A Broader Approach

This year marks the five-year anniversary of the Cairo conference, in which the international community endorsed a broader approach to family planning service delivery. Towards this goal, family planning workers need to be better informed and prepared to address sensitive topics such as STIs and sexual health. They need to be comfortable with the topics, ready to give clients accurate information, and familiar with related health services in the system. Training in these attitudes and skills can bring us closer to achieving the Cairo objectives. The following two articles address these issues.

1. Counseling: A Critical Element in STI Services
2. Understanding Reproductive Health Needs

Counseling: A Critical Element in STI Services

Providing reproductive health care means more than simply diagnosing a client's condition and prescribing treatment. It also involves counseling--affording clients an opportunity to engage in confidential, two-way communication in order to obtain information about their options and support for making decisions about their health care.

Counseling clients who have been diagnosed with a sexually transmitted infection (STI) can be challenging. In many cultures, both clients and providers can find it difficult to talk openly about sexual behaviors that resulted in an STI, which can interfere with full disclosure of information.

Another problem is that clients with STIs may be the subject of bias or stigmatization within their communities and may be fearful of being judged by health care workers. In addition, the possibility of serious health consequences of some STIs and the potential for spread of STIs throughout the community may cause tensions between public health imperatives and the client's right to make free choices about treatment.

The use of effective counseling techniques can go a long way toward addressing these challenges and enabling counselors to give clients the full information and support they need.

Avoid Judging Clients

The key principle of counseling is respect for clients as individuals. This means accepting all clients--regardless of who they are or their medical conditions--as valuable human beings with values, needs, and concerns of their own.

In the case of counseling clients who have STIs, respect also means refraining from judging clients because of the behavior that led to the STIs. This can be difficult for providers to achieve, especially when clients have engaged in behaviors they feel are socially unacceptable or personally disagreeable.

Clients Should Make Decisions

Respecting clients also means respecting their right and ability to make decisions about their own health care.

Although individuals who seek STI services often need medical advice and treatment, they also choose how much to tell providers about their sex partners or practices, whether or not to tell their partners about their symptoms or need for STI treatment, and whether or not to pursue and follow up on treatment themselves. While providers try to guide clients in making decisions that are right for them, these are fundamentally personal decisions.

Communicate Respect for Clients

Providers can use a number of techniques that show respect for clients and allow clients to talk freely about their situation.

Keeping communication confidential and private increases the likelihood that clients will talk openly with providers. Counseling should be conducted in a private room, if possible, with only necessary staff members present.

Asking open-ended questions--those that begin with "how," "what," or "why"--rather than questions that can be answered yes or no, lets clients communicate what is on their minds and give detailed and complete information.

Reflecting and paraphrasing what the client has said is another way to encourage open communication. The use of such statements as "What I'm hearing you say is ..." and "If I understand you correctly, you're upset that ..." can reassure clients that they have been heard and help providers understand the clients' concerns. This reflection can also help clients clarify their concerns and encourage them to say more about the problem.

By gaining some skill in counseling, providers can lead clients to deeper discussion of their situations and point them to the resources they need.

This article is based on a paper written by Jill Tabbutt-Henry and Carolyn Smith. Victor Chen is a freelance writer for AVSC.

Understanding Reproductive Health Needs

During a routine physical examination, a young man about to be married alludes to the fact that he is nervous about his first sexual encounter with his new bride. A woman in her early 40s, frightened and confused, travels two hours to the nearest clinic because she has been experiencing "hot flashes."

Reproductive health care traditionally has focused on reproduction. This is not surprising, when limited resources are available for supporting reproductive health care services and policy attention focuses on family planning.

But individuals at all stages of the life cycle have reproductive health concerns that do not relate directly to reproduction. Having a broadened understanding of what these concerns may be, and the difficulties clients and providers may have in discussing them, can help providers become more comfortable when talking with clients and better able to meet their needs.

Age and Sexuality

Reproductive and sexual health concerns begin before puberty and extend well beyond the childbearing years. Many clients require services related to the reproductive system, sexual health, and sexuality. Typically, these concerns change over the course of a person's life, influencing the kinds of issues clients may ask providers' help in addressing.

Early Experiences

Though variations occur, specific issues tend to be raised at various stages of the life cycle.

Adolescents, who are first becoming aware of their sexuality, are most concerned with issues related to body image and initial sexual encounters. They may need guidance in coping with new and unexpected responsibilities related to STIs, pregnancy, abortion, and parenthood.

Young adults encounter more intimate, stable, and prolonged sexual relationships. During this time, clients may wish to discuss problems related to marriage, pregnancy, childrearing, and sexual functioning.

Growing Up and Older

During middle age, adults tend to feel more comfortable with their sexuality and get more pleasure out of sex. But they may also raise concerns about sexual performance, menopause, and feelings related to separation and divorce.

Some elderly persons may experience the satisfaction of a long and intimate sexual partnership. But, while free of many of the worries characterizing their earlier years, many older clients may seek help dealing with illness, sexual inadequacy, loss of independence, and loneliness.

Overcoming Inhibitions

While becoming more aware of clients' concerns can enhance providers' ability to address them, clients and providers may have difficulty talking about sex and sexuality. These generally taboo subjects may cause embarrassment or reveal a lack of knowledge on the part of both clients and providers.

By using basic communication skills, providers can become more effective at helping clients express their concerns and choose ways to address them. Speaking in a calm and nonthreatening tone, gaining clients' trust, and establishing rapport with clients are skills that, once developed, can become a natural and essential part of providing quality services.

Sometimes, clients ask questions that are outside the realm of service delivery that providers are unable to answer. In many such situations, providers can help clients simply by listening to them, providing sympathy and an affirmation that their concerns are valid, and attempting to identify community resources that may be able to address the client's concerns.

Amy Van Hoogstraat is a freelance writer for AVSC.