumed and to encourage women and men to take a more active role in making their own choices. In short, they are learning to respect client choice. Counseling training programs sponsored by AVSC and other organizations are helping to bring this about.

Role of Training

Every year, AVSC trains hundreds of doctors, nurses, and other health care workers in counseling and communication skills. In countries as diverse as Bangladesh, Colombia, Turkey, Ukraine, and Zimbabwe, providers are enthusiastic about the training and are changing how they behave with their clients.

Feddis Mumba, who works for AVSC in East Africa, reports that before training, family planning workers "provided a certain method, depending upon the age and parity of the client. This means decisions on methods were done by the service provider." But things are changing in East Africa and other countries.

In AVSC-sponsored programs in Central Asia, evaluators found that counseling training has resulted in major changes in the ways in which providers communicate with clients. Doctors are listening more and making fewer decisions for clients. One doctor said, "The patients like to come back to the consultation now; they want to talk to us."

In Bangladesh, providers are doing "less advising and more assisting clients." Jane Wickstrom, AVSC's country director for Vietnam, reports, "After AVSC's training, providers are more careful to take the time to think about the client's needs and circumstances. They learn that clients will continue using a family planning method that is right for them."

Asking the Right Questions

Despite the remarkable improvements that AVSC staff are seeing, a lot of work still needs to be done. Some providers continue to fail to assess client needs and interests at the outset. Often health care workers give extensive information about contraceptive methods that are of little interest to the client because they do not apply to his or her particular situation.

Counselors may neglect to learn answers to such basic questions as: What contraceptive methods has the client used in the past? Has she been satisfied with them? Is she interested in spacing births for a long or short period of time?

More Information Needed

In addition, providers themselves may still lack the basic information necessary for being truly responsive to informational needs of women and men. James Griffin, who has coordinated AVSC counseling training programs in several Asian countries, reports, "Developing counseling skills is not enough. We need to promote a thorough understanding of contraceptive technology if a counselor is going to be effective in helping clients make informed decisions."

Moreover, in many countries family planning workers are ill-equipped to talk with clients about such sensitive topics as sexuality and sexually transmitted infections, as well as ill-informed about side effects of contraceptive methods and what those side effects may mean for the lives of women clients.

Without knowledge in these areas, even family planning workers who are trained to emphasize listening and client choice cannot adequately facilitate choice when the client is uncertain or faces a sensitive health or personal situation.

Greater Client Satisfaction

As more providers listen to the needs of clients and facilitate and respond to client choice more successfully, more women and men will be satisfied with family planning services and more clients will feel empowered by family planning care.

Pamela Beyer Harper is director of communications for AVSC.