Talking with Clients: An Example

It’s a rainy Wednesday morning. Patricia, a street vendor, arrives at your clinic seeking a family planning method for the first time. After a short wait, you warmly greet the young woman, repeat her name, and lead her to a private area where you sit down together. You ask Patricia a series of medical questions and listen attentively to her responses. Patricia tells you that she is married and that she has never used family planning before, but her sister-in-law uses the pill, and Patricia thinks that she would like to do the same.

Using a traditional approach, the rest of your interaction might look like this:
After you restate what Patricia has said to confirm you understand it, you ask her if she knows about other family planning methods. When Patricia indicates that she knows only a little, you describe each method in detail, explaining how each is used. Patricia tells you that she would like to use the pill. You now spend a little extra time describing the pill and tell her what to do if she misses a pill. You also spend some extra time describing the condom and show one to her, explaining that condoms are good to use if she forgets to take a pill and that it is important to use them when she starts taking the pill, until it becomes effective. You then show her the different pills available and discuss the price. Patricia leaves the clinic with a three-month supply of pills and a free sample of condoms.

But what have you missed? Here’s an example of the interaction using a sexual and reproductive health approach:
You spend a few minutes exploring Patricia’s life and situation, discussing her family, her current partner, her previous partners, and her level of satisfaction with her sexual life. When she mentions that her husband travels for work, you ask her if she thinks that he might have other partners when he travels. Patricia says that she believes that he does. You and she then discuss the fact that this could be putting her at risk of contracting HIV or another STI. You discuss what she knows about HIV and STIs, and you clarify some misinformation, making sure to describe the types of sexual activities that are safe and unsafe.

You ask Patricia whether she has ever had an STI, then inquire as to whether she has ever discussed the subject with her husband—or whether they have in fact ever discussed their sexual life. Patricia admits that they have not, and says she has wanted to but has been afraid to. You then briefly discuss some strategies for bringing up the subject with her husband in a nonthreatening way.

You briefly review the available family planning methods, emphasizing that it is necessary to use a condom with all other methods to protect against HIV and STIs. You discuss the benefits of condom use, and demonstrate on a penis model how to use a condom correctly, emphasizing that condoms can be highly effective against both pregnancy and STIs when used consistently and correctly. You encourage Patricia to practice putting the condom on the penis model, to refine technique and gain confidence. You mention some ways to make condom use more appealing to a man by putting it on for him and massaging his penis while doing so.

In the end, Patricia selects the pill as her method, saying that she would like to try to use the condoms as well, but isn’t sure how her husband will respond. You explain in detail how to use the pill correctly—reminding her that it is important to use condoms when she starts taking the pill, until it becomes effective—and show her the different pills available, then discuss the price. Patricia leaves the clinic with a three-month supply of pills and a free sample of condoms to try.

© 2007 EngenderHealth