THE EVOLUTION OF THE PHILIPPINE FP PROGRAM

The FP Program has been implemented for about 54 years, which started from a demographic perspective to a health
intervention-oriented program. The Family Planning Organization of the Philippines (FPOP) was established in 1969 after
President Ferdinand Marcos declared a National Policy on Family Planning. FPOP was formed from the merger of two
organizations that pioneered the family planning movement in the Philippines.

In the year 1970 to 1985, PFPP started as a family planning service delivery component to achieve fertility reduction by a
contraceptive- oriented approach. From 1986 to 1993, the program was reoriented from mere fertility reduction to a
health intervention by improving the health of women and children.

From 1994 to 1999, the family planning program underwent another shift that emphasized integration with other RH
programs giving importance to recognizing choice and rights of FP users. This shift was in line with the country's
commitments made in the International Conference on Population and Development (ICPD), held in Cairo in 1994, and
the Fourth World Conference on Women, held in Beijing in 1995. During this period, the Philippines has adopted and
developed a policy framework in Reproductive Health (RH) with the goal of providing universal access to RH services with
family planning as the flagship program. Implicit in the policy is the right of men and women to be informed and to have
access to safe, effective, affordable, and acceptable family planning methods of their choice including the right to access
appropriate health care services that will enable women to go safely through pregnancy and childbirth, and provide
couples the freedom to decide if, when, and how often to do so.

In the period between the year 2000 to the present, the national FP policy. AO NO. 50-A, s.2001. was formulated to
prescribe the key policies of FP services in the country, which is "family planning as a means towards responsible
parenthood". Likewise, to signify the government's commitment to the MDGs on the improvement of maternal and child
health and nutrition and reduction of maternal and child mortality, the Maternal, Newborn, and Child Health and
Nutrition (MNCHN) strategy was introduced in 2008.

DOH also issued AO No: 005, series of 2011 to ensure Quality Standards in the Delivery of FP Program and Services
through Compliance to Informed Choice and Voluntarism.

Family planning in the Philippines has evolved over time to address a variety of concerns, including population growth,
health, and family welfare:

National family planning program

Responsible Parenthood and Reproductive Health Act of 2012

This law, also known as the RH Law, provides access to contraception, fertility control, sexual education, and maternal
care.

Family planning campaign

Launched in 2021, this campaign shares information about family planning methods, dispels myths, and encourages
discussion.

VISION:

To empower women and men to live healthy, productive, and fulfilling lives with the right to achieve thei desired family
size through quality, medically sound, and legally permissible FP methods.
  Quality: there are six facets of FP quality care: choice of method, technical competence of providers, informing
and counseling clients, interpersonal relations, mechanisms to encourage continuation and appropriateness and
acceptability of services.
 Medically sound: sound medical treatment is defined as the use of medical knowledge or mean to cure or
prevent a medical disorder, preserve life, or relieve distressing symptoms
 Legally permissible: all FP interventions must be legal and must not violate any existing Philippine law.

MISSION:

The DOH, in partnership with the LGUs, NGOs, private sector, and communities shall ensure the availability of FP
information and services to men and women who need them.

GOAL

To provide universal access to FP information and services whenever and wherever these are needed

OBJECTIVES:

1. The FP Program addresses the need to help couples and individuals achieve their desired family size within the
context of responsible parenthood and improve their reproductive health to attain sustainable development
2. It aims to ensure that quality FP services are available in DOH-retained hospitals, LGU-managed health facilities,
NGOs, and the private sector.

GUIDING PRINCIPLES OF THE PFPP:

Family Planning Program services are to be delivered within the context of the following principles:

1. Respect for the sanctity of life. Family Planning aims to prevent abortion and therefore can save the lives of both
women and children.
2. Respect for human rights. Family Planning services will be made available using only medically and legally
permissible methods appropriate to the health status of the client. Family Planning services shall be provided
regardless of the client's sex, number of children, sexual orientation, moral background, occupation, socio-
economic status, cultural and religious belief.
3. The freedom of choice and voluntary decision. Couples and individuals will make family planning decisions
based on informed choice including their own moral, cultural or religious beliefs.
4. Respect for the rights of clients to determine their desired family size. Couples and individuals have the basic
right to decide freely and responsibly the number and spacing of their children.

Couples and individuals are free to decide and choose the FP methods they will use based on informed choice. They will
exercise responsible parenthood in accordance to their religious and ethical values and cultural background, subject to
conformity with universally recognized international human rights.

This means that in any FP method service delivery, providers must give good counseling and ready access to
contraceptive options, free of any provider bias for or against particular methods, so that clients can exercise their rights
to make informed and voluntary decisions based on accurate and up-to-date information.
Counseling helps clients choose and correctly use any contraceptive method and reassures a positive impact on method
adoption, continuation, and client satisfaction. It enables clients to achieve their reproductive goals and good health
outcomes.

FP POLICIES AND STRATEGIES

The National FP Policy (Administrative Order No. 50-A, s. 2001), prescribes the key policies for FP services focused on
modern FP methods including natural FP. Policy statements that guide FP program promotion and implementation are
the following:

1. Family Planning as a health intervention to promote the overall health of all Filipinos particularlywomen and children
by:

 preventing high-risk pregnancies:

 preventing unwanted/unplanned pregnancies
 reducing maternal deaths: and
 responding to unmet needs of women

2. Family Planning as a means towards responsible parenthood. Planning for the future reflects the will and the ability to
respond to the needs of the family and children.

3. FP information and services will be provided based on voluntary and informed choice for all women and men of
reproductive age regardless of age, number of children marital status, religious beliefs, and cultural values.

4. Orly medically safe and legally acceptable FP methods shall be made a le in all public, NCDs, and private health
facilities.

5. Quality care must be promoted and ensured in providing FP services, Privacy confidentiality should be strictly
observed in the provision of services at all times.

6. Efforts must be undertaken to orient clients on fertility awareness as the basic information to fully understand and
appreciate FP.

7. Multi-agency participation is essential. Involvement of the private sector, academe, church, media, community, and
other stakeholders must be encouraged at all levels of operation.

8. FP services, in the context of the RH approach must be integrated with the delivery of other basic health services.

9. Sustainability of FP services and commodities must be promoted through the localization and adoption of the
Contraceptive Self-Reliance (CSR) strategy (i.e., market segmentation and LGU empowerment, etc).

STRATEGIES:

1. Focus service delivery to the urban and rural poor;

2. Re-establish/strengthen the FP outreach program;

3. Strengthen FP provision in regions with high unmet need;

4. Promote frontline participation of hospitals;

5. Mainstream modern natural FP;

6. Promote and implement CSR strategy to include other non-commodity-based methods (e.g. BTL, Vasectomy, Fertility
Awareness-Based Methods);

7. Integration of FP with other RH services (i.e., maternal, neonatal, child and nutrition services, adolescent health
services, etc.);

8. Ensuring quality care through compliance to informed choice and voluntarism principles;

9. Capacitate high volume providers.

COMPONENTS

• Service Delivery

• Logistics Management

• Information, Education and Communication and Advocacy

• Monitoring and Evaluation

• Research and Development

• Management Information System

• Training

FP PROGRAM METHODS

Modern methods

Permanent methods

 Female sterilization/Bilateral Tubal Ligation

 Male sterilization/Vasectomy

Temporary Methods
a. Supply methods
 Pills
 Intrauterine Device
 Injectable
 Male condom

b. Fertility Awareness-Based Method

 Cervical Mucus/Billings Ovulation Method
 Basal Body Temperature
 Sympto-thermal Method
 Standard Days Method
 Lactational Amenorrhea Method
THE HEALTH AND FAMILY PLANNING SITUATION IN THE PHILIPPINES

1. Current Status of Maternal, Infant, and Under-5 Mortality

Maternal Mortality

Maternal mortality refers to the death of a woman during pregnancy, childbirth, or within 42 days after delivery.

Current Status:

As of the latest data, the Philippines has a maternal mortality ratio (MMR) of approximately 178 deaths per
100,000 live births. While this shows improvement over the years, it remains higher than the Sustainable Development
Goal (SDG) target of 70 deaths per 100,000 live births by 2030.

Contributing Factors:

 Limited access to skilled birth attendants in rural areas.

 High rates of teenage pregnancies.
 Inadequate prenatal care.
 Delays in accessing emergency obstetric care.

Infant Mortality

Infant mortality measures the number of deaths of children under 1 year per 1,000 live births.

Current Status:

The infant mortality rate in the Philippines is around 22 deaths per 1,000 live births.

Contributing Factors:

 Premature birth complications.

 Infections like pneumonia and sepsis.
 Poor nutrition and inadequate breastfeeding practices.

Under-5 Mortality

This measures the number of deaths of children under 5 years per 1,000 live births.

Current Status:

The under-5 mortality rate is approximately 28 deaths per 1,000 live births, which has steadily declined due to
improved vaccination coverage and health interventions. However, disparities remain in remote and underserved
communities.

Contributing Factors:

 Malnutrition, affecting around 28% of Filipino children under 5.

 Preventable diseases such as diarrhea and measles.
 Lack of access to clean water and sanitation facilities.
2. Family Planning and Health Targets

National and Global Targets

Sustainable Development Goals (SDGs):

 Reduce MMR to less than 70 per 100,000 live births by 2030.

 End preventable deaths of newborns and children under 5, aiming for neonatal mortality of no more than 12 per
1,000 live births and under-5 mortality of no more than 25 per 1,000 live births by 2030.

Philippine Development Plan (PDP) 2023–2028:

 Increase contraceptive prevalence rate (CPR) to reduce unintended pregnancies.

 Ensure universal access to maternal and child health services.

Family Planning in the Philippines

Family planning plays a critical role in reducing maternal and infant mortality.

Current Status:

 The contraceptive prevalence rate (CPR) is around 58% among married women, which needs to improve to meet
national targets.
 High unmet needs for family planning, particularly among adolescents and women in marginalized sectors.

Challenges:

 Cultural and religious barriers to contraceptive use.

 Gaps in the implementation of the Responsible Parenthood and Reproductive Health Act (RPRH) of 2012.

3. Efforts and Interventions

Government Initiatives

 Expansion of the Universal Health Care (UHC) program to improve access to quality maternal and child health
services.
 Strengthening the implementation of the Reproductive Health Law by providing free contraceptives and
comprehensive sexuality education.
 Increasing the number of health facilities equipped to provide emergency obstetric and newborn care.

Community-Level Actions

 Promoting breastfeeding and proper infant nutrition.

 Conducting immunization campaigns to prevent vaccine-preventable diseases.
 Engaging barangay health workers in health education and monitoring.
Maternal High-Risk Factor

Maternal high-risk factors refer to:

-Too young (mothers who are below 18 years of age).

-Too old (mothers who are 35 years old and above).

-Too many (mothers who have four or more pregnancies).

- Too close (birth interval of less than three years) and,

- Too ill (mothers having chronic diseases or disorders).

Mother's age at birth, birth order, and birth interval can affect a child's chances of survival. These are major factors in
increasing maternal and infant mortality.

1. “Too Young”

Pregnancy complications of mothers who at young age (below 18 yrs of age) include the following:

 Hemorrhage/Anemia
 Toxemia
 Iron Deficiency Anemia
 Miscarriage/Stillbirth
 Prolonged Labor

A teen-age mother is prone to these complications because her reproductive system is not yet fully developed, and
pregnancy interrupts her body's normal course of growth and development. These complications are compounded by
the heavy social and economic responsibilities of parenthood for which they are rarely ready.

Infants of mothers who are too young are in danger of the following:

 Low birth weight

 Birth-related defects
 Prematurity
 High incidence of fetal death and morbidity

2. “Too Old”

Pregnancy complications of mothers who are at advanced age (35 years old and above) includes the following:

 Hemorrhage
 Prolong Labor
 Toxemia

As a woman’s age advances, the muscles of the uterus also become less firm, making pregnancy and childbirth difficult

Infants born to older women are also at much greater risk of having the following birth defects:

 Hearth Disease
 Birth defects (i.e., cleft palate and lip)
 Down’s syndrome
 Higher incidence of stillbirths and fetal deaths
If childbirth could be postponed until the “too young” mothers is old enough, and averted in mothers who are “too old”
and “too ill” the impact on both maternal and infant mortality would be significant.

3. Birth Number (“Too Many”)

 Women who have had four or more deliveries are more likely to experience problems during pregnancy
and labor and to acquire Caesarean section (which is often not readily available or not performed early
enough)
 This group has a significantly higher risk of miscarriage and perinatal mortality than women undergoing
their second or third delivery.
4. Birth Interval (“Too Close”)
 Complications to mothers of birth intervals less than three years includes:
- Anemia and malnutrition
- Increased vulnerability and illness
- Physical stress
 Child birth interval of at least three years is good enough to ensure enough opportunity for the mother
to complete recover her health and nutritional status.
 Babies born less than three years after early weaning of the child from the mother’s breast which often
times may result to:
- Child diarrheal disease and malnutrition
- Low birth weight
- High infant death which is 1-1.5 times more likely to happen
 when child interval is more than three years, children become more resistant to infections and
communicable diseases.
5. Too ill or unhealthy or with medical condition
Women with chronic medical conditions like tuberculosis, cardiac disease, mental health condition, and cancer
or malignancies require treatment and therefore need to postpone or limit pregnancy through family planning.
 Pregnancy complicates physiological processes of treatment and rehabilitation.
 Pregnancy adds burden to a body already burdened by disease.

This also poses danger to the infant due to the adverse effects of medications being used to treat the disease
including congenital malformations and stillbirth.
LAWS AND LEGISLATIONS RELATED TO FAMILY PLANNING

1. PRESIDENTIAL DECREE No. 965 July 20, 1976

A DECREE REQUIRING APPLICANT FOR MARRIAGE LICENSE TO RECEIVE INSTRUCTIONS ON FAMILY PLANNING AND
RESPONSIBLE PARENTHOOD

WHEREAS, the Government has adopted a national population program to achieve and maintain levels of population
most conducive to the national welfare;

WHEREAS, an essential element of the population program is to inform and instruct the people on family planning and
responsible parenthood; and

WHEREAS, an effective mode of implementing the program would be to require all applicants for marriage license to
receive instructions and information on family planning and responsible parenthood before they are issued the marriage
license, and to create the administrative machinery for giving such instructions and information;

NOW, THEREFORE, I, FERDINAND E. MARCOS, President of the Philippines, by virtue of the powers vested in me by the
Constitution, do hereby order and decree:

Section 1. Office of Family Planning. There is hereby created in every city and municipality an Office of Family Planning to
be headed by the city or municipal health officer. He shall be assisted by the city or rural health nurse, members of the
city or rural health unit, and such other personnel from the different agencies of the government involved in the family
planning program, who shall perform family planning duties in addition to their regular duties. Private entities or
individuals duly accredited by the Commission on Population engaged in family planning activities may also be impressed
into the service.

Section 2. Duties of Family Planning Office. The Office of Family planning shall give instructions and information on
family and responsible parenthood to applicants for marriage license and other interested persons in the form of
personal instruction and/or handbook, pamphlets or brochures. Furthermore, such instructions and information shall be
consistent with the policies of the Commission on Population.

Section 3. Certificate of Compliance. Applicants for marriage license shall, upon filing an application therefore, be obliged
to receive instructions and information on family planning and responsible parenthood from the Family Planning Office.
Such instructions and information may be in the form of personal instruction or in the form of brochures, pamphlets, or
handbooks. In places where there are no health officers, any person duly accredited by the Commission on Population
may give the instructions herein provided.

No marriage license shall be issued by the Local Civil Registrar unless the applicants present a certificate, issued at no
cost to the applicants, by an Office of Family Planning that they had received instructions and information on family
planning and responsible parenthood.

If, for any reason, the information or instructions shall not have been given within the period required by law for the
issuance of a marriage license, a certification to that effect shall be given to the Civil Registrar by the Office of Family
Planning and the former shall withhold the issuance of the marriage license for a period of two weeks to enable the
Family Planning Office to give instructions and information and the applicants to receive the same. At the end of such
period, when no instructions shall have been given, the Civil Registrar may issue the marriage license.

Section 4. Assistance of National Office. Agencies of the National Government charged with the implementation of the
Family Planning program shall render assistance to family planning offices herein created.

Section 5. Penalties. Any member of the Office of Family planning who fails or refuses without just cause to give the
instructions and the certificate herein provided: any local Civil Registrar who issues the marriage license without the
requisite certification from the Office of Family Planning, or any person who obtains the certificate fraudulently, shall be
subject to appropriate administrative or criminal charges.
Section 6. Rules and Regulation. The Commission on Population shall issue rules and regulations to implement the
provisions of this Decree.

Section 7. Repeal of Prior Law. All laws and ordinances inconsistent with the provisions of this Decree are hereby
repealed or modified accordingly.

Section 8. Effectivity. This Decree shall take effect immediately.

Done in the City of Manila, this 20th day of July, in the year of Our Lord, nineteen hundred and seventy-six.

2. PRESIDENTIAL DECREE No. 79

Presidential Decree (PD) 79 of 1972, also known as the Revised Population Act of the Philippines, authorized the
promotion of family planning methods in the Philippines. The decree aimed to reduce population growth, alleviate
poverty, and improve the lives of Filipino citizens.

What the decree did:

 Allowed the use of clinics, pharmacies, and commercial distribution channels to promote contraceptive methods

 Made all acceptable contraceptive methods available to Filipino citizens, except abortion

 Established the Commission on Population and Development (CPD) as the government agency responsible for
the national family planning program

 Emphasized the importance of involving both public and private sectors in the family planning program

What the decree sought to achieve:

 Improve the lives of Filipino citizens

 Alleviate poverty

 Reduce population growth

 Strengthen the family

 Protect children

 Give everyone a chance to develop and earn a decent living

3. Republic Act (RA) 6365

Republic Act (RA) 6365, also known as the Population Act of the Philippines, established a national family
planning program in the Philippines. The act was approved on August 16, 1971.

Goals

 To establish a national policy on population

 To create the Commission on Population (POPCOM)

 To promote a national family planning program that respects religious beliefs

 To establish quantitative goals

 To promote understanding of the effects of population growth on welfare

  To reduce mortality and morbidity rates

Program

 The program is voluntary and helps people attain their aspirations to have smaller families

 The program integrates family planning into educational programs

 The program provides safe means for couples to manage family size

Commission on Population (POPCOM)

 POPCOM is the central coordinating and policy making body of the government in the field of population

 POPCOM is made up of designated Cabinet members, heads of other government agencies, and representatives
from civil society organizations

4. P.D. 69 of 1972

Presidential Decree (PD) 69 of 1972 limits the number of children that qualify for tax exemption to four. This limit applies
to additional personal exemptions.

Explanation

 PD 69 limits the number of children that can be claimed as dependents for tax exemption purposes to four.

 Each qualified dependent child allows the taxpayer to deduct a specific amount from their taxable income.

 To qualify as a dependent, a child must be unmarried and under 21 years of age.

 A child who is over 21 but has a physical or mental disability may also qualify as a dependent.

5. R.A 10354 the Responsible Parenthood and Reproductive Health Act of 2012

The Responsible Parenthood and Reproductive Health Act of 2012, also known as the Reproductive Health Law or RH
Law, and officially designated as Republic Act No. 10354, is a Philippine law that provides universal access to methods of
contraception, fertility control, sexual education, and maternal care.

DOH ADMINISTRATIVE ORDERS

1. DOH E.O. 12. S. 2017

EXECUTIVE ORDER NO. 12, S. 2017: ATTAINING AND SUSTAINING “ZERO UNMET NEED FOR MODERN FAMILY
PLANNING”
Executive Order No. 12, s. 2017: Attaining and Sustaining “Zero Unmet Need for Modern Family Planning” Through the Strict
Implementation of the Responsible Parenthood and Reproductive Health Act, Providing Funds Therefore, and for Other Purposes
WHEREAS, Republic Act No. 10354, otherwise known as the Responsible Parenthood and Reproductive Health Act of 2012 (RPRH
Law) recognizes the right of Filipinos to decide freely and responsibly on their desired number and spacing of children, within
the context of responsible parenthood and informed choice, and to access needed reproductive health care information and
services; WHEREAS, the Administration’s 10-point socio-economic agenda includes, among others, ...
Purpose
 To ensure that Filipinos have access to reproductive health care information and services
 To help couples and women choose their desired family size
 To reduce teenage pregnancy
 To help poor couples make informed choices about family planning and finances
 How it was implemented
 The order mandated the strict implementation of the Responsible Parenthood and Reproductive Health Act (RPRH Law)
 The order provided funds to support the implementation of the RPRH Law
 The order directed the Commission on Population and Development (CPD) to coordinate with the National Economic and
Development Authority (NEDA)
2. Administrative Order 2017-0005: Guidelines in achieving Desired Family Size through accelerated and Sustained Reduction in
Unmeet Need for Modern Family Planning Methods
3. DOH Administrative Order No. 2017-0002
GUIDELINES ON THE CERTIFICATION OF FREE STANDING FAMILY PLANNING CLINICS
ensures universal access to reproductive health care services in the Philippines by providing guidelines for the certification of
private health facilities that offer modern family planning services, in accordance with the Responsible Parenthood and
Reproductive Health Act of 2012.
4. Department Order 2017-0345 is a set of guidelines from the Department of Health (DOH) of the Philippines that covers the
forecasting, procurement, distribution, and allocation of modern family planning.

5. DOH Administrative Order No. 2015-0006 is a policy that made progestin subdermal implants a modern method of contraception
in the Philippines. It was issued on February 9, 2015.
Rationale
 The Philippines had a high maternal mortality rate and low likelihood of meeting its Millennium Development Goals
Objective
 To make progestin subdermal implants a safe and effective family planning method
Scope
 Applied to the entire health sector, including public and private sectors, hospitals, and local government units
Guidelines
 Provided guidelines for introducing the progestin subdermal implant to the public and private sectors
 Described how to integrate the implant into existing family planning services

6. DOH administrative order 2014-0042

The concerned DOH RO shall provide and manage funds for the conduct of FP Outreach Services to augment resources of the
concerned PHO. It shall support the operation of the Mobile FP Outreach Team, such as, commodities and supplies, including funds
and other resources for managing complication and adverse reactions.

7. The Family Planning Logistics Hotline was established in the Philippines through Department Memorandum No. 2015-0384. The
hotline monitors the distribution and status of contraceptives and other health products at local health service delivery points.

Explanation

The Family Planning Logistics Hotline is part of the Family Planning Logistics Management Information System (FPLMIS). The
FPLMIS helps program managers make decisions about the distribution of contraceptives and other health products.
The goal of the family planning program in the Philippines is to ensure that everyone has access to family planning services. The
program also aims to improve reproductive health and help people achieve their desired family size.
 ROLES AND FUNCTIONS OF THE MIDWIFE

Role and Function of the Midwife

Counselor/ Motivator
Family Planning Counselor
Provides individual counseling to female, male and adolescent family planning clients regarding basic anatomy and physiology,
human reproduction, contraceptive methods, pregnancy testing, pregnancy options, and appropriate referral(s).
Provides information to clients about establishing and maintaining optimum health practices, safe sex practices, HIV/AIDS
prevention, violence prevention and intervention, and routine health care and screening recommendations.
Counselor Characteristics:
1. Believes in and is committed to the basic values and principles of family planning and client rights
2. Is accepting, respectful, non-judgmental and objective when dealing with clients
3. Is aware of her/his own values and biases and does not impose them on clients
4. Understands and is sensitive to cultural and psychological factors (such as family or community pressures) that may
affect a client's decision to adopt family planning

Always maintains clients' privacy and confidentiality

Counselor Skills
An effective counselor possesses strong technical knowledge of contraceptive methods:
 Knows all technical aspects of family planning methods thoroughly
 Is prepared to answer contraceptive and non-contraceptive questions comfortably on subjects such as myths, rumors,
sexuality, STDs, reproductive and personal concerns
 Is able to use visual aids and explain technical information in language that the client understands
 Is able to recognize when to refer the client to a specialist or other provider

An effective counselor possesses and is able to apply good interpersonal communication skills and counseling techniques:
 Relates/empathizes
 Listens actively
 Poses questions clearly, using both open- and close-ended questions
 Answers questions clearly and objectively
 Recognizes nonverbal cues and body language
 Interprets, paraphrases, and summarizes client comments and concerns
 Offers praise and encouragement
 Explains points in language the client understands in culturally appropriate ways

Counseling
 An important prerequisite for the initiation and continuation of an FP method.
 An interactive process between the service provider and client; it allows for information exchange and support, so that clients
can make decisions, design a plan, and take action to improve their health.
 Essentials of Good Counseling
A good counselor is trained to:
Understand and respect the client’s rights.
 Earn the clients trust.
 Understand the benefits and limitations of all contraceptive methods.
 Understand the cultural and emotional factors that affect a clients (or a couples) decision to use a particular contraceptive
method.
 Encourage the client to ask questions.
 Use a nonjudgmental approach, which shows respect and consideration to the client.
 Present information in an unbiased, client-sensitive manner.
 Actively listen to the clients concerns.
 Understand the effect of nonverbal communication.
 Recognize when she or he cannot sufficiently help a client and refer the client to someone who can.

To be effective, counseling must be based on the establishment of trust and respect between the client and counselor. All clients
have certain rights, including:

 The right to decide whether to practice FP

 The freedom to choose which method to use
 The right to privacy and confidentiality
 The right to refuse any type of examination
 The freedom to choose where to seek services

The Counseling Process

When discussing contraceptive options with clients, service providers should briefly review all available methods of FP. Service
providers should be aware of a number of factors about each client that could be important when selecting a method. These factors might
include:
 The reproductive goals of the woman or couple (i.e., the spacing, timing, or limiting of births)
 Personal factors, including the time, travel costs, pain, or discomfort likely to be experienced
 The need for protection against STIs and HIV

Steps in FP Counseling
The GATHER Approach
GATHER is a useful memory aid to help us to remember the basic steps in the counseling process and to add structure to a complex
activity. It can be adapted to meet each individual client’s needs.
Steps in FP Counseling
The following are elements of a successful counseling session:
G = Greet client in a friendly, helpful, and respectful manner.
 A = Ask client about family planning needs, concerns, and previous use.
T = Tell client about different contraceptive options and methods.
H = Help client to make decision about choice of method s/he prefers
E = Explain to client how to use the method.
R = Return: Schedule and carry out return visit and follow-up of client.

II. Service Provider

 Should be competent in counseling for all methods of FP and should have basic counseling skills appropriate to individual client
needs.
 Who are counseling for and providing FP might encounter clients who are coming for FP services, but have other needs as well.
 Should be prepared to counsel clients about sex and sexuality, fertility, childbearing, prevention of HIV and other STIs.

Provision of Contraceptives
Contraceptives should be provided to clients in accordance with approved method-specific guidelines and job-aids, by providers
who have been trained to provide that method. A supermarket approach should be adopted; that is, clients should have a wide range
of methods (method mix) from which to choose. These guidelines recognize task-shifting as an important mechanism for increasing
access to services (especially at levels 1, 2, and 3), and specify which cadre of service providers may provide which method, subject to
appropriate training.
Follow-up and Referral System
All clients who choose an FP method must be informed of the appropriate follow-up requirements and encouraged to return to the
service provider if they have any concerns. Clients that require or choose a method that is not available at a facility must be advised
where they can obtain the method. Providers should follow the established referral system.
Record Keeping
All FP providers should maintain proper records on each client and the distribution of contraceptives. Non- governmental organizations
(NGOs) and the private sector also should follow the Ministry of Healths record-keeping and service provision guidelines.
Supervision
Supervision is an essential component of program monitoring and evaluation; it ensures that guidelines are being followed and client’s
needs are being met. Facilitative (supportive) supervision should be encouraged, and the supervisor should be seen as a team member who
motivates staff and guarantees the rights of providers and clients. Supervision activities should extend to private-sector.
Logistics
Service providers are expected to have a consistent supply of methods available in order to offer a choice to clients.
Categories of FP Service Providers
Many categories of people can be involved in the provision of FP services after they have received the necessary training and
instruction. Similarly, FP services can be provided at various levels of the health care system (e.g., from community to tertiary care levels)
and within facilities that are operated by varying providers (e.g., public, faith- based, private). However, certain standards must be met
before providers can offer a particular FP method.
Values and Attitudes
 Attitudes, opinions, and beliefs (including misconceptions among health service providers) can affect the way providers interact
with clients. Everyone has a right to her or his own beliefs, but health care providers have a professional obligation to provide care in a
respectful and non- judgmental manner. Every interaction between health care staff and clients from the moment clients enter the health
care setting until they leave the facility affects the clients and has an impact on their:
Values and Attitudes
 Willingness to trust and to share personal information and concerns
 Ability to listen and to retain important information
 Capacity to make decisions that accurately reflect their situation, needs, and concerns
 Commitment to adopt new health-related behaviors
 Willingness to continue using the facility
 Ability to be agents of positive change in the community
Clients Rights
 Information
Service providers should ensure that clients receive adequate information regarding the services provided. Clients need to be
informed about the workings of the SDPs their opening hours, services provided, and costs involved
Clients interested in a particular method need to know how it works and how to obtain/ use it, the importance of follow-up,
information about potential side effects and how to manage them, warning signs, and the protection from STIs (including
HIV/AIDS) that it may or may not offer.
Clients also need to be informed about how to switch to another method if they so desire.
Access to Services

 All clients, including adolescents and PwDs, have the right to FP services at all levels of care. The SDPs should be clean, well-
organized, and adequately supplied with quality contraceptives. Clients should not have long waiting times and should be able to
obtain the contraceptive of their choice.

Informed Choice
Clients should be counseled on the range of contraceptive options and methods that are available at all levels of care, and should
be provided with accurate and complete information to enable them to make an informed decision.
Safety of Services
Service providers should adhere to infection- prevention practices and client instructions for effective use of the contraceptive
method.
Privacy and Confidentiality
Care should be individualized and discrete. Clients should be protected from both auditory and visual exposure. Client information
should be protected from access by anyone who is not directly involved in his or her care.
Dignity, Comfort, Expression of Opinion
Clients should be treated with dignity and friendliness. Precautions should be taken to ensure minimal discomfort. Client’s
opinions should be sought and their wishes and perspectives respected.
Continuity of Care
The clients records and follow-ups should be accurately and completely documented to ensure appropriate client management and
clinical safety.
Provider Staffs Needs
Supportive Supervision and Management The work environment and facilitative supervisory system should be supportive and
emphasize mentoring and joint problem solving. The system should help staff provide the best possible FP services.
Information, Training, and Development
Staff should be knowledgeable and skilled in providing FP, and have ongoing opportunities for training to update and maintain a
high level of performance.
Supplies, Equipment, and Infrastructure
Staff should have sufficient and appropriate supplies, instruments, and logistics infrastructure to ensure uninterrupted FP
services and the safety of service providers.