In the International Journal of Reproductive Medicine article “Assessment of Family Planning Counseling for Postpartum Women and Associated Factors” (2020) Abdulreshid and Dadi assessed postpartum family planning counseling at Saint Paul’s Hospital Millennium Medical College in Addis Ababa, Ethiopia. Family planning counseling is important when women are postpartum to ensure desired birth spacing is achieved; but it has been shown that family planning counseling is most successful when it begins during the prenatal period and continues to the postpartum period. Success in this regard is defined as when patients begin contraception postpartum and then continue to use their method of choice for the first year after childbirth. Abdulreshid and Dadi focus specifically on immediate postpartum counseling. They found that while there are many studies that evaluate prenatal counseling, there is a lack of data regarding postpartum counseling. The study’s assessment of the counseling sessions was guided by the GATHER framework (Greet, Ask, Tell, Help, Explain, and Return). Each component includes its own variables, including providers greeting patients and creating a space with privacy for Greet; asking about concerns and previous use of family planning methods for Ask; explaining all contraceptive methods, their side effects, and correcting incorrect information the patient has about a method for Tell; answering patient concerns and including the patient’s partner in the consultation for Help; using visual aids to discuss how the method of choice is used, and asking the patient to repeat this information to the provider for Explain; and scheduling a next visit for Return.
| Greet | Ask | Tell | Help | Explain | Return |
| Greet the client | Ask Medical History | Mention all methods of family planning available | Ask about partner’s attitude towards using a method | Explain how to use a method | Schedule a follow-up appointment |
| Make welcoming gestures | Ask how much time the client and her partner lived together | Ask what is already known about the method | Ask client’s worries about using modern methods | Use visual aids to help explain the method | Tell client to come back before appointment if there are any problems |
| Address Respectfully | Ask client’s plan to have more children | Describe the effectiveness of methods | Acknowledge and respond to client’s concerns about using a method | Explain possible side effects related to use | |
| Arrange for Privacy | Ask if client has used family planning methods before | Ask the preferred method | Discuss the reason why some methods might not be appropriate for the client | Explain how to deal with possible side effects | |
| Ask if client is interested in using modern methods | Clear up myths/rumors/incorrect information | Recommend a specific method | Ask to repeat important instructions | ||
| Ask if client was concerned about using modern methods |
To investigate the postpartum counseling patients were receiving, a cross-sectional study was completed. 209 immediately postpartum women who had received postpartum family planning counseling at St. Paul’s Hospital Millennium Medical College’s labor ward from February to March 2019 were randomly selected and interviewed about the level of postpartum counseling they received. The level of counseling was determined by how the provider complied with the GATHER Framework. The providers who were counseling included OB/GYN residents, interns, and midwives. It was found that overall (71.8%) of the postpartum family planning counseling sessions were inadequate. Inadequacy was especially prevalent when the woman being counseled had very limited or no formal education. 58.9% of counseling sessions did not maintain patient privacy and 74.2% of patients being counseled were not told about side effects associated with the birth control methods. Communication between providers and patients was seen as the area in most need of improvement; when patients feel unable to ask questions and/or voice their concerns, counseling sessions are met with higher rates of dissatisfaction. Abdulreshid and Dadi concluded that formal training for family planning counseling that includes a sensitivity to the sociodemographic backgrounds of patients-particularly education level-should be provided for healthcare providers that perform these counseling sessions.
“Structured counseling rubrics centered in principles of autonomy and respect can help guide providers in ensuring consistent and quality care. A large body of research has demonstrated that when it feels ‘natural’ or ‘intuitive’ to adapt counseling practices to specific groups, unconscious and conscious bias about race, age, and gender come into play. By memorizing and relying on a series of patient-centered steps, providers can help disrupt and counteract their biases.”
–Elizabeth Janiak, ScD, Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology Brigham and Women’s Hospital and Harvard Medical School, Director of Social Science Research, Planned Parenthood League or Massachusetts
References:
Abdulreshid M, Dadi HB. Assessment of Family Planning Counseling Provided for Postpartum Women and Associated Factors. International Journal of Reproductive Medicine. 2020;2020: 1-5.https://www.hindawi.com/journals/ijrmed/2020/2649340/#abstract. Published January 27, 2020. Accessed February 7, 2020.