While promoting informed choice is important in all health care fields, it is especially so in the provision of family planning services. A legacy of informed choice abuses--including coercion, force, and aggressive targeting of particular groups--has historically plagued family planning, often causing mistrust and avoidance of these services.
Today, violations of a client's right to informed choice tend to be more subtle and harder to document than they have been in the past. But abuses do occur, both purposefully and unknowingly. Because of this, efforts to ensure informed choice must concentrate not only on policies and informed consent forms, but must also uncover the true nature of the client experience: what clients are told and what they are offered.
What It Means
Informed choice in family planning means ensuring that clients have a variety of contraceptive methods to choose from and the information needed to choose a method and use it successfully--including information about what to do if problems arise.
To make an informed choice, clients need to know the effectiveness, risks, and benefits of a proposed method or procedure, as well as the risks and benefits of alternatives. Most importantly, they must also have the option to decline any of the methods and procedures offered.
Efforts Under Way
Though a commitment to informed choice in family planning appears in many documents, laws, and policies the world over, we are a long way from making this resolve a reality. AVSC's work in counseling and clinical training, as well as many of the agency's research projects, contribute to efforts to ensure informed choice.
Counseling and Training
Counseling is at the heart of the informed choice process. AVSC trains health care providers in counseling techniques, helping them provide accurate information, listen closely, and enable individuals to make their own decisions.
Along with information, individuals must have access to a choice of contraceptive methods. Through clinical training, AVSC introduces new and safer techniques and methods to individual clinics and national programs.
Research Projects
Several of AVSC's research projects explore the reality of informed choice.
With the support of the World Health Organization and in collaboration with the Instituto Mexicano del Seguro Social (the Mexican Social Security Institute), AVSC recently began a research project at four sites in Mexico. This study aims to determine whether clients who sign informed consent forms for sterilization have made fully informed, voluntary choices about having the procedure.
Through focus group discussions, interviews, and observation, the study will explore clients' understanding of the reason for and content of the informed consent form, as well as what information clients feel they would like to have in order to make an informed choice. The findings will enhance AVSC's contribution to strengthening the informed choice process in family planning and reproductive health services in Mexico and worldwide.
Client Focus
AVSC has also undertaken many research projects aimed at determining clients' perceptions of services. These have included studies of clients' knowledge and attitudes about contraceptive methods, satisfaction with services, and vasectomy decision-making (see "How Couples Choose Vasectomy").
As part of the agencywide commitment to providing clients with the services they want, much of AVSC's research examines the needs of clients. AVSC also provides guidance to local providers on how to interview clients to determine their satisfaction with services.
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The Right to Self-Determination
The World Medical Association Declaration of Lisbon on the Rights of the Patient, which was adopted in Lisbon, Portugal, in 1981 and amended in Bali, Indonesia, in September 1995, states in part:
"The patient has the right to self-determination, to make free decisions regarding himself/herself. The physician will inform the patient of the consequences of his/her decisions.
"A mentally competent adult patient has the right to give or withhold consent to any diagnostic procedure or therapy. The patient has the right to the information necessary to make his/her decisions. The patient should understand clearly what is the purpose of any test or treatment, what the results would imply, and what would be the implications of withholding consent."
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Anne Lang Frahn is a public affairs associate at AVSC International.
